Penn State Health provides healthcare to patients and communities across 29 counties in Central Pennsylvania, with more than 2,000 physicians and direct-care providers at 127 medical office sites.

THE PROBLEM
The health system’s goal is to enhance the quality of life for its patients, yet for those struggling with neurological conditions such as amyotrophic lateral sclerosis, treatment requires an extensive – and often burdensome – amount of time, energy and resources. And patients with ALS, or Lou Gehrig’s disease, often have an issue with mobility, so traveling long distances routinely for care is burdensome.

"Specifically, ALS treatment requires an integrated care team, which includes neurologists, nurses, physical therapists, occupational therapists, speech pathologists, dieticians, social workers, behavioral health counselors and respiratory therapists," explained Dr. Zachary Simmons, director of the Penn State Health ALS clinic. "The traditional model of ALS care involves visits by patients once every three months to an ALS center, where they have a 3-4 hour visit, during which they are seen by most or all of these specialists."

This can be exhausting for the patient, particularly if they have a long drive to the ALS center, and have limited mobility and poor stamina, he added. Some may also lack the resources to come to a multi-disciplinary clinic at all. The goal for the health system was to maintain or improve access to high-quality multi-disciplinary care while reducing the burden for patients.

PROPOSAL
When Penn State Health began to explore the benefits of telehealth, telemedicine vendor American Well stood out for a variety of reasons, Simmons said.

"First, its platform worked well with our existing EHR," he said. "Second, they could scale with us, offering technology that could support care for both common and complex conditions. Additionally, their platform could support some of the more unique requirements of ALS care, such as allowing for multiple people to attend appointments from wherever they are located."

The telehealth vendor proposed starting with a direct-to-consumer telehealth service for urgent care visits. This would enable Penn State Health to grow its program organically over time, as various stakeholders – across clinical, administrative and IT – acclimated to the system, Simmons said.

"American Well also proposed building a system that would ease collaboration, enabling providers to log into the same virtual appointment at different times through an easy-to-use interface," he explained. "In 2018, we went live with Penn State Health OnDemand. The response was quite strong, so we began to discuss other ways we could use the technology to better meet the needs of our patients. Considering the challenges of ALS care, we decided a tele-ALS program made sense."

MARKETPLACE
There are many vendors on the market today offering telemedicine technology, including American Well, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services and Tellus.

MEETING THE CHALLENGE
From a provider perspective, the telemedicine technology at Penn State Health enables multiple providers to treat patients from wherever they are located, which means they no longer have to travel to the same location to provide care.

"In our case, sometimes this means nurses from the ALS Association are logging into a session with a patient from their iPads," Simmons said. "The telehealth solution is also embedded with Penn State Health’s Cerner EHR, used by all providers across the network, so participating in a virtual consultation and coordinating care is much easier."

Penn State Health has identified three ways in which telehealth can be used to benefit patients. One is to ease the patient burden during multi-disciplinary visits. To accomplish this, the patient logs in from home and appears on a computer screen in an exam room for their OnDemand appointment. Members of the ALS healthcare team, all of whom are in clinic that day to care for ALS patients in person, come into the room 1-2 at a time, just as they would if the patient were there.

"When implementing any telehealth solution, healthcare provider organizations must first consider the problems they’re trying to solve."

Dr. Zachary Simmons, Penn State Health

"This permits an entire multi-disciplinary visit from the comfort of the patient’s home," Simmons noted. "Another use of telehealth is for 1-to-1 visits with ALS healthcare providers. For example, if a patient requires a counseling session for depression or anxiety, that can be done via telehealth with the mental health specialist from the patient’s home. Similarly, genetic counseling can be done remotely with a physician, or a nurse can view a problem with a feeding tube through a video link."

A third use of telehealth is to reduce the length of multi-disciplinary team visits. If some parts of the visit can be conducted via telehealth from home in advance (for example, nursing and social work), then the rest of the multi-disciplinary visit can be completed face-to-face in a shorter time.

"Before the program, it could take an entire day to get a patient ready, get them in the car, travel to the appointment, wait for each subsequent provider and then get home," Simmons said. "The technology has made this process much easier and less burdensome for all involved."

RESULTS
In the 12 months since the tele-ALS program launched, Penn State Health has conducted more than 115 virtual ALS visits, which have resulted in:

• Travel savings of more than 8,780 miles. Patients no longer have to travel great distances to see their care team and receive treatment. This also has saved patients incremental costs associated with traveling for a visit, such as gas, food and lodging.
• High patient satisfaction and reduced burden. Because patients are able to interface with their care team from the comfort of their home, they are not exhausted at the end of their appointment day and have more time for other activities. As one patient said in an interview, “This works really well through a screen – and saves us a lot of hassle.”
• Expansion of specialty care management programs. The tele-ALS program is performing so well that it is now being used as a model for new programs to be implemented in 2020, including those for patients with inflammatory bowel disease, certain heart and vascular diagnoses, and maternal-fetal medicine. Penn State Health also plans to add reproductive endocrinology and infertility care, behavioral health, specific surgical follow-up visits, and lactation consultation. This way, Penn State Health doctors can see a greater number of patients through specialty OnDemand programs.

ADVICE FOR OTHERS
"When implementing any telehealth solution, healthcare provider organizations must first consider the problems they’re trying to solve: Does the organization reside in an urban area with a high population of seniors with multiple comorbidities? Or do they serve a wide demographic of patients across a broader landscape" Simmons said. "Answering questions like these will help your organization prioritize the right solution and the right vendor for the job."

It also is important to seek a vendor that sees itself as a true stakeholder in a healthcare organization’s success, he added.

"You want a vendor that is a true partner and understands the needs of your organization even as these evolve over time. It’s also important to select a partner that has the capabilities to scale with you. For example, we started with a DTC, urgent care solution before expanding into ALS care, and now we hope to expand further into other specialty areas. Having a singular partner who can support our telehealth journey as it grows is highly valuable."

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
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