Telehealth and RPM are improving care at Tanner Health System
A few years ago, Tanner Health System, based in Carrollton, Georgia, recognized that as it moved from uncoordinated, volume-based delivery of health services to an integrated, patient-centric, value-based model, the healthcare industry's future will hinge on its ability to achieve higher-quality care, improved patient outcomes and lower costs.
"In enabling our organization to provide anytime/anywhere care to patients and operate more efficiently and cost-effectively, our initiation of a telehealth platform was an important part of the strategy to achieve these goals," said Hugh Jackson, service line administrator with clinical program development at Tanner Health System.
In addition, Tanner's service area consists of predominantly rural areas that are designated as Healthcare Professional Shortage Areas and Medically Underserved Areas by the Health Resources and Services Administration.
Telemedicine would enable Tanner Health to tap into the expertise of qualified physicians miles away, ensuring that distance is no barrier to exceptional patient care.
In 2018, Tanner Health launched a telemedicine program using vendor InTouch Health's technologies. The program is focused on the following:
- Behavioral health, providing virtual access to therapy and behavioral health services and empowering behavioral specialists, including psychiatrists and therapists.
- Consultations and specialist referrals.
- Neurology services, including virtual stroke therapy and rehabilitation services.
- Tele-ICU and critical care services.
"The COVID-19 pandemic forced telemedicine to an even more important role in curbing the exposure to and transmission of infectious disease, while helping keep our front lines safe and ensure they have the resources to respond adequately to the challenges presented by COVID-19," Jackson said.
"Through the FCC grant, more of Tanner's clinics are equipped with high-speed Internet. Those patients who have poor Internet access at home will be able to visit those remote clinics and receive the same services as at Tanner's main campuses."
Hugh Jackson, Tanner Health System
"Through assistance from an FCC COVID-19 Telehealth Program grant in 2020, Tanner has been able to expand its existing telemedicine platform through InTouch Health, to include additional specialties and locations, and new remote patient monitoring technologies through Vivify Health, all integrated with Tanner's newly launched Epic electronic health record," he added.
Tanner Health recognizes the increasingly critical role that telehealth has to play in healthcare delivery, enabling patients to access healthcare services without needing to visit a provider's physical location.
In addition, an important benefit of telehealth during the COVID-19 pandemic is that it enables Tanner providers to treat patients while maintaining physical separation, thereby minimizing the risk of further transmission.
"With this, Tanner's approach to expand and implement new telehealth services included a web-based telehealth solution with remote patient monitoring program, integrated with Tanner's existing electronic health record, that is enabling the organization to expand its patient reach both in outpatient and in-hospital settings and ensure the health and safety of our community and patient population," Jackson said.
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MEETING THE CHALLENGE
Tanner Health is using its telehealth platform to expand inpatient, outpatient and post-acute care services to all patients throughout the community.
"Our inpatient teams use robots and tablets integrated into our telehealth platform to allow remote specialists to consult patients for complex conditions relating to psychiatry, maternal fetal medicine, internal medicine and emergency medicine," Jackson explained.
"All of Tanner's medical group practices have the ability to complete patient visits via telehealth."
Inpatient and ambulatory care management now can assign patients a remote monitoring kit as patients discharge from hospital care to ensure close tracking of vital signs as patients convalesce in their homes, he added.
The InTouch platform and devices integrate to allow Tanner teams to schedule and launch visits out of Epic for improved clinician workflows, Jackson noted.
"The integration also provides an added layer of security to ensure the visits are tied to a specific patient," he said. "The remote patient monitoring technology from Vivify also integrates with Epic to allow for patient information to flow across for registration into the Vivify system."
The overarching goals of Tanner's telemedicine program are to:
- Improve patient and clinician access to specialty expertise while keeping care local.
- Enhance patient care experience (engagement, satisfaction and convenience).
- Reduce overall healthcare costs and improve efficiency.
- Enhance clinical outcomes through improved responsiveness, coordination and communication.
Among the successes Tanner Health has had with telehealth, two stand out for Jackson.
"There are a lot of telehealth-specific best-practice metrics Tanner is using across our multiple use-cases," he said. "Two examples we like to highlight are tied to access and readmission avoidance. For access, we look at the completed telehealth outpatient visits as a percentage of total outpatient visits and review that number with comparisons to historical volumes. This allows our medical group to monitor if patients who are hindered by infection risks are able to maintain access to their respective physicians."
So, in a given month, if the medical group visits are at 100% of historical norms and 10% of visits are performed virtually, Tanner Health knows it has leveraged telehealth to meet the needs of those at highest risk for COVID-19, while still meeting the needs of the entire community, he explained.
"The second metric we track for success highlights the impact of our remote monitoring program," he noted. "We look at the ratio of remote monitoring patients escalated for care management interventions to readmissions. Historically, patients discharged from acute care with complex conditions can seek care from the emergency room if they fear their health is worsening."
Remote patient monitoring allows Tanner's care managers to identify patients in distress and provide an intervention, improving the patients' health while avoiding overuse of healthcare facilities, he added.
So if 80% of remote monitoring enrollees have a care management intervention, but 0% of the patients readmit to the hospital, Tanner Health knows it is succeeding in providing healthcare value to the community, he said.
USING FCC AWARD FUNDS
Last year, Tanner Health System was awarded $879,520 by the FCC telehealth funding program to implement new telehealth services and expand existing telehealth services to treat inpatients, and to provide remote services to patients needing treatment for chronic conditions, behavioral health services and other medical conditions, including COVID-19 high-risk, vulnerable, underserved and low-income patients.
"Tanner's FCC grant funds are being used in three different areas," Jackson said. "First, funds are being used to expand the same telehealth services already in use for neurology and psychiatry at the health system's Carrollton and Villa Rica facilities in Georgia, to the campuses in Bremen, Georgia, and Wedowee, Alabama, including expanding to other specialty services."
The second use of funds is helping expand those services further to outpatient services, to include 38 Tanner Medical Group locations with more than 100 providers, including six rural health clinics in Georgia and Alabama.
"The third use of funds is directed at adding remote monitoring of patients in their homes, allowing for enhanced care management of chronic conditions that will decrease patients' chances of having to be hospitalized," he said.
One factor that potentially limits the full use of telehealth services is the lack of broadband access in much of rural west Georgia.
"Through the FCC grant, more of Tanner's clinics are equipped with high-speed Internet," Jackson noted. "Those patients who have poor Internet access at home will be able to visit those remote clinics and receive the same services as at Tanner's main campuses. While telehealth has been used in some areas, one new area for Tanner is to remotely monitor patients through their personal computers or smartphones."
This enables doctors to discharge their patients sooner, or perhaps even avoid a hospital stay entirely because the doctor is able to check on them, he added.
"Tanner's expansion of its telehealth platform has freed up resources to manage our current reality through several key measures," he said.
"Telehealth has supported physical distancing efforts to reduce COVID-19 virus transmission, ensured care availability to those who need it most by triaging low-risk urgent care, and provided follow-up appointments for chronic disease and behavioral health patients who may require routine check-ins."
By reducing unnecessary visits to healthcare environments, Tanner's expanded telehealth platform aims to curb the exposure to and transmission of infectious disease while helping to keep front lines safe and ensure they have the resources needed to take on the challenges presented by COVID-19, he concluded.
Healthcare Everywhere, Every Day
The onset of the COVID-19 crisis a year ago, with its widespread quarantines and lockdowns, offered telemedicine its moment to shine after years of under-fulfilled promise. As states look toward a post-pandemic world it's time to build on that promise.