COVID-19 arrived in Maine on March 12, 2020. For the safety of patients, Portland Community Health Center postponed all in-person appointments that were not considered essential by federal and state guidelines. Simultaneously, many patients canceled appointments and did not schedule new appointments for fear of becoming exposed to the virus.

THE PROBLEM

Portland Community had not provided telehealth appointments prior to March. This created a problem in that it could not care for patients because it no longer was seeing them in person.

To address this problem, the health center started using telehealth. Over the course of a weekend, staff created a workflow through HIPAA-compliant Zoom so that providers could carry out appointments via videoconferencing.

PROPOSAL

“Using Zoom, we were able to conduct HIPAA-compliant telehealth appointments during the first months of the pandemic,” said Ann Tucker, CEO of Portland Community Health Center. “Zoom also provided our health center with an easy-to-implement telehealth option while we researched an integrated telemedicine option for our electronic health record, which would be more permanent.”

To support staff and patients, the health center began reviewing a telemedicine application called Otto that could integrate with its NextGen EHR.

“Our health center has transitioned from the traditional face-to-face model of care to offering care via telehealth as much as possible,” Tucker explained. “Virtual appointments minimize in-person interaction between patients and staff, and reduce the risk of patients and staff contracting and spreading the virus. The health and safety of our patients and staff is our priority. Offering remote access to our range of primary medical and behavioral health services during the pandemic allows patients to continue accessing the care they need while staying safe and physically distancing from others.”

"Our health center also has purchased information technology services and equipment that will integrate our telehealth technology with our existing EHR."

Ann Tucker, Portland Community Health Center

Before it received FCC funding for telehealth earlier this year, Portland Community was able to provide telehealth appointments using Zoom. Staff was able to care for patients with preexisting conditions without putting them at risk of exposure to COVID-19.

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MEETING THE CHALLENGE

At Portland Community, staff conduct telehealth activities through videoconferencing and by phone. Through these appointments, physicians, nurse practitioners, physician assistants, social workers, psychiatrists and nurses provide many of the same services they typically offer face-to-face.

Services the health center is able to offer via telehealth include sick visits, chronic disease management, well visits, behavioral health counseling, psychiatry, substance use services, medication-assisted treatment, medication refills and family planning.

“During this uncertain time, the need for mental health support from behavioral health professionals such as licensed clinical social workers is especially great,” Tucker said. “Fear for personal safety and the safety of loved ones, uncertainty about the future, rapidly changing environments at home and at work, and social distancing practices due to the global pandemic have created a stressful situation for all in our community.”

Behavioral health providers are available to provide ongoing emotional support to those who need it through virtual telehealth sessions. The health center’s providers are important to its response in this crisis, she added.

“Our team’s ability to use Zoom to stay connected to our patients was vital to continuing to support our mission of providing high-quality, patient-centered healthcare that is accessible, affordable and culturally sensitive,” Tucker said of the technology.

“The FCC funds have financially supported our licenses to use Zoom while we worked on finding a solution that would be integrated with our NextGen EHR,” she continued. “We are implementing Otto telehealth technology as we plan to continue to offer telemedicine as an option for our patients indefinitely.”

RESULTS

Tucker said the No. 1 success “metric” is staying connected to patients and being able to provide services while maintaining social distancing protocols.

“The number of telehealth encounters we have reached each month is a testament to the speed with which telehealth can be set up by providers and adopted by patients, and the immediate impact it can have,” she noted. “Our health center provided its first telehealth appointments on March 17. By March 31, we had recorded 795 telehealth appointments.”

From there, encounters only continued to grow. Portland Community recorded at least 2,300 telehealth appointments each month in April, May, June, July and August. These appointments allowed patients to receive care while staying safe at home, and may have helped slow the spread of COVID-19, Tucker said.

“To track the telehealth experience of our patients, we administer a 15-question survey at the conclusion of each appointment,” she explained. “The survey results allow us to improve the quality of care and telehealth experience for patients. Survey results from late August to late September indicate that 72% percent of patients strongly agreed and 17% agreed that they were overall satisfied with their telehealth experience. This survey helps our health center monitor the efficacy of our telehealth program.”

USING FCC AWARD FUNDS

Earlier this year, the FCC awarded Portland Community Health Center $245,988 for a telehealth platform, computers, tablets, diagnostic equipment, mobile hotspots and other telehealth equipment to monitor and provide care for patients in isolation who have tested positive for COVID-19, to set up dedicated telehealth rooms for all patients without the ability to participate in a remote telehealth visit, and to deploy a portable telehealth clinic system to monitor the vitals of patients without a healthcare worker having to be in the same room.

“A large part of our funding request to the FCC is focused on alleviating barriers to telehealth,” Tucker explained. “We have patients that do not have access to the technology required for videoconferencing, such as a smartphone, tablet, or laptop, and some do not have access to a private space to conduct remote telehealth appointments. We are purchasing technology and data packages to bring access to care to patients, wherever they are.”

The health center will also create dedicated spaces with videoconferencing technology where patients can conduct telehealth appointments safely and privately.

“Our health center also has purchased information technology services and equipment that will integrate our telehealth technology with our existing EHR,” she continued. “These purchases, along with additional laptops for providers, will increase our capacity for telehealth and our efficiency. We plan to provide telehealth services as long as patients need them.”

The purchase of a telemedicine program that integrates with the EHR will support the team and patients in a streamlined approach for setting up and managing visits, she added. The health center, she concluded, also purchased mobile telehealth equipment to support patients at its healthcare for the homeless program.

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