3 Lessons Learned From Saint Thomas Health's Telehealth Pilot

Nashville, Tenn.-based Saint Thomas Health, part of St. Louis-based Ascension Health, piloted a telehealth program from Jan.-June 2011. The goal was to increase access to specialists for patients in rural or remote regions by using telehealth during patients' scheduled appointments. Saint Thomas Hospital in Nashville, two remote facilities associated with Saint Thomas Health and a mobile medical unit had the telehealth technology installed.

Jason Dinger, CEO of MissionPoint Health Partners, the accountable care platform for Saint Thomas Health, says patients' and physicians' reception of the pilot was very positive. For one, telehealth saved both patients and physicians from having to travel. The telehealth program also benefited patients' caregivers — a spouse, child or friend — who often had to drive patients to appointments. "One of the things we underestimated was that most patients have caregivers they rely on to help them navigate care. When [they] have to spend hours driving in [for an appointment], someone else is with them having to make that same commitment," Mr. Dinger says. "Patients were incredibly grateful, not only for making their life easier, but also their caregivers' lives easier."

Mr. Dinger shares three primary lessons learned from the telehealth pilot.

1. Start with an existing relationship. Saint Thomas Health introduced telehealth to existing relationships between patients and physicians, which helped ease the transition to this new way of interacting, Mr. Dinger says. The health system worked with a clinic where cardiologists and other specialists visited weekly to meet with patients. Instead of meeting face-to-face, however, the telehealth pilot allowed the physician and patient to conduct the appointment remotely in real time via a video and computer system. At a remote location, a clinician would examine the patient and the telehealth system would immediately relay the data to the physician at a different location. Beginning with an established patient-physician relationship ensured that the only new component of the appointment was the technology, not the patient or physician.

Furthermore, several aspects of the technology were designed to minimize any disruption in the patient-physician interaction. For example, the physician's image was life-size. "That's important because we've found that if we reduce the scale of someone, the patients think they are talking more to a computer than to a physician," Mr. Dinger says. In addition, the technology uses high-definition video and advanced audio to create a "same room" environment, Mr. Dinger says.

Once patients and physicians in an existing relationship become comfortable with the new technology, the program can start to include new relationships. "Begin by enhancing an existing relationship. Then expand out to other physicians and then other patients in a very succinct and stable fashion," Mr. Dinger says.

2. Telehealth allows you to engage the patient in new ways. "The recommendation we would have is to use the tool to activate patients in new and exciting ways," Mr. Dinger says. As an example, he explains how a cardiac patient was able to listen to his or her own heart beat along with the physician. "The doctor is able to say, 'Do you hear this swoosh sound at the end? That's what I'm worried about,'" Mr. Dinger says. "It allows patients to participate in their care in an entirely new way."

Initial surveys showed that patients who participated in the telehealth program adhered to their medications more and made lifestyle changes faster. In addition, patient satisfaction was higher in telehealth than in face-to-face appointments. "The patients attribute [their adherence and satisfaction] to the fact that they can really understand much more about what's going on inside their own bodies and their health needs," Mr. Dinger says.

The telehealth technology can also enable physicians and other care providers to discover new ways of interacting with patients in face-to-face visits. "It would be interesting to see how the advent and use of telehealth reframes the face-to-face visit, because it's going to teach us new things about how patients want to engage in their care," Mr. Dinger says. For example, patients in the telehealth pilot expressed interest in having appointments with other specialists via this technology, according to Mr. Dinger.

3. Consider the telehealth infrastructure as a community resource. Mr. Dinger says as patients became more engaged in their health through telehealth, they began to see it as a community resource that could offer other services. "People began to innovate around the technology. Patients were asking for more access to harder-to-find specialists," Mr. Dinger says. "They saw telemedicine as a resource to do that." Telehealth also became a resource for patients' education — whether about a specific disease or preparation for an upcoming surgery. "The technology can go much further beyond a typical physician-patient interaction and can bring a whole host of new resources to bear for those patients and the community itself," Mr. Dinger says.

Related Articles on Telehealth:

Sisters of Mercy Health System in Missouri Offers Telestroke Program
Nevada Hospitals Partner With Valley Hospital in Las Vegas for Telehealth Program

Report: Telehealth Expansion in California May Save Up to $408M Annually

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