From the time Burrell Behavioral Health in Springfield, Missouri, received initial reports of the COVID-19 pandemic reaching the surrounding areas, clients and staff members became concerned about their physical health and wellbeing.

THE PROBLEM

Out of fear of getting sick, many isolated themselves and did not leave their homes. Burrell team members wanted to be able to work remotely and reduce the risk of exposure to COVID-19. At the same time, there was increased anxiety over the uncertainty of the situation, along with depression due to loneliness.

The need for engagement and connection was greater than ever for both clients and staff. It was necessary to shore up the provider organization's virtual platform, Zoom, for providers to engage with clients and patients without having to conduct a face-to-face visit.

Additionally, the call center and supporting departments needed the ability to run their operations from their homes.

"While we know that in-person interactions can produce more connection between people, we've also learned that having virtual options give us the ability to serve clients whose anxiety might be too great to come into a building when they're starting services," said CIO Darren Johnson.

"Now we can also serve individuals who are living in a more remote area that has no mental health services and [who] may not be able to make the trip to one of our locations.

"On days when there is winter weather and driving might be dangerous, our staff has the ability to still see clients while staying safe at home," he continued. "We are committed to meeting people where they are and helping them with whatever they're facing. Having the capability to offer virtual services is a game-changer for the people we care for, and the staff we employ."

"The FCC telehealth funds allowed us to purchase laptops, monitors, keyboards, cameras and headsets for a large portion of our staff to work from home. We also purchased additional server capacities and Citrix licenses to run core applications remotely."

Darren Johnson, Burrell Behavioral Health

At the same time, Burrell will not become a fully remote organization. Leaders there know there is great value in meeting with people face-to-face and that won't go away. Having the telehealth option just gives the organization a chance to help more individuals who would opt for that service moving forward.

PROPOSAL

As a healthcare organization, information technology security is extremely important, Johnson noted.

"Keeping client and staff information safe online remained a priority as we implemented the infrastructure for virtual care," he explained. "We broke the project into three primary objectives. First, we aimed to build up computer resources to support the remote workforce.

"Then we expanded our network capacity to handle increased bandwidth of external traffic. Finally, we provided technology for staff to work from home in a secure and private manner."

One of the first pieces of technology deployed was Cisco's phone software, so the call center and scheduling departments could easily take client calls from a remote location instead of being physically in the offices.

The contact center technology was run through a Citrix Thin Client deployment, so the footprint was small. It required minimum bandwidth on employees' home internet services. Burrell also increased the processing power of its infrastructure for remote computing and access to the electronic health record through Citrix.

"For the telehealth visits, we expanded our Zoom capability so providers could engage clients with audio and video from the provider's home to the patient's home," Johnson said. "This gave our providers the opportunity to see and hear their clients – and vice versa – while being able to use visual aids through the Share Screen option, just as they might normally do in a therapy room.

"For the additional supporting departments such as accounting, revenue cycle, human resources and marketing/communications, we used Citrix and a remote desktop application to allow teams to work from home. These systems allowed our staff in all departments to be able to have access to their files, email and other applications while working in a setting that was not their normal work space."

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MEETING THE CHALLENGE

When clients call in or when providers reach out to clients, the nursing staff or client navigators prepare them for the visit by reviewing the consent to treat and any additional verbal agreements needed for the visit.

Once the pre-visit work is completed, a link is emailed to the patient to start the visit or join the Zoom meeting. The provider has the ability to visually and audibly interact with the patient, while documenting the visit in the electronic health record.

The clinical team created standards of do's and don'ts on how the providers need to conduct themselves in a telehealth session. These guidelines assure the session is professional and private.

"The virtual meeting options also give our staff a chance to connect with each other," Johnson explained. "We knew our teams were facing uncertainty, confusion and potentially loneliness during peak COVID-19. We used the teleconference capabilities in Zoom to create daily wellbeing engagements with all staff to support the mental impacts they were facing due to isolation.

"This became the Be Well Initiatives, which quickly extended to our entire communities through Facebook," he continued. "The meetings offered a chance for self-check-ins and self-care for anyone who had internet access. We created meetings for our staff that offered updates, announcements and hope from our system leadership that also continue on today."

RESULTS

After building the capabilities to do so, Burrell was able to have 80% of staff work from home. This allowed team members to reduce their risk of being exposed to COVID-19 and stay home while supporting their own families through the start of the pandemic. Leadership believes that option gave the teams a peace of mind and increased employee satisfaction.

"With telehealth therapy options, we increased our client engagement," Johnson said. "We also reduced client-canceled appointments – no-shows and notified cancellations – by 25% between average pre-pandemic and post-pandemic (defined as April 2020 or later) levels.

"This reduction rose to nearly 50% between the pre-pandemic monthly high (22%) and the post-pandemic monthly low (12%)," he continued. "Anecdotally, we have seen that, instead of clients canceling appointments due to illness, road conditions or other variables, they can still connect with their providers for services from a virtual setting, without having to come to an in-person appointment."

USING FCC AWARD FUNDS

Burrell Behavioral Health was awarded $767,184 by the FCC telehealth grant program for laptop computers, mobile hotspots, network upgrades and videoconferencing equipment to expand and offer connected mental health services for Missourians affected by COVID-19, including existing mental health patients, new patients experiencing anxiety related to COVID-19, and essential frontline workers.

"The FCC telehealth funds allowed us to purchase laptops, monitors, keyboards, cameras and headsets for a large portion of our staff to work from home," Johnson noted. "We were able to equip staff with the necessities they needed to do their jobs remotely.

"However, just because they have the equipment doesn't mean they can access the systems," he continued. "So, we also purchased additional server capacities and Citrix licenses to run core applications remotely. We expanded our firewalls to allow for remote desktop applications and increased external traffic to our data center."

All of this was in an effort to help staff work from wherever they are, while protecting the identities and information of the clients who were receiving care. The funds helped support the technology to make engagements easy and productive, allowing clients to feel safe and secure during their sessions.

Burrell wanted the funds to alleviate some of the technology challenges associated with poor internet connectivity, so that staff can work remotely on their home internet systems without dealing with buffering that could add to their stress and disrupt time with a client.

"The pandemic has been hard on all of us, especially in those first several months, when we were all trying to figure out how to carry on normal life while hardly leaving our homes," Johnson said.

"Now we can see the technological strides we've made as a society on the other side of it all. The FCC funds didn't just help us through the initial phase of stay-at-home orders. They've helped us grow as an organization in the years to come."

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