August 11, 2020 -Small hospitals across the country are turning to telehealth to expand their treatment options and give patients access to specialists they might otherwise have to travel long distances to see. These services not only improve care for patients, but help the hospital to keep that care in the community.

Such is the case with the Beauregard Health System, an acute care hospital in rural DeRidder, LA. This past June, the 49-bed not-for-profit hospital launched a platform, through a partnership with SOC Telemed, to provide critical care, psychiatry, in-patient and emergency neurology and cardiology services via telemedicine.

The need for cardiology services was especially important. The hospitals only full-time cardiologist had left the previous April, and the hospital was transferring, on average, 30 patients each month to other hospitals.

Our community was vulnerable without a full-time local cardiologist, Traci Thibodeaux, MHA, CMPE, Beauregards chief operating officer, said in a press release. We wanted to partner with a cardiology group in Lake Charles, but knew they couldnt meet our needs for an onsite full-time physician.

In a recent Q&A with mHealthIntelligence, Thibodeaux explains how Beauregard planned out and launched its connected health strategy.

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Q. What was the thinking behind deciding to partner with a telehealth company to offer these services on a telemedicine platform?

A. Beauregard Health System decided to partner with a telehealth provider because we needed to evolve from our grass roots approach and expand to include additional specialists - on one platform, using one process and the same equipment - to make it as seamless as possible for patients, nursing, and physicians.Since we are small rural acute care hospital, there are some specialties that we know well never offer locally.

Q. How were these 5 specialties psychiatry, critical care, inpatient neurology, emergency neurology and cardiology chosen? Were there specific arguments that these particular specialties need to be included in a telehealth strategy?

A. The specialties are critical for various reasons.

With psychiatry, our Emergency Department can get overwhelmed with trying to care for the sensitivities and complexities that this patient population presents.We have to consider patient safety, staff safety, and the safety of other patients and families, which includes children.We want all of our patients and families to feel safe and well cared for in our facility.

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Tele-psych consultation allows us to expeditiously determine the best and safest course and place of treatment, which often requires a transfer to a more appropriate care setting.

Cardiology and Neurology are important because, without these consultations, patients were automatically transferred to other facilities for a higher level of care, whether or not they truly needed it, since we werent able to offer on-site cardiology and neurology evaluations.

Telemedicine creates an opportunity to keep patients local when it is safe to do so.Our team on the ground, in consultation with a specialist who has assessed the patient, effectively care for many patients using this approach.This prevents unnecessary disruption for patients and families (and) prevents adding unnecessary direct and indirect cost of care for families, which includes transportation, travel, lodging, insurance, child care and missed work.

When we launched Tele-Critical Care in December of 2019, we had no way of knowing what a profound impact this would have on our patients, nurses, physicians and community.We were perfectly positioned to effectively care for every wave of COVID 19 that we first started seeing in March of this year at our hospital and through our current peak.This has allowed us to provide excellent care and weve undoubtedly gained a tremendous amount of community trust and support.

Q. What are the biggest challenges in launching a telehealth platform to address these services?

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A. The biggest challenges were uncertainty of utilization and success.We questioned whether we would have a return on our investment with insurance plans reimbursing the service.We hoped that nursing would support the technology and see it as value-add for patient care.We prayed that the patient and family would have a great experience.We worried that we would have the WiFi and audio/video quality to support the interaction without interruption. We questioned whether the patient and family would have a good experience without the face to face interaction.

Q. How were clinicians and other staff brought on board? Was there any pushback or concerns about moving to telehealth?

A. The medical staff and board members were supportive of the project, but I might generalize that they were all cautiously optimistic going into this. Before COVID 19, the support of specialists were nice to have, but not essential, as we would transfer higher risk patients out for higher level of care.

Mid-pandemic, the medical staff and board have been so supportive that the telemedicine project has evolved and expanded into an organizational strategy.Tenured physicians who have practiced traditional medicine and bedside care are extremely supportive and accept that telemedicine is here to stay.

