Leveraging Virtual Care through COVID-19 and Beyond

Episode Summary

Learn how Citizens Memorial Hospital’s early deployment of Virtual Visits helped them to stay connected with patients throughout the pandemic. You'll hear about their creative use of this technology in their mental health, maternity, and long term care settings, as well as the expanded role virtual care and patient engagement solutions will have in their IT strategy moving forward.

Episode Transcription

Title: Leveraging Virtual Care through COVID-19 and Beyond 

Guests: Sherry Montileone, Chief Information Officer, Citizens Memorial Hospital

 Dr. Lou Harris, Chief Medical Information Officer, Citizens Memorial Hospital

Host: Christine Parent, Associate Vice President, MEDITECH


Sherry: The utilization has gone up almost 40 percent. Everybody's using the portal, we have more portal users. Users that we had use it more, and we keep adding functionality.

Christine: Welcome to another episode of MEDITECH Podcast, the leader in healthcare technology empowering you to be a more informed healthcare consumer and provider. Hear the latest from our friends and colleagues in the US, Canada, and abroad on topics we think you should know about. I'm happy to welcome two leaders from Citizens Memorial Healthcare in Bolivar, Missouri, Sherry Montileone, Chief Information Officer, and Dr. Lou Harris, Chief Medical Information Officer.

Citizens Memorial has long been an advocate for patient engagement and was already in the process of implementing virtual visits when the pandemic began. It was these digital advancements that helped them stay connected with their patients throughout the pandemic and in doing so increase their portal enrollment. Today we will hear more about their strategy.

I know a lot of organizations began looking at implementing virtual visits when the pandemic hit, but you were fortunate to have already started implementing before that. How quickly were you able to onboard virtual visits?

Dr. Harris: We really were ahead of the game and then we'd been doing this and started some virtual visits with our Acute Care, but we were able to transfer that really quickly within about three days honestly. We were able to start some new documents to allow providers to do routine care from their clinics. Patients began to cancel, obviously, when that March 13th date hit. They didn't want to leave their homes, they were told to lock down, so this allowed us to continue some of that chronic ongoing care that we needed to provide to them and allowed it to be really really easy. We were able to maintain their appointments, in fact we would just switch them from in-person visit to a tele-visit. To get our providers up to speed, because we hadn't really trained that many providers to do this, I did several webinars with them to allow them to log in and we would go through the visit for them specifically. To see the difference in how you were able to document, how you're able to connect with the patients and not just our clinic could do it, but all the clinics across our system can maintain that continuity.

Sherry: Dr. Harris did a fabulous job of removing any barriers to the providers. The other thing we did was we stood up a Portal Help Desk, because we knew that even though we had a strong portal utilization that virtual visits were different, it's Android, it's Apple. Is my camera on? Is the audio working? So we grabbed a couple of people that had been furloughed and they manned a Portal Help Desk and they fielded all the questions from the patients. Pretty soon after that we were able to do some pre-test calls. Testing that helped, but I think Dr. Harris is a very available education to the providers and the patients being able to call and walk through; how do I get a portal account? I can't see the provider. What's going on? And I think that group helped a lot. 

Dr. Harris: Really our providers did a really good job of making that switch as well. You give them the tools and then really teach them those tools and then they just ran with it. 

Sherry: And quite honestly in MEDITECH they make it easy.The portal visits show up whenever the provider sees their schedule, the patients are all listed some of them are virtual visits some of them are in-person visits, but the provider stays in his same home screen and same documentation, so that made it easy as well. 

Christine:  Just as a follow-up to that, do you still have that help desk in practice? 

Sherry: We were able to disband the temporary help desk for the flood of calls, and now our Health Information Management department fields those calls. The portal is pretty self-sufficient, you can easily change your own password, and change your credentials, and security questions. We don't get a lot of calls, but those that do have questions called the Health Information Department and we just make sure we keep them trained on all the new features and functionality. 

Christine: Yeah, I think also many of our consumers have gotten digital savvy over the past 12 plus months. Obviously COVID-19 pushed you really to implement virtual visits in more places and also in more specialties than you probably imagined at first. So what areas have been the biggest surprises to you related to success? 

Sherry: In the beginning of the pandemic every day was a surprise, a lot of us never worked from home and we stayed here because it allowed us to collaborate. We now have a clinic where their providers are in quarantine, and they need to be able to still see their patients who are also at home so we have virtual providers, virtual patients. Every one of those situations we had to think about. How are we going to schedule this, how is it going to work? How do they document, follow it all the way through and make sure that it bills properly? And so we would run every one of those scenarios through. We thought virtual visits would be the big win these ad hoc almost a CVS Pharmacy type, or teladoc virtual visit. In reality, it was what we call telemedicine, and it was us switching our clinic appointments to virtual to maintain the care for the patients and the volume for the clinics. 

