Telehealth Benefits The Patient And The Practitioner

Edited by Erin Harris, Editor, Health IT Outcomes

Telehealth enables convenient access to a wide range of health services, in turn helping to provide timely diagnosis and treatment.

One of the biggest challenges facing U.S. healthcare is the ability to provide quality care to the underprivileged and underserved. Telehealth has enabled healthcare systems to treat patients in a timely manner, particularly those located in rural or remote areas. Indeed, some healthcare systems that have adopted telehealth technology have been able to successfully blend acute care with wellness care, and one such healthcare system is St. Joseph Health based in Orange, CA. I recently caught up with Dr. Elliot Sternberg, executive VP for wellness and health improvement, to find out how St. Joseph Health has become proficient in providing telehealth services and the benefits its patients and practitioners have reaped along the way.

Q: What challenges were facing St. Joseph Health that drove you to implement telehealth technology?
Dr. Sternberg: About six years ago, our CEO was new at the time, and her intention was to evolve our system during her tenure. In a system that makes a preponderance of its money taking care of sick people in the hospital and by outpatient services, that meant introducing the concept of wellness. That said, a patient may eat sensibly, exercise regularly, have access to a good school system, etc., but if they don’t have timely access to high-quality healthcare, they are going to be compromised. From that sprung the realization that we needed to move forward with providing access to healthcare, particularly to underserved and underprivileged individuals, for the populations and communities that we serve. And so began the pursuit of telehealth.

From a business case standpoint, telehealth can be used as a way to generate revenue by working with self-funded employers, for example. By implementing telehealth units on their campuses, we could extend access to the doctors we work with, and those doctors can be a conduit into our acute care system for diagnosis.

When telehealth and its promotion of access, particularly to the underfunded and underserved, are realized, they can provide cost avoidance. Patients who don’t have access to care — be it primary or specialty care — often find themselves in emergency rooms, which are not the most efficient place to deliver primary care or even specialty care.

Q: What kind of technologies are you leveraging? How do the technology components work together?
Dr. Sternberg: We leverage the partnership between AT&T and Cisco. AT&T provides the connectivity. Cisco provides the televisions, the cameras, and the routers. We also work with a company called AMD Global Telemedicine, and it provides the electronic stethoscopes, dermascopes, and ENT scores, all of which are integrated into the system. We’ve also implemented Emerge MD, a telehealth SaaS solutions provider, which operates our entire workflow by providing the electronic medical record. All components are fully integrated at this point.

Q: Telehealth has many potential benefits in terms of reducing expenses on patients. Yet there are some reimbursement hurdles to telehealth. How are you overcoming these?
Dr. Sternberg: We wrote and applied for a grant from UniHealth Foundation, which saw this as a tremendous opportunity to provide care to the underserved and under-resourced, so they helped fund us for two years. We contracted with CalOptima, the Medicaid managed care program in Orange County, and it reimbursed us for providing telehealth consultation. We allowed the money that we collect for those services to stay within the community clinics, because I did not want to undermine the clinics’ financial wherewithal. Once the telehealth consultation has been deemed sustainable, which it has been, my plan is to approach healthcare plans and have them contract for the telehealth services we provide.

However, a bureaucratic hurdle to consider is that the physician must be licensed in the state in which the patient is being seen. For example, let’s say I am a licensed dermatologist in California. Even if I am willing to provide service to a patient needing dermatology consultation in Nevada, I could not do so without obtaining a Nevada license to practice.

I think over time (within the next decade) the laws will change and there will be some liberalization in being able to provide telehealth consultation across state lines. However, right now it is a struggle.

Q: How did you train your physicians as you rolled out the telehealth solution?
Dr. Sternberg: Obviously, I didn’t have to train the physicians on how to listen to the heart, lungs, etc. I had to train them to use the medical record and the e-prescribing, how to initiate the visit, how to terminate the visit, etc. We used simulation patients and walked the doctors through a visit from beginning to end. Especially for younger physicians, it has proven to be very intuitive technology. Many professionals were trained on the telehealth solution, including independent physicians and practitioners affiliated with St. Joseph Health, such as specialists, primary care physicians, psychiatrists, diabetes educators, etc.

Q: What benefits have you seen as a result of the telehealth implementation?
Dr. Sternberg: First, our telehealth patients are averaging less than a 15-minute wait.

Second, telehealth will enable the patient to ultimately, I believe, see an academic specialist anywhere in the county or, for that matter, the world, who can review the case, talk to the patient, examine them, talk to the local specialist, go over with the patient what that local specialist is recommending, and so on. For example, if my office is equipped with a telehealth solution, a diabetes educator can virtually see my patient in my office, and provide diabetes education, and my patient doesn’t have to travel all over the place or wait weeks for an appointment. And it saves my practice the cost associated with staffing a diabetes educator, since I never know when or how often these appointments will be needed.

Third, enabling quicker access to specialist care is not only a boon to the patient and their convenience, but also provides an ongoing education and mentoring relationship between primary care physicians and specialists.

Patient education is another benefit, and I have experienced the following example myself. As the medical assistant shone the camera on the back of the patient’s throat, not only was I seeing it 30 to 40 miles away, but the patient also saw his throat in high definition on a 37” monitor. Now I can begin to educate him on why I think he has strep throat or not because he sees it firsthand.

Our patients survey and score our telehealth services, and we consistently score over 95%. Specifically, patients stated that they’ve established better eye contact with the practitioner. They’ve noted that the doctor has listened more intently via telehealth than when they are in the office, because during in-person visits, doctors are often fumbling through the medical records and looking over their shoulder at them. If you think about that, it’s not intuitive but it makes sense.

Finally, I view telehealth as a tremendous way for women in their reproductive years to be able to maintain their practice, as more than 50% of people in medical school now are female. For example, if female physicians have children, and they don’t want to run a full-time practice, telehealth consultation allows them to see patients from the comfort of their home.

When someone is critically ill, we don’t want to get them involved with telehealth. But if patients are selected carefully, I believe it’s certainly very effective in promoting access to specialty care.