Cincinnati Children's puts focus on patient experience with its telehealth program

辛辛那提儿童医院通过远程保健项目关注患者体验

2021-02-12 05:02:15 Healthcare IT News

本文共3429个字,阅读需9分钟

In 2013, Cincinnati Children's Hospital wanted to establish a Center for Telehealth. At the time, the interest in video visits and other forms of telehealth was growing, and the provider organization had a few clinical programs already up and running. THE PROBLEM The organization decided it wanted to be able to approach the challenge of meeting patients and families where they are and improving access to care, and telehealth was a tool to do that. Additionally, it was important to the organization that it have a strategic approach to developing clinical programs, using consistent technology, rather than having telehealth done differently in each clinical area. "At that time, we were already engaged with Cisco as technology partners, and when we constructed the physical center, we were able to upgrade hardware and software solutions to allow our clinical experts to be available around the world," said Dr. Ken Tegtmeyer, professor of clinical pediatrics, division of critical care medicine, and medical director of the Center for Telehealth, at Cincinnati Children's Hospital. "However, as with most large academic centers, each specialty area has different needs and different strengths," he continued. "Over time, we added additional technology vendors, including Microsoft Teams, Vivify and Teladoc, along with several others. While we would all prefer one platform solution for all of our telehealth needs, each of these platforms has some benefits in specific specialty areas." Having a variety of tools available also allows staff to be flexible in the care they can provide, he added. PROPOSAL Each solution offered different benefits, said Jennifer Ruschman, senior director of the Center for Telehealth at Cincinnati Children's Hospital. "For example, Cisco products are strong hardware solutions and worked incredibly well in our inpatient facility to allow remote consultations from a specialist to a satellite suburban hospital location and far-end camera control," she explained. "We primarily used Cisco products, including Jabber Guest, for video visits and to address access initially, as we were doing few visits in the home." When the pandemic began, Cincinnati Children's Hospital needed a scalable solution that could be integrated quickly. "Microsoft Teams was already a collaboration partner that was new internally, and has been a wonderful tool to utilize for video visits with patients," Ruschman said. "It allows for multiple party calls and especially made it easy for us to address multidisciplinary visits, as well as adding an interpreter to a visit. The ease of use is critical for addressing access to services." As the staff began to look beyond traditional video visits to remote patient monitoring as a tool to connect with patients between visits, it identified Vivify as a vendor of choice. "At that time, they had the most flexibility for adding in additional peripheral devices on a custom basis, and that was important as pediatric devices are limited," Tegtmeyer related. "As companies grow, their ability to be flexible or change can be impacted, and that can make it hard to address some pediatric-specific challenges." Finally, staff had been evaluating Teladoc for direct-to-consumer telehealth services. The vendor approached the hospital with an opportunity to consult as it developed its platform to meet the needs of pediatrics. "This was key, as we know their platform is strong technically, but we know from over time that often pediatrics is going to have some unique needs," Tegtmeyer explained. "In this case, the vendor recognized that and said let's work together to figure out those challenges and address them." Through all of this, the hospital had developed a strong video visit platform as well as remote patient monitoring and direct-to-consumer capabilities. However, the ability to remotely examine complex patients was still a challenge. Additionally, scaling solutions in house, since so much of the care is multidisciplinary, staff often have hybrid visits that have in-person providers and remote providers. This hybrid workflow was also a remaining challenge. MARKETPLACE There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News recently compiled a