Then we had all of the providers at home, we had a provider in a clinic who was willing to come into the clinic but wasn't in a position to do face-to-face with the patients, so the patients could actually come in. We had a telehealth room they could sit in. Our Long-Term Care facilities were a huge win with virtual visits. Obviously they were the most locked down location that we worked with and you really did not want to be the one that went into the long-term care facility to bring anything in, and if you went in you were fit tested, N95 mask it was a giant deal. So immediately all of the physicians rounds all of that also went to virtual visit.

Dr. Harris: We really did not want our providers even going into our long-term care facilities, so for the nurse to facilitate a visit with the patients was just genius and really helpful. I'll never forget doing rounds like that and the nurse have the patients there and they bring them in and I see them face-to-face and I talk with them and they respond back. It was so helpful to know that the patients felt like they was continuing to get cared for, even in these very strict lockdown they couldn't see their family anymore they couldn't do those kind of things, but they were able to see us and be able to continue to get care that way. 

Sherry: I thought, are the residents going to understand this? Is it going to feel cold and impersonal? And I mean they interacted with him like he was standing right there, and it was just so touching to see how he could still care for them virtually in that very scary time. One of the wins I don't want to forget to talk about is OB. Our OB population that was a very 'at risk' population, so we started doing virtual visits with them and purchased doppler monitors as well as blood pressure cuffs and said for these monthly well mom low-risk pregnancies you don't have to come in and be at any risk at all we'll just do a virtual visit and you'll get to monitor yourself and we'll make sure you stay healthy. To me, as a mom myself, I thought how awesome that is to not have to spend a half a day come into the clinic and being around other people. The stories we're hearing are that these moms love having the monitoring equipment that they use it all the time, they can listen to the baby's heartbeat, they can monitor their own blood pressure. I just think that's a big win for healthcare. 

One of the surprises that we had was the success of virtual visits with our mental health patients, and they actually continue to be about 22 percent of our total virtual visit numbers. It has just proved to be a very successful strategy for them and an effective way to see those patients. They often have transportation issues, and other things that make a traditional office visit a barrier even just sitting in the waiting room. We're delighted that mental health visits continue to be strong. 

Christine:  I'm very interested to see how many of these programs do last beyond pandemic, because I do think there have been advancements. What other strategies did you have for engaging your patients throughout the pandemic? 

Dr. Harris: One was allowing them to see their COVID results. How anxiety provoking is getting a COVID result. I think that is a huge thing for for both patients and employees. Employees would know clearly whether they're going to have to call into work that day, patients would know very quickly if they had been exposed, if they were able to get out of their quarantine. So it was really important to get those reports and get those results as soon as they were available, we wouldn't have to wait for the provider to call them, they can just see it immediately. 

Sherry: We have about 700 employees in the long-term care facilities; they were tested twice a week for months, almost a year. We've got 1,400 COVID test results coming back every week for weeks and weeks, and they can't show up for work if they're positive. So we very quickly realized that we could not call patients or employees back with their results. Our standard protocol was that they needed to get a portal account and they would just check themselves and check the portal. All kinds of stories of long-term care employees that would get up at six in the morning, look at their portal and be like great, I can go to work today, negative result. 

Dr. Harris: The other one was patients able to schedule on the waitlist for vaccines, and we can work on contacting them to arrange for vaccine clinics when we have them. Really helpful to be able to have those all available to see. The patients can know exactly when they're supposed to come in they can look on their portal, oh, I've got an appointment for my first Pfizer vaccine, or Moderna on such and such a day. Then we would schedule them for their second one after they received their first one, so they wouldn't have any question about when they were supposed to come back and wouldn't have to keep calling the clinic, or maybe they lost their card. So it really really is helpful to have those wait lists and then be able to schedule those patients for their vaccinations. 

Christine:  As we move to talk about the portal a little bit more. What effect did COVID-19 have on your portal utilization numbers? 

Sherry: The utilization has gone up almost 40 percent, everybody's using the portal, we have more portal users, the users that we had use it more, and we keep adding functionality.

We have the COVID vaccination certificate, we have more results than ever that are going to the portal and just keep building the functionality of the portal and making it valuable to people. 

Dr. Harris: I do a lot of dermatology, and so when I do a biopsy it's really nice for me to call the patient and tell them what's going on and then they can go in and see exactly what I've talked to them about. The other thing I think about with engagement is that it's a competitive world out there and these insurance companies, Amazon and those partners are out there trying to get care for these patients creating their own systems for that. So us to be able to provide that for the patient they don't have to look elsewhere, they can stay here with us and get better care longitudinally anyway. 

Christine:  So where do you see your patient engagement strategy progressing in a post-pandemic world? 

