Garfield Health Center, based in Monterey Park, California, did not have a telemedicine program in place prior to the COVID-19 pandemic.

THE PROBLEM

With the outbreak of COVID-19 in Los Angeles County, the health center’s primary goal was to reduce the number of patients who needed to physically visit the center in order to slow the spread of the virus and ensure the healthcare facilities had adequate staff and resources to care for those who were sick.

In order to fulfill GHC’s mission of service to low-income individuals and families and continue to uphold values of being accessible, consistent and responsive to community needs, GHC’s senior management and board of directors made the decision to implement telehealth services.

Once the safer-at-home order was issued by L.A. County, the health center reasoned that rolling out telemedicine, and thereby reducing foot traffic to the clinics, was the only way that it could safely continue to treat patients with non-acute needs.

PROPOSAL

GHC decided to use the OTTO Health telehealth platform, which would seamlessly integrate into the organization’s NextGen electronic health record system and enable GHC to quickly and efficiently launch telehealth services, said Lionel Yu, chief operating officer at Garfield Health Center.

“No dual documentation was required. Rather, a single application programming interface connection would integrate OTTO with our EHR, practice management and patient portal, creating a streamlined user experience,” Yu explained.

“The platform is easily accessible for our patients because it does not require an app or specialized hardware. Only a smartphone that is connected to a network is needed for patients to use the service and to see a provider privately.”

Patients would be able to join their virtual visit on any device through a secure link in an e-mail or a secure link in a text message sent to their phone. This system allows providers to have video visits with patients as part of their normal workflows. Providers would be able to share their screen, pass documents and chat with patients, all within the virtual visit.

"These exciting expansions to our telehealth capacity will help with GHC’s goal to deliver care to our low-income patients in the most efficient, high-quality, convenient and effective ways."

Lionel Yu, Garfield Health Center

“OTTO uses HIPAA-compliant encryption, so the patient data is secure and confidential,” Yu said. “For these reasons, we felt confident that patients would feel comfortable adapting to seeing their doctors virtually. Our providers and support staff could easily be trained to conduct virtual visits, while we continued to be able to see as many patients in person, following strict guidelines to ensure that we were doing so safely.”

Staff also knew that having telemedicine technology available in the future as an option could be ideal for patients for whom virtual appointments would be preferable, he added.

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MEETING THE CHALLENGE

In order to launch initial telehealth services, GHC used Federal Communications Commission funds it was awarded for virtual care to purchase telehealth infrastructure and Internet services. GHC’s IT department assessed need, determined the impact of the proposed telehealth program, and initiated contact with OTTO Health to develop the project and implementation plans.

“The project plan included tasks needed to build, test, deploy and operate the program; staff required to perform the tasks; hours required; and timeline,” Yu said. “The implementation plan put into action the plans, decisions and approaches identified in the project plan, as well as provided for monitoring of the program.”

To date, GHC has had a soft rollout of OTTO Health. GHC’s providers and medical assistants are the users of OTTO Health. OTTO Health enables GHC’s providers to offer safe and convenient access to care, especially during this time of the pandemic, Yu said. The platform allows staff to send virtual visit appointment reminders, including instructions for a visit, and receive appointment confirmations.

RESULTS

IT and operations staff revised all provider and medical-assistant accounts and schedules for telemedicine purposes and rebuilt existing templates for billing for services. Staff installed all-new hardware, retrofitted exam rooms to meet telemedicine capacity needs, and provided training on usage of software to all providers and medical assistants.

To date, GHC has successfully upgraded its Internet capabilities and had a soft rollout of OTTO Health during the first two weeks of October 2020. It has provided a total of 680 telehealth visits. Prior to the pandemic, GHC had a no-show rate of 15-20%. Data for October 2020 shows a no-show rate of less than 5% for telehealth visits.

“Many of our patients experience transportation issues and find it difficult to take time off from work or find child care in order to physically come to the office for an appointment. Telehealth helps to reduce no-shows and cancellations,” Yu reported.

The biggest issue staff encountered during the soft rollout has been the instruction link to connect to video conferencing, which is in English. GHC serves a large population of monolingual Chinese patients, some of whom have technology challenges. GHC had to call all patients scheduled for telehealth visits and tell them how to access telemedicine, and also send them screenshots.

“To improve communication, GHC made the decision to purchase a robust communication platform, Well, which integrates with OTTO Health and NextGen, and enables GHC to communicate quickly and securely across a patient’s preferred channel – including text messaging, e-mail, phone and live chat – in their preferred language,” Yu explained. “This way we can easily communicate instructions to our patients on how to access telemedicine in Chinese.”

Well’s platform has bidirectional functionality so patients can easily send questions or concerns via text. Well will be fully implemented this month. There have been some delays due to connection issues between the NextGen and Well platforms.

Consequently, GHC made the decision to delay further rollout of OTTO Health because the communication issue has been a barrier for many patients.

USING FCC AWARD FUNDS

Garfield Health Center was awarded $130,217 to provide remote care to low-income, vulnerable patients with underlying and/or chronic health conditions who are at high risk for COVID-19, while triaging COVID-19 patients in the San Gabriel Valley.

“The FCC award has enabled GHC to implement telehealth services – mobile phones, laptops, monitors, webcam speakers, remote monitoring equipment and more,” Yu said. “These exciting expansions to our telehealth capacity will help with GHC’s goal to deliver care to our low-income patients in the most efficient, high quality, convenient and effective ways.”

These funds will serve to develop and sustain a strong telemedicine infrastructure under which patients can stay safe at home and have the ability to receive care remotely – and, critically, reduce contact between patients and providers/clinic support staff, ensuring that the workforce remains healthy and able to continue providing care, he added.

“Using FCC funds, via remote patient care, GHC’s personnel will be able to screen for COVID-19, refer patients to our health center for testing who meet L.A. County Department of Public Health requirements, provide treatments, coordinate care, treat other acute illnesses and manage chronic medical problems, provide behavioral health, provide ongoing case management monitoring and follow-up, and prevent unnecessary emergency room visits,” Yu said.

Telehealth will increase access to care among vulnerable patients, reducing barriers to keeping appointments even during times without a significant crisis to affect care delivery, he added. The need for continuity and expanded care through video visits is critical, he concluded. It is a service GHC is planning and looks forward to continuing to develop, refine and execute post-pandemic.

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