comprehensive list of these vendors with detailed descriptions. To read this special report, click here. MEETING THE CHALLENGE The direct-to-consumer platform allowed Cincinnati Children's Hospital to address a problem it was seeing with access to telehealth – the ability for a patient to initiate a telehealth visit request for a minor illness or injury. "Implementing our Teladoc platform, CincyKids Health Connect allowed for our APRN in emergency medicine to offer a direct-to-consumer service," Ruschman said. "This is currently not integrated with our EHR or other platforms, and that works as the users are an isolated group." In contrast, as the organization rolled out its video visit platform for all specialists, it found that the number and variety of users pushed it to further integration. "The MS Teams video visit process has been integrated into our EHR experience for providers," Ruschman said. "They can launch into a video visit from a patient's chart, join rounds from the EHR home screen, or even conduct inpatient or ED consults remotely. Because the vast number of providers – more than 1,000 – and the variety of roles (MA, RN, MD, dietician, therapist, etc.), we knew we needed integration and to simplify how video visits were launched across the organization. This drove our decision for integration." Finally, when the hospital added remote-exam functionality, it integrated that into its direct-to-consumer platform. "The rationale was that these would more likely be visits driven by patients and families," Tegtmeyer explained. "Further, that platform is designed to support primary care workflow best, and this was the area in complex care where we were launching that remote-exam capability. Eventually we would hope to integrate into our EHR with remote-exam devices, as well." However, there can be conflicting resources to get integration into the EHR, and that would have necessitated two platforms in use – remote exam and the TytoCare video platform – and the hospital was trying to limit introduction of any new video platforms, he added. RESULTS One metric is overall volume of visits and the geography of patients participating. As has been the case with most telehealth providers during the pandemic, Cincinnati Children's Hospital has seen its video visits skyrocket – from about 200 per month to more than 20,000 per month – and even higher at times of lockdown. "We are maintaining approximately 20% of all outpatient visits and those are still being done as a video visit," Ruschman said. "Our patient and family experience shows 84.7% of families rank these services as nine or higher on a 10-point scale. Many have commented that telehealth has been the bright spot for them during this pandemic." These numbers alone are reassuring as the hospital looks at access to services. It also is able to drill down into this data and identify populations that it may not be serving as well. "An example includes patients who speak Spanish as their primary language," Ruschman said. "Although interpreter services are available, we still have some work to do in order to create the access this population needs from video visits. "Finally, we are seeing impact on utilization as we look at outcome measures. In our remote patient monitoring program, we have seen readmissions reduced by 50% in NICU patients who are sent home on remote patient monitoring." USING FCC AWARD FUNDS In mid-2020, the FCC telehealth funding program awarded Cincinnati Children's Hospital $719,098 to provide telehealth services to the highest-risk pediatric patients with complex healthcare needs, including tracheostomy and ventilator dependence, and gastrostomy and tube feeding dependence, in order to limit their potential exposure to COVID-19 by keeping them out of the hospital and safely at home. That improves their health prognosis and frees up resources to care for children with COVID-19. "The FCC funds are first being used to obtain remote examination devices through TytoCare," Ruschman said. "This can be integrated with the CincyKids platform, and we are looking to work with populations to provide care to patients in the home. "Our technology-dependent patients, with multiple chronic medical conditions, are seen by our complex care team. This team wanted to embrace video visits but, because of the fragile nature of their patient population, were reluctant to do