Last year, M Health Fairview, a health system based in Minneapolis, was awarded $598,000 by the FCC telehealth funding program for connected tablets to assigned patients in the inpatient setting for video visit capabilities with medical staff and family members; other tablets would be mobile and used to monitor patients from the nursing station to provide palliative care services to avoid prolonged potential exposure to COVID-19.

Prior to having telemedicine technology in place, M Health Fairview was only able to provide specialty care and other services like hospice or diabetes education to patients throughout its 10 hospitals if it had someone who could "round" (come in person to see a patient) at that hospital.

Without the technology

Otherwise, those patients would need to get that care after discharge from the hospital or through a transfer to a hospital with that specialty offering if emergent.

"If a patient has a neurologic issue such as a stroke and arrives in a hospital that does not have a neurologist, they are not able to get certain types of emergent care that needs specialized assessment," explained Dr. Susan Pleasants, M Health Fairview's chief medical informatics officer. 

"Those treatments can prevent disability and even death leading to avoidance of extremely sad outcomes that are avoidable with access to more advanced care," she said.

"Additionally, patients usually prefer to stay at a hospital close to home if that is an option because their family or friends are able to provide support that we know leads to improved engagement in care planning while in the hospital, faster discharge to home, and better adherence to post-hospital care at home because the family was there for the discussions about what they will need to do," she added.

"We were able to spread our ability to provide primary team, specialty physician and other services such as educators across all of our hospitals."

Dr. Susan Pleasants, M Health Fairview

During the ongoing COVID-19 pandemic, the health system's specialty physicians as well as some of the non-specialty doctors (such as hospitalists) have had to limit the amount of time they spend in close quarters with patients who have COVID-19.

Working in quarantine

"We also have had potential risks of not having coverage for critical specialties in hospitals if a provider was exposed to COVID-19 – for example, a child at home tests positive – and was not allowed to come on-site but could 'work from home' because they were just in quarantine – not actually sick," Pleasants said.

"Through the use of iPads purchased with our FCC grant, we deployed 1,500 devices using Cisco's Polycom application," she continued. "We were able to spread our ability to provide primary team, specialty physician and other services such as educators across all of our hospitals. 

"A physician or other healthcare worker – hospice, pastoral care, diabetes educators, pharmacists, nurses, etc. – could look in a patient's chart to find a unique code that would allow them to connect virtually to a patient in their room after the local team turned it on and set it up to face the patient."

They could complete assessments of the patient's condition with or without the local nursing team helping with the exam and even invite a family member at home to hear the updates to their care when they were not present.

"Additionally, we used those same unique patient codes to allow a family member or anyone the patient chose to provide their code to connect with their loved one while in the hospital – especially while we limited visitors," Pleasants noted. 

"Through that COVID-19 experience, we found there are family members who may be out of town or unable to come to the hospital due to their own medical conditions or who can't come at the right time to talk to the doctor or hear the discharge instructions provided by nurses that are critical to successfully getting home and staying home after a hospital stay."

Using this technology, staff can bring family members into the hospital without having them come into the building, she added.

When the pandemic ends

The pandemic kick-started this work and enabled M Health Fairview to test it in ways that pre-pandemic insurance payment models did not allow (for example, one could only provide these services in extremely rural hospitals). The health system plans to continue to develop best practices and learn how it can sustain this kind of practice when the public health emergency ends.

"We have many 'not the big city but not truly rural' hospitals that are not large enough to support even a small subset of the 100-plus specialties our organization has to offer," Pleasants explained. 

"Even if they have a specialist, they may not have a subspecialist that specializes in an unusual condition. So continuing to provide access to specialty care across all of our facilities is an important strategy we continue to advance and embed into our everyday practices."

Outside of the FCC funding, the health system also has expanded telehealth services to its ambulatory clinics, with massive expansion from very few virtual visits to 30,000 ambulatory video visits per month. It also has been adding in remote patient monitoring to let patients go home safely with close monitoring, as well as other virtual care tools.

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