Sherry: We just want to continue to remove barriers for patients, we want to be competitive, we think that the expectation is that we have these features I think healthcare was late to the game. It is really exciting to think that now you can schedule your own well-person visit at your convenience, you can look at an estimate of what something will cost, you can pay a bill, remote patient monitoring, you can be engaged with your provider. We think it's all about just giving the data to the patient, and them being engaged with us and just some brand loyalty. We want that portal to make their experience with us the easiest and most valuable thing they can do. We're really lucky because we have Expanse implemented across all of our entire Continuum of Care so everything from Ambulatory, to Acute, to Home Care, to Long-Term Care, so that makes our portal in my mind just very valuable. 

My mom is a chronic patient and I can help manage her care through all of those different service lines on the portal. She's given me proxy access and I can keep track of that for her. One of the things we did to basically remove any barriers to patients for the portal is that we have enabled auto enrollment. Whenever you come into any of our service lines and check in, or register, if you've got an email address on file it'll automatically create a portal account for you and you'll get an email just saying you now have a portal account click here to set up your credentials and your password. It's up to us it's all about trying to remove the barriers. 

Dr. Harris: Promoting that in the room is huge for patients and I'll actually show the patients the app and say it's really easy. Look right here is how you add it here's how you have things on there, and it's just that in person promotion really goes a long way. I'll look and see they've got a portal account but they haven't accessed it for six months or a year and so able to re-engage them that way. 

Sherry:  The other thing that we have actually recently offered is that we've met with the orthopedic surgeons last week and every patient we all have the portal and we're all patients, but not all of us have a lot of data in our portal because we're healthy. We've offered to put test patients as proxy patients on everybody's portal, just so that they can go to test correct and navigate and see what it looks like for discharge instructions for a hip replacement or something like that.

Christine:  I will say that I do believe the pandemic has accelerated a lot of engagement and adoption with the patient engagement technologies. Many have suggested that remote monitoring combined with telehealth is the next evolution to virtual care you alluded to some of this with the OB patients. Can you take us through your remote monitoring strategy and where are you starting?

Dr. Harris: Well we just enabled our health tracker and right now we're just focused on hypertension, but people may be surprised how much people want to engage in being able to monitor say hypertension. I have one patient in particular that when I enabled this for her we were in the process of adjusting some of their anti-hypertensive medications and she sends me daily her blood pressure. When I go into the widget and look at her blood pressures it's just beautiful. I can see every day what she's running I can communicate back to her and say hey, we need to add this meds. We did that before she was scheduled to have her physical to see me about a month after we enabled this, and I was able to make changes in her blood pressure medicine before she even came in. So you didn't have to wait on me to make that decision when she was in person. It allows real-time adjustment of their treatment and really better care of them. The future is just huge and we're really looking forward to that. 

Sherry: So one of the things we're really excited about is self-check-in, we're starting a pilot on that. And if self-check-in will allow our patients to check in 15 minutes before their appointment time, whenever they get to the clinic they can finish any questionnaires that are pending that they haven't finished in pre-registration, which also can be done on the portal. They pay their co-pay and basically it is they're ready to go back to the doctor as soon as they're called. 

Christine:  So Sherry and Dr.Harris, I want to thank you for this informative discussion. So at the end of each podcast we always end on a personal question. So Sherry, I understand that your leadership role extends beyond Citizens Memorial, and that you're also President of your book club. What's catching your attention these days?  

Sherry: My book club, we've been together for 25 years, and every year we pick 11 books to read, one a month and then one big party. We read everything from classics, to fiction, to historical fiction you name it, but the last one I read that I really liked was the Thursday Murder Club by Richard Osmond. It is a group of older people in an assisted living facility that have a special set of skills and they've come together and every Thursday they open up some cold cases and solve murders. It's all about how an 80 year old nurse can get into a hospital and social engineer her way to the records and it's a clever book. 

Christine: Dr. Harris, what are your hobbies outside of work? 

Dr. Harris: Cycling is probably my biggest outdoor hobby and hiking things like that, my wife and I really like to do that together. I've really enjoyed getting out of the indoor cycling and back to outdoor cycling. This last weekend, in fact, it's our first really small group ride we had five guys that got together and rode about 20 miles this weekend, on a beautiful Saturday. That's where I really like to spend my time outside the office.

Christine:  Thanks for tuning in. In our next episode we'll talk to Jennifer Zelmer, PhD, President and CEO, of Healthcare Excellence Canada. I'm excited to talk about this brand new organization formed through the coalition of the Canadian Foundation for Healthcare Improvement (CHFI) and the Canadian Patient Safety Institute (CPSI), with the aim to achieve safer, higher quality, and more coordinated patient-partnered healthcare. Jennifer also recently spoke at our Nurse Forum, so it'll be a great chat with her in more detail. 

As always, be sure to subscribe to hear our latest episodes and we'll talk to you next time.