NewYork Presbyterian's telehealth strategy: Closing the access gap for underserved populations & making the ER more efficient

Last month, NewYork-Presbyterian dedicated The Hauser Institute for Health Innovation in recognition of Rita E. Hauser and Gustave M. Hauser, who have given more than $50 million to support the health system's telehealth services.

Since 2011, the health system has invested in innovative health IT and telemedicine programs to expand access to care for its underserved population. But they have also realized operational efficiencies systemwide and expect to see further development in telehealth in the future.

Here, CIO Daniel Barchi discusses NewYork-Presbyterian's telehealth strategy and the potential of telehealth in the future.

Question: How does telehealth fit into your overall care delivery strategy?

Daniel Barchi: Telemedicine is a chief component of digital medicine and how medicine will be practiced in the future. The Hauser donation is helping us make that happen. Telemedicine is important because it allows us to deliver the right medicine, through the right doctor, to the right patient at a convenient time for them. We serve one of the largest Medicare and Medicaid populations in the country and a significant portion of our patient population is from underserved communities. Telemedicine can break down the disparities in transportation, access to care, language barriers and education in a way that nothing else can.

Q: Why is it so important for your physicians and care providers to participate in telehealth?

DB: Telemedicine makes healthcare delivery efficient internally and gives broader access to specialists. Patients in our Accountable Care Organization (ACO) might see a primary care physician and be told they need a follow up consultation with a specialist. Traditionally, it would take several days or weeks to schedule a consult with the specialist. Now, we can have our team reach out to the patient over the phone and remind them that they need a specialist follow-up. If the patient has access to a smartphone or computer, we can connect them with a neurologist or dermatologist almost in real-time so they can have a telemedicine consult. What used to take two to three weeks to schedule, now can be done right away, or within a few hours.

Q: How does the telemedicine process work operationally within the health system?

DB: Telemedicine helps us drive down the cost of care delivery and leverage staff to do more enterprisewide. Today, when the patient arrives at the ER, a physician or nurse might spend 45 minutes or an hour conducting the mediation and reconciliation to take the patient's history and understand the problem and current medications. More and more, when patients are admitted to the ER, we roll out the telemedicine chat so we can conduct the reconciliation right there. It's more efficient and our staff does a good job of collecting the information.

Another example is when a patient comes to the ER and needs a triage or screening, we used to have to call the patient back and have a nurse take their vitals and talk to them. Now we can do a tele-medical screening exam with a video camera in the triage area. At the same time the nurse does the triage, the physician or physician extender can place orders on what needs to happen next so we can treat the patient quickly.

If we can do this thousands of times per month, it will make the ER more efficient.

Q: How do you measure the effectiveness of telehealth efforts?

DB: Most of the benchmarks are not advanced technology measures; they are operational measures. We look at the average days between the consult being ordered and delivered for specialists like neurology and dermatology. For the ER, we collect data on the time to door, and time from the door to discharge. For the medication reconciliations, we measure how many minutes it takes to conduct the reconciliations, and how quickly we can admit the patient. Although we are using advanced tech, the methods are operational and typical.

Q: Where do you see the telehealth program headed in the future?

DB: We expect that this funding will allow us to adopt new and novel ways to use telemedicine internally and externally. We are providing wraparound services. For example, if cardiology has a video visit with the patient, the cardiologist can be more efficient, and the patients don't have to take time off work to travel to the cardiologist's office. But if that's all it is, the program is only marginally efficient. We want to create a clinical and operational ecosystem of services so it's not just the cardiologist that sees the patient during the video visit, but also the social worker, nutritionist and other consultants so the patient can see all the specialists in one visit.

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