Ive (also) gotten additional feedback from nurses in the units who have learned from the online physician, as theyve had to be the hands of these virtual physicians.Nursing has to be on point in communicating vitals, assisting with the evaluation and assessment as directed by the on-screen physician and reporting pertinent details and changes in status.As one of our seasoned ICU nurses stated, I have to be prepared and on my game.Its made me a better nurse.

Q. Had you looked at other health systems/hospitals to see how they adopted telehealth? If so, what lessons were learned in how they did this?

A. At the time we were gearing up to launch telemedicine, our organization was also shopping for a new electronic health record. While we were checking references and networking with users of the various systems, we would ask about telemedicine and virtual visit capabilities.Most facilities had Tele-Stroke programs (as did we) but were not yet offering robust inpatient telemedicine services.

We had a need to stop unnecessary transfers; we realized that telemedicine was more of a sure thing than our ability to successfully recruit for the needed specialties. We decided to forge ahead with telemedicine and were determined to make the technical and logistics side work.At that point, the biggest wild card was whether the patient and family would have a positive experience and the service would add-value to our hospitalists and community physicians.

Q. What advice would you give a similar-sized hospital about launching a telehealth strategy?

A. Design your implementation strategy with a multi-disciplinary team. While medical staff and board support are certainly foundational to the strategic plan and investment, youve got to have champions -namely, physician (such as hospitalist leader or CMO), executive sponsor, IT, nurse leader, nurse educator, clinical workflow and documentation, heath information, contracting and revenue cycle.This team will have to collaborate on workflow, logistics and the what-ifs.

It is best to have folks involved on the front-end so that they buy in, remain engaged and have enough knowledge and familiarity to help trouble-shoot the workflow at go-live. If you have the right folks, a sense of pride and ownership develops, and failure is not an option.

Q. How will you measure success for these services? What benchmarks are being used to note whether a particular program is improving care or reducing workload stress?

A. We expect to see the number of patients we are transferring out by service line decrease, as compared to the baseline data prior to our telemedicine launch.We expect to find our case mix index trend up a little, as we are caring for slightly more complex patients relative to neurologic, cardiovascular and critical care. We expect a corresponding uptick in revenue relative to the level of care provided.

We expect to see physician satisfaction improve, since they will be better supported by specialists that we didnt previously have access to. We expect our patient experience to be impacted since the engagement between the patient and family and on-screen physician has been remarkable from a patient experience perspective.

For example, over the weekend we were able to keep and care for two neurology patients who we might have otherwise transferred out prior to telemedicine.Weve effectively cared for critically ill patients.Weve also been able to survive the challenges of the COVID 19 pandemic, while so many other hospitals have had to lay off staff or close their doors.In addition, weve provided our medical staff with access to specialists that we would not have otherwise had.

The most surprising aspect of our telemedicine program is how the nursing staff appreciates being able to provide more comprehensive care for their patients, how the nursing staff is able to learn from the on-screen physician, and how well-received the service has been with our patients who had mostly only been exposed to face-to-face care.

Q. How will you scale up or expand your telehealth strategy in the future?

A. We look forward to launching virtual visits in conjunction with our patient portal and the new EHR, which goes live January 1, 2021. We are exploring other specialties and virtual services (and) are open to any virtual opportunity that is affordable, sustainable, and adds value to our patients and medical staff.

Q. What can or could state and federal officials do to help hospitals like yours use more telehealth?

A. The loosening of some regulations related to telemedicine has been a great start, but it is in response to COVID 19, and were not certain what the new regulatory normal looks like.Especially burdensome for providers is the ongoing battle with insurance plans to figure out which hoops they require to approve services and then, even more challenging, is how to get reimbursement.There are very few standard rules of engagement. Every plan has its own requirements and nuances, which is frustrating, discouraging, labor intensive and costly.

Especially for rural communities, we need more planning and investment in infrastructure to support access to care, such as fiber networks, affordable internet and device availability for home monitoring systems for elderly and other at risk populations.Additionally, shifting focus to programs that support more population health initiatives and comprehensive and sustainable programs to close the gap on disparities in health care is crucial.

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How a Rural Hospital Developed and Launched its Telehealth Platform - mHealthIntelligence.com