Located in the heart of North Philadelphia, Temple University Hospital serves one of the nation’s most economically challenged and diverse urban populations. More than 85% of the patients served by Temple are covered by government programs, including Medicare and Medicaid.

Patients dually eligible for both Medicare and Medicaid make up roughly half of the Medicare inpatient base. More than 40% of total inpatient cases include a behavioral health diagnosis.

Temple also is a critical access point for vital public health services. Each year it serves thousands in its emergency department, inpatient behavioral health unit, labor and delivery unit, and other departments. It also has one of the most active trauma units in the Commonwealth of Pennsylvania.

THE PROBLEM

In response to the COVID-19 pandemic and the limited access to associated resources (both personnel and equipment), strategies to facilitate medical care quickly evolved to incorporate non-contact, remote options in hospital settings, outpatient offices, skilled nursing facilities and in-home, said Deborah Cancilla, senior vice president, data strategy, and CIO at Temple University Hospital.

“While telemedicine existed in our health system prior to COVID-19, the adoption of this technology accelerated exponentially due to the pandemic, which unlocked a new level of patient care,” she said. “This acceleration also was made available by the opportunities to be reimbursed for telemedicine-related services and relaxed CMS guidelines that waived penalties for HIPAA violations against healthcare providers that serve patients in good faith through everyday communications technologies.”

This opportunity allowed Temple to be flexible in the modality of telemedicine visits in multiple settings. It sampled a variety of different services and ultimately selected Zoom Healthcare as its video visit software.

PROPOSAL

While much of the increase for telemedicine visits could be attributed to the fact that CMS relaxed modality guidelines, Temple ultimately knew that HIPAA considerations would eventually come back into play. Through trial and error, the Zoom Healthcare software won due to the favorable user interface from a provider and patient perspective, ease of use, the integration into Temple’s Epic electronic health record, vender responsiveness and the price point, Cancilla said.

“This vendor also provided great options for e-visits that included video and voice or voice-only,” she added.

MARKETPLACE

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MEETING THE CHALLENGE

By centralizing access to specialty care, consults and outpatient appointments, Temple has seen an increase in appointment adherence and overall patient experience, Cancilla reported.

“There are workflows that were created as a foundational base of knowledge for our multidisciplinary care team to pull from when scheduling telemedicine appointments or consults,” she explained. “In the hospital and ED, the charge nurse schedules the telehealth encounter, the patient’s nurse provides the patient with a device, and the clinician then initiates the telehealth encounter.”

"Given the quick pivot and positive reaction to rapid scaling of telemedicine adoption, the health system has identified telemedicine as a strategic priority, and we are in the final stages of a comprehensive plan to fully adopt this modality as the future backbone of our operations."

Deborah Cancilla, Temple University Hospital

For outpatient and office appointments, a medical assistant confirms the appointment does not require physical presence, and the patient is contacted prior to the appointment to seek approval for a tele-visit and to determine if it's amicable.

“Given the quick pivot and positive reaction to rapid scaling of telemedicine adoption, the health system has identified telemedicine as a strategic priority, and we are in the final stages of a comprehensive plan to fully adopt this modality as the future backbone of our operations,” Cancilla stated.

RESULTS

Cancilla said given the newness of this telemedicine strategy at Temple and the rapid rate at which Temple was required to adopt it, staff have not spent too much time defining quality metrics for telemedicine beyond volume and clinician/patient feedback, which all have been quite positive.

“Incorporated in our strategic plan for rolling out telemedicine as a sustainable solution are the analytics we will be closely monitoring in order to gauge intervention effectiveness,” she said. “The main metrics include volume, access, patient experience and total cost of care.”

USING FCC AWARD FUNDS

Temple University Hospital earlier this year was awarded $902,290 for a remote monitoring platform, symptom diagnosis software, tablets, phones and other telecommunications equipment to diagnose and treat patients who are COVID-19 suspected and/or confirmed, as well as to conduct telemedicine interventions for other patients who require consultation for specialty services or outpatient appointments.

“A majority of the funding is dedicated to purchasing the necessary hardware, such as monitors, microphones, cameras and devices, to be able to provide virtual visits in more areas of our hospital,” Cancilla said. “The most impressive factor to come out of this experience is how well clinicians have adopted this new way of engaging with patients and providing top-notch care.”

Given the feedback Temple has received from clinicians and patients, the efficiencies that virtual consultation and appointments have brought, and the opportunities afforded by the FCC grant, staff believe that the telemedicine program will continue to expand and push the envelope on caring for a vulnerable population, she said.

“Regarding pushing the envelope, a portion of the funding was dedicated to supplanting resources to support our well-established chronic care management programs,” she added. “These technologies, such as patient-reported outcomes measurement software and connected care devices that will provide real-time data directly into the EHR, will allow for a deeper knowledge about our patients that will inform a quicker pivot in a plan of care based on hard data and an ability to continuously monitor.”

Temple looks forward to integrating these services into its programs over the next six months, Cancilla concluded, measuring effectiveness and scaling up based on the outcomes.

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