so without the ability to provide some remote examination." It is also a patient population where the burden of coming in for a clinic visit is greatest, due to all the equipment involved, she added. "We had received a demo and discussed TytoCare devices prior to the pandemic," she recalled. "When the pandemic arrived, our ability to take the very best care of this population became a prominent need. TytoCare and the integration into one of our video platforms, CincyKids Health Connect, allows us to begin to do that." Finally, many of the organization's clinics include multiple disciplines in providers, and through the pandemic and into the future it sees the need to provide this kind of care while also adhering to social distancing. "We want to allow patients and providers the flexibility to adjust an appointment to telehealth based on illness or weather," she said. "Thanks to the FCC funds, Cincinnati Children's was also able to purchase a number of tablet stands that are now available in all outpatient clinics and inpatient units. "Because of the availability of these devices, our application development team was able to build some key workflows that now allow for easy connection to any outpatient visit, or inpatient, as long as one of the tablet carts is present." More than 100 times a day, remote Cincinnati Children's providers join in for inpatient rounds, she added. Hundreds of outpatient encounters each week include some combination of in-person and video-based care in these hybrid clinics. This has changed how the organization will deliver care to patients and families well into the future, she concluded. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication.
2013年,辛辛那提儿童医院想要建立一个远程健康中心。当时,对视频访问和其他形式的远程健康的兴趣正在增长,而且提供机构已经有几个临床项目在运行。 问题所在 本组织决定,它希望能够应对挑战,即在病人和家属所在的地方与他们见面,并改善获得护理的机会,而远程保健是实现这一目标的一个工具。此外,对本组织来说,重要的是,它有一个战略方法来开发临床项目,使用一致的技术,而不是在每个临床领域有不同的远程保健。 辛辛那提儿童医院重症医学科临床儿科教授、远程健康中心医学主任Ken Tegtmeyer博士说:“当时,我们已经与思科作为技术合作伙伴进行了合作,当我们建造物理中心时,我们能够升级硬件和软件解决方案,使我们的临床专家能够在世界各地提供服务。” “然而,与大多数大型学术中心一样,每个专业领域都有不同的需求和不同的优势,”他继续说。“随着时间的推移,我们增加了更多的技术供应商,包括微软团队、Vivify和Teladoc以及其他几家公司。虽然我们都倾向于一个平台解决方案来满足我们所有的远程健康需求,但每个平台在特定的专业领域都有一些好处。” 他补充说,拥有各种可用的工具也使工作人员能够灵活地提供他们所能提供的护理。 提案 辛辛那提儿童医院远程健康中心高级主任詹妮弗·拉什曼说,每种解决方案都提供了不同的好处。 她解释说:“例如,思科产品是强大的硬件解决方案,在我们的住院设施中运行得非常好,它允许从专家到卫星郊区医院的远程会诊和远端摄像头控制。”“我们最初主要使用思科产品,包括Jabber Guest进行视频访问和访问地址,因为我们很少在家里进行访问。” 当大流行开始时,辛辛那提儿童医院需要一个可快速整合的可扩展解决方案。 Ruschman说:“微软团队已经是一个新的内部合作伙伴,并且已经成为一个很好的工具,可以用来与病人进行视频访问。”“它允许多方通话,特别是让我们很容易处理多学科访问,以及在访问中增加一名翻译。易用性对于处理访问服务至关重要。” 当工作人员开始将目光从传统的视频访问转向远程患者监控,作为访问之间与患者联系的工具时,它确定Vivify为首选供应商。 Tegtmeyer说:“当时,他们有最大的灵活性,可以在定制的基础上添加额外的外围设备,这一点很重要,因为儿科设备是有限的。”“随着公司的发展,他们的灵活性和变革能力可能受到影响,这会使他们很难应对一些儿科特有的挑战。” 最后,工作人员一直在评估Teladoc直接面向消费者的远程保健服务。在医院开发平台以满足儿科需求的过程中,供应商找到了咨询的机会。 Tegtmeyer解释说:“这是关键,因为我们知道他们的平台在技术上很强大,但我们知道随着时间的推移,儿科通常会有一些独特的需求。”“在这种情况下,供应商认识到了这一点,并说让我们一起努力,找出这些挑战,并解决它们。” 通过所有这些,医院开发了一个强大的视频访问平台,以及远程病人监控和直接对消费者的能力。然而,远程检查复杂病人的能力仍然是一个挑战。 此外,在内部扩展解决方案,因为很多护理都是多学科的,所以工作人员经常进行混合访问,既有亲自访问的提供者,也有远程访问的提供者。这种混合工作流程也是一个仍然存在的挑战。 市场 当今健康IT市场上有许多远程医疗技术和服务的供应商。Healthcare IT News最近整理了一份这些供应商的综合列表,并对其进行了详细的描述。要阅读这篇特别报道,请点击这里。 迎接挑战 这个直接面向消费者的平台使辛辛那提儿童医院能够解决它在使用远程健康服务时遇到的问题--病人如果有小病或小伤就可以发起远程健康访问请求。 Ruschman说:“CincyKids Health Connect实现了我们的Teladoc平台,使我们的APRN在紧急医疗方面能够提供直接面向消费者的服务。”“这目前还没有与我们的EHR或其他平台整合,因为用户是一个孤立的群体。” 相比之下,当本组织推出面向所有专家的视频访问平台时,它发现用户的数量和种类推动了它的进一步整合。 Ruschman说:“MS Teams视频访问流程已经被整合到我们为供应商提供的EHR体验中。”“他们可以从病人的病历中启动视频访问,从EHR主屏幕中加入查房,甚至远程进行住院或ED咨询。由于提供商数量庞大--超过1,000个--以及各种角色(医学硕士、注册医生、医学博士、营养师、治疗师等),我们知道我们需要整合,并简化整个组织中视频访问的启动方式。这推动了我们做出整合的决定。” 最后,医院增加了远程检查功能,并将其整合到直接面向消费者的平台中。 Tegtmeyer解释说:“其基本原理是,这些更有可能是由患者和家属驱动的探视。”“此外,该平台设计是为了最好地支持初级保健工作流程,而这正是我们在复杂保健领域推出远程检查功能的地方。最终,我们希望也能将远程检查设备集成到我们的电子病历中。” 然而,整合到EHR可能会有资源冲突,这就需要使用两个平台--远程检查和TytoCare视频平台--医院正在努力限制任何新的视频平台的引入,他补充道。 结果 一个指标是总的就诊量和参与的患者的地理位置。与疫情期间大多数远程保健服务提供商的情况一样,辛辛那提儿童医院的视频就诊量猛增--从每月约200人次增加到每月2万多人次--在封锁期间甚至更高。 Ruschman说:“我们保持了大约20%的门诊量,这些仍然是以视频访问的方式进行的。”“我们的患者和家庭经验显示,84.7%的家庭在10分的评分中将这些服务评为9分或更高。许多人评论说,远程保健是他们在这次大流行期间的亮点。” 单是这些数字就足以让人放心,因为医院正在考虑如何获得服务。它还能够深入到这些数据中,并识别它可能没有服务的人群。 “一个例子包括以西班牙语为主要语言的患者,”Ruschman说。“虽然提供了口译服务,但我们仍有一些工作要做,以便为这些人提供视频访问所需要的访问。 “最后,在我们观察结果的同时,我们看到了对使用率的影响。在我们的远程病人监护项目中,我们看到通过远程病人监护送回家的NICU病人的再入院率减少了50%。” 使用FCC奖励资金 2020年年中,FCC远程健康资助计划向辛辛那提儿童医院授予719098美元,用于向具有复杂医疗保健需求(包括气管造口和呼吸机依赖、胃造口和管饲依赖)的最高风险儿科患者提供远程健康服务,以便通过将他们排除在医院之外并安全在家,限制他们对新冠病毒的潜在暴露。这改善了他们的健康预后,并腾出资源来照顾COVID-19患儿。 “FCC的资金首先用于通过TytoCare获