The Stony Brook Medicine health system, which, before COVID-19, had already grown from a two-hospital system to a four-hospital system with the inclusion of Eastern Long Island Hospital and Southampton Hospital, reflects a diverse and geographically widespread patient population of more than 1.4 million people in Suffolk County, New York.

It uses telehealth technology to connect specialists and clinicians to areas of need, to help monitor patients' health status and behavior remotely, to promote timely and efficient care, and to help providers reach previously isolated populations of patients.

The opportunities telemedicine provides

Dr. Gerald J. Kelly, CIO at Stony Brook Medicine, said the health system's ongoing use of telehealth continues to provide the opportunity to:

• Promote better access to care.
• Increase the reach of the organization's specialists and providers.
• Reduce healthcare disparities and costs of unnecessary transport, visits and readmissions.
• Improve health outcomes by ensuring adequate follow-up and better patient adherence and patient satisfaction.
• Secure the institution as an academic health center using innovative biomedical technology.

"One of the biggest challenges at the outset was figuring out what technology to use, and what services would be most appropriate for telehealth," Kelly noted. "The questions were: What platform could help us connect to patients regardless of location? What platform could integrate with our electronic medical record and scheduling systems? What platform was easy and efficient for providers and patients to learn?

"We understood that telehealth would support our institution as a leading academic health center using innovative technology and data analytics in our clinical, educational and research endeavors," he continued. "To develop a strategy around digital medicine, a telehealth workgroup was first convened on May 22, 2017, and included key stakeholders across the hospital and schools."

The goal was to establish an infrastructure and strategy in the launch of telehealth activity at Stony Brook Medicine. The first strategic plan developed in 2018 has evolved to include supporting the larger objectives of the Stony Brook Medicine Clinically Integrated Network.

Accelerating adoption of the technology

"Although our efforts started with a few small pilot projects, during the pandemic Stony Brook Medicine, like many other health systems, immediately accelerated and expanded the adoption of telehealth in March 2020," Kelly recalled.

"This was necessary to meet the needs of our ambulatory patients in more than 20 specialties, help the ED triage folks as they entered the hospital and connect families to their loved one while in-person visits were prohibited to limit exposure to the virus for everyone's safety," he added.

A strategic relationship was in development with Microsoft prior to the public health emergency and quickly advanced in March 2020. Stony Brook launched the use of Microsoft Teams as its initial telehealth platform, and visits accelerated from a few dozen per month to approximately 20,000 per month at the height of the pandemic.

Subsequently, through funding from a nearly $1 million Federal Communication Commission grant – the largest FCC funding of any health system on Long Island through the program – a more permanent technology from vendor Teladoc was purchased and rolled out as a standard platform. The platform was rolled out for use with all medical specialties, allowing visits to continue seamlessly, even when patients could not leave their homes.

Smartphones for those in need

In addition to the Teladoc purchase, the FCC grant enabled Stony Brook to purchase and distribute 200 iPhone 7S devices with one year of service to patients in need for remote patient monitoring. Through this initiative with Vital Care Services, which continues today, Stony Brook monitors 60 patients per month post-discharge with pulse oximetry, blood pressure, vital signs and virtual visits.

"The Teladoc platform answered the questions we had earlier in our exploration," Kelly said. "Teladoc has a wide range of capabilities when it comes to video connectivity, it's easy to learn for both patients and providers, and can be integrated with our EHR and scheduling systems.

"Given the significant increase in digital visit volume during COVID, we focused on supporting clinical departments', providers' and patients' needs as telehealth programs expanded," he continued. "This support also included creating a more robust governance structure and the start of a comprehensive strategic plan for the expansion of telehealth services."

In addition to the platform-specific questions Stony Brook had at the outset, pre-pandemic, the biggest challenge had been in obtaining consistent and broad buy-in for resources to build the telehealth program. This led to hesitancy around telehealth decision-making.

Generating enthusiasm and support

"Post-pandemic, these challenges are not completely eliminated. However, the Teladoc enterprise-wide platform that is being used successfully has resulted in enthusiasm and support expressed by both providers and patients," Kelly stated.

"Teladoc provides 24/7 support that patients can reach by bot, email and phone," he added. "The platform features 'Seamless Join,' which means you don't have to use an app to connect to a call. For some patients, this is important, because they don't know their app store password or how to download an app."

With Teladoc, it's recommended that patients use their app, but it's not mandated. The Teladoc platform also features embedded translation services, patient intake and consent forms, and a branded app so patients know who they are connecting with.

In addition, it's the same platform that serves Stony Brook's inpatient services and allows providers to connect with patients in each of the health system's four hospitals and in the ambulatory setting.

Compliance and credentialing

"The enterprise-wide platform also has motivated the further development of a robust telehealth compliance program and credentialing process, crisis management infrastructure, and further commitment to infrastructure development," Kelly noted.

"Although we're using Teladoc for our enterprise-wide platform, there are several noteworthy telehealth initiatives that Stony Brook organized and launched on Microsoft Teams during the pandemic that are still in use today," he added.

These include: a Wellness Champions channel where posts provide local and national mental health resources and strategies for managing stress and virtual mindfulness and meditation sessions for faculty and staff. Stony Brook also has 24/7 counseling via telehealth, which was nearing launch just prior to the pandemic, and is offered to students through Counseling and Psychological Services.

Stony Brook Medicine consistently provides approximately 10% of its monthly outpatient visits through telehealth, reflecting the stability of the service from the spikes it saw from the earlier part of the pandemic.

Specialty inpatient consultations

"We also have successfully implemented specialty inpatient consultations, improving access to our geographically distant hospital partners and patients," Kelly said. "We have reduced unnecessary transfers and ambulance trips through the provision of these consultations, and enabled patients to remain closer to their homes.

"And we periodically monitor our telehealth program in more than 17 categories against national benchmarks for quality, access, experience and ease of use," he continued.

Kelly and staff are most proud of both the consistent work and advocacy of a group of champions who weathered the ups and downs and continued forward with the goal of making telehealth a part of Stony Brook's academic health center, as well as the speed and breadth of expansion during the pandemic.

Multiple processes and systems were established during a very hectic and difficult time, resulting in patients continuing to have access to the care they needed, Kelly said.

Focus on ambulatory

"Today, the largest focus of Stony Brook telehealth is for virtual visits for patients from our ambulatory offices," he said. "The current leader in virtual visits is mental health services through our Department of Psychiatry and Behavioral Health.

"Stony Brook Medicine now is participating in the Association of American Medical Colleges-Manatt Health Telehealth Implementation Learning Collaborative," he added. "This collaborative provides an advanced forum for participants to share their telehealth strategies and challenges and learn from each other regarding practical opportunities and methodologies used by others for integrating telehealth into everyday clinical care and operations within an American medical college."

At Stony Brook Medicine, telehealth supports the academic health center using innovative technology and data analytics in clinical, educational and research endeavors.

"With advances in technology, alongside the current public health emergency, advancing our telehealth strategy makes our participation in this initiative an imperative," Kelly concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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