As some rural hospitals are closing, a Wyoming system is using tech to thrive

St. John's Health in Jackson, Wyo., established its telehealth program around 18 months ago and it became crucial to the system's response to COVID-19.

Since Wyoming has a largely rural population, healthcare providers in the state already had access to HIPAA-compliant Zoom licenses, which is something Lisa Finkelstein, DO, St. John's medical director of telehealth, has worked on for years. "From my perspective, the secret to our success in telemedicine was that we were prepared," she said. "I worked for several years to get the telemedicine program rolled out and it took a while to get clinicians onboard. Little by little, they started using it. Then when the pandemic hit, we had a team in place to support the billing and marketing side of things so that we could treat those patients."

In the past, CMS has geared its telehealth capabilities toward rural medicine and federally qualified health clinics in places where individuals don't have access to specialists or physicians. But then when the pandemic hit, the agency expanded coverage to urban and metropolitan areas as well.

"It's really glaring to see that physicians and health systems that were not thinking about how to incorporate telemedicine into their everyday clinics are suffering," said Dr. Finkelstein. "The systems that we have in place helped us fare much better, and I think those that don't put a good telemedicine program in place will be left behind, partly because patients recognize that having access to efficient healthcare at their convenience is a lot better than waiting in the clinic or ER."

Still, telemedicine isn't effective for all visits, and before the pandemic many people still preferred in-person visits. But with social distancing orders in place, the team was able to develop Zoom accounts for all physicians and nurses as well as staff who would be working remotely; the team jumped from 400 telemedicine visits to 2,000 visits in a month. From July 2019 to February 2020, the health system reported an average of 25 new enrollees in the telehealth program per month. In March, the system enrolled 1,568 patients in the program.

"It was amazing," said Dr. Finkelstein. "We have a repository Wyoming telehealth network for physicians to access and they are aware of how to connect with patients through it."

When the pandemic began to hit the area in the first week of March, St. John's Health leadership mobilized the telehealth, IT, risk, nursing and physician clinic teams to develop a COVID-19 hotline and plan for how calls would be triaged. This cohesive team connected daily debriefings about the previous day and discussed how they can better mobilize the program. The team also developed a standardized process for registering and scheduling patients.

The hotline and telehealth capabilities rapidly expanded access to care for the largely rural population and patients embraced the technology to ensure the hospital could continue serving the community through the pandemic.

"There are other rural hospitals that are shutting down in other states. They are going bankrupt and furloughing employees," said Program Manager of Innovation and Telehealth Sandip Ray. "This program was a lifesaver for us."

The St. John's team sees telemedicine becoming part of the "new normal" of how healthcare is delivered across all hospital departments. Mr. Ray and his team are working with the IT department to integrate Zoom calls into the patient portal for a more seamless patient experience.

"It's becoming part of our life, not a separate service line," he said.

"We are now recognizing the things we need to integrate so our telemedicine program functions at a high level and networked into everything we do," said Dr. Finkelstein. "We can use it to check on patients as well as educate patients about their care. Our team has expended and the IT and informatics have taken a larger role in patient care. Our front desk staff have even stepped up for ongoing education on telemedicine and the new codes that are coming out."

St. John's CIO Lance Spranger also predicts there will be an increased use of telemedicine on multiple mobile platforms, and said the system will need to continuously improve applications. "We don't think telemedicine will replace in-person care, but it will provide a great option for patients," he said. "The continued evolution and integration of technology, leveraging Zoom and Cerner video visits, will be critical. We also have a partnership with MDLive to serve our own established patients."

There are more than 6 million visitors to the Jackson, Wyo., area as well each year and the health system needs to provide convenient and secure care to them as well. "We can deliver great care through telehealth and we are continuing to learn the appropriate use," said Mr. Spranger.

Moving forward, the health system aims to set up additional remote monitoring capabilities to care for patients at home. But the team can't do it alone.

"We need more strong partnerships between healthcare delivery organizations and vendors because vendors have more visibility and we can learn from them as well as each other," said Mr. Ray. "This is the best time to do that since we are already collaborating in our pandemic response. The more involvement we can get from IT and its counterparts, the more we improve."


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