Telehealth enables health center to tackle rural and COVID-19 challenges
At the beginning of the COVID-19 pandemic, Jordan Valley Community Health Center in Springfield, Missouri, was facing the problem of providing quality patient care in a safe environment while most of its patient base was staying home.
The provider organization believed telehealth was the future, but had only been using the technology in small niches, such as school-based care. When COVID-19 hit, the organization was required to use telehealth in a much broader sense.
“We expanded our solutions to include TytoCare, Zoom video conferencing and OTTO, which is a NextGen product,” said Dr. Matthew Stinson, vice president of medical and behavioral health services at Jordan Valley Community Health Center. “In the early phases of the pandemic, we also used telephone visits for behavioral health visits, medication refills, chronic disease management like diabetes symptom management, etc.”
While these platforms worked relatively well, he added, the scope of clinical diagnoses that can be made in video or audio consults is limited.
One of the workarounds Jordan Valley considered sought to add data points to the video consults by providing patients with unconnected peripherals – weighing scales, blood pressure cuffs, pulse oximeters, etc. – and asking them to manually input or communicate the data from those peripherals during a Zoom call or OTTO visit.
“This was only ever seen as a bridge solution, as there is no opportunity for EHR integration with the non-connected peripherals, or any way for a provider to take live, real-time, synchronous inputs from non-connected peripherals,” Stinson explained. “The store-and-forward nature of this solution left more opportunity for user error, and made it hard for providers to verify the information being communicated from the patient.”
Jordan Valley also had trialed the use of the TytoCare devices by sending community health workers into the patient homes to augment video consults with a provider using an otoscope, stethoscope, thermometer, exam camera and tongue depressor, which are connected to the TytoCare device.
"Additional funding from the State of Missouri has provided Internet hotspot devices to ensure patients without high-speed Internet access are still able to access expanded and improved telehealth services."
Dr. Matthew Stinson, Jordan Valley Community Health Center
“While this solution helped to expand the clinical considerations that could be made via telehealth, the availability of community health workers and pandemic conditions were limiting factors in scaling up this solution,” Stinson said.
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MEETING THE CHALLENGE
Jordan Valley was awarded telehealth funding from the FCC. This allowed it to provide TytoHome units to 700 health center patients for in-home use, so allowing the patient to request a visit and connect to a provider who can synchronously request and use inputs from a connected otoscope, stethoscope, basal thermometer, exam camera (with a tongue depressor attachment), blood pressure cuff, and pulse oximeter to augment the video consultation and inform clinical diagnosis.
“Clinical workstations are configured to allow the provider to access the TytoCare platform, including controls for the patient-side TytoHome device on one screen, while charting directly into the EHR on another screen,” Stinson noted. “Integration between the TytoCare platform and our NextGen EHR still is being built out to improve the scheduling and visit experiences for patients and streamline some workflows on the clinical side.”
As the largest federally qualified health center in the State of Missouri, Jordan Valley’s service area covers a significant rural population facing unique access barriers due to their geographic distance from clinical sites and persistent issues with broadband availability, reliability and cost.
“Additional funding from the State of Missouri has provided Internet hotspot devices to ensure patients without high-speed Internet access are still able to access expanded and improved telehealth services,” he said. “In distributing TytoHome devices, we consider Internet availability in the home, and are able to include hotspots and connected tablets for those families who lack Internet connection or a compatible personal device to use with Tyto.”
Jordan Valley’s service area largely is classified as a health professional shortage area, or HPSA, meaning even patients with access to primary care may not be able to access specialists, behavioral health providers or other essential services.
“An example of this is medication-assisted treatment for substance use disorder,” Stinson explained. “While Jordan Valley has a number of MAT-waivered providers who deliver MAT on a walk-in basis at some of our larger clinic locations, in rural areas the wait for these services can be significant and often prohibitive.”
By enhancing telehealth offerings, including the use of Tyto kiosks in satellite clinic locations, Jordan Valley has been able to expand access to specialists, behavioral health services and MAT for substance use disorder to individuals in more remote or rural areas.
Jordan Valley still is in the implementation phase of the rollout of the 700 TytoHome units and the set-up of clinical telehealth kiosks. However, in looking more broadly at telehealth usage, the provider organization has observed a 50-fold increase in telehealth visits, comparing the period of March 2020 and August 2020 (six months) to the period of March 2019 through February 2020 (12 months).
While some of this was due to a reluctance to attend appointments in person due to COVID-19 concerns, Jordan Valley expects demand for telehealth to stabilize and remain higher than pre-pandemic levels as patients grow accustomed to the convenience, safety and accessibility of receiving services via telehealth.
“Second, we have been able to expand MAT to rural areas,” Stinson added. “We currently have a kiosk in place at our clinic in Lebanon, Missouri, and have been able to provide walk-in services for substance use disorder.”
USING FCC AWARD FUNDS
Jordan Valley Community Health Center was awarded $742,780 for a telehealth platform, remote diagnostic and monitoring equipment, and tablets to provide diagnostic services and treatment for COVID-19 patients at the patients’ homes and, by using multiple telehealth solutions, provide access to healthcare for all other patients and expand clinical applications of the telehealth technology.
“The FCC funding allows for the distribution of TytoHome units to 700 families in Jordan Valley’s service area,” Stinson concluded. “Additionally, it will support TytoClinic kiosks to be installed for provider and patient use. These kiosks will serve as a force multiplier – ensuring access to quality, comprehensive medical and behavioral health services in rural areas.”