Why telehealth will be the new standard of care: Q&A with Dartmouth-Hitchcock's Dr. Kevin Curtis and Mary Oseid

At Lebanon, N.H.-based Dartmouth-Hitchcock Medical Center, telehealth isn't delineated by technology. It's simply a way to deliver care.  

Kevin Curtis, MD, medical director of telehealth and connected care at DHMC, and Mary Oseid, DHMC senior vice president for regional operations and strategy, are heavily involved in the direction of the health system's telehealth program. Since the program's launch in 2012, DHMC has completed an estimated 20,000 video encounters in addition to more than 1 million telepharmacy orders, according to Dr. Curtis.

Here, Dr. Curtis and Ms. Oseid discuss their respective leadership roles within DHMC's telehealth program and their predictions for the future of telehealth in traditional care settings.

Editor's Note: Responses have been lightly edited for clarity and length.

Question: How has DHMC’s telehealth center affected patient care? 

Dr. Kevin Curtis: We're located in an incredibly rural region; since forming our center for telehealth in 2012, we've continued to up the goal of 'how do we help to bring outstanding care to the region' — especially specialty care — in a way that will improve meaningful outcomes and achieve the quadruple aim?

As far as affecting patient care, when a hospital, community or a provider comes to us and says, 'how about some of that telehealth?' we start by focusing much more on the care than the technology. We say, 'what are the needs and gaps of your community or your patients?' Then we think about which one of those needs and gaps might be solved by telehealth and we try to bring resources to them. We then say to wrap up some technology around it at the very end of the experience. For example, with our emergency telepsychiatry service, which provides 24/7 psychiatrists for patients in mental health crisis in emergency departments, we're seeing that almost 40 percent of patients can be discharged from the ED after a telepsychiatry consult. This not only helps patients and their families but also the ED mental health boarding crisis in the country.  

Mary Oseid: When I think about our impact on patient care, we're improving access, patient convenience and overall outcomes. What we're most proud of is we're helping rural hospitals to keep patients local for care. Working with those rural hospitals, we are providing those patients access to specialized and evidence-based care using our telehealth program.

Q: Since launching in 2012, DHMC has completed nearly 20,000 video encounters and more than 1 million tele-pharmacy orders. How do you support continual growth in the program through your respective leadership roles?  

MO: I interface with and have partnerships with a lot of the local hospitals in our service area in New Hampshire and Vermont. As we think about growth, we are really working with the leadership of those hospitals and partnering with them to bring telehealth services to patients in their local communities. These are specialty and other high-acuity services that previously had only been offered at the academic medical center, so it's through these partnerships that we're able to grow our services and provide telehealth at these local hospitals.

KC: Regarding the big picture as we're talking about growth, I think both nationally and in our program we're really at a tipping point of exponential growth right now. Both in terms of growing our current services and as far as looking at what services would be beneficial to expand into for the region. From my medical director standpoint, one of the additional pieces I'm regularly thinking about is how does telehealth become something that is no longer called out as a unique entity and is just part of how we deliver care?

Q: What is your No. 1 priority in your leadership role?  

KC: I'm constantly thinking about my No. 1 priority being not that we're delivering telehealth just because we can or because it's the new popular way of delivering healthcare. And how do we do it in a way that bends the cost curve and improves access, improves meaningful outcomes, enhances the patient and family experience, allows people to get their care close to home, supports local workforce challenges and supports clinicians in rural regions.

MO: My overall sense is that we just want to make healthcare better by keeping patients in their local communities for care and providing them with access to telehealth specialty care that's evidence based. We're really into supporting rural hospitals and providers through enhanced telehealth services. That allows them to retain revenue and keep those patients local. We think we're really providing some infrastructure for rural hospitals by providing expert treatment locally, so when patients are really sick they don't have the added risk and inconvenience of being transferred to a larger center where their family and loved ones have a hard time visiting and caring for them.

We also prioritize being a resource for local care providers. Providing them with the infrastructure and expertise that they can draw not only from that important individual care episode, but they can use in the future as they see patients. 

Q: How do you think telehealth technology will evolve in the next three to five years?

MO: We can't emphasize enough that we don't think telehealth is about the technology. It's a clinical service that we supply using some form of remote communication technology: video, text or email. When I think about the next three to five years, we're at this inflection point where we see the transformation that's going to occur is the widespread acceptance of these remote technologies, video mostly, that will support patient care. As Dr. Curtis said, it will become the standard of care. You'll be just as comfortable seeing your physician in the office as you are seeing them on video. 

KC: I expect that for much of the country, if you get your care in a local intensive care unit, tele-ICU, as part of it, will be the standard of care. If you go to an ED that doesn't have 24/7 neurology access, the standard of care will be that teleneurology is part of the care you receive in that ED. Even from an outpatient clinic standpoint, I think providers will show up in the morning and they won't think twice about the fact that their first two patients may come through the door and their next two will show up on the screen. That will just be how care is delivered. 

To participate in future Becker's Q&As, contact Jackie Drees at jdrees@beckershealthcare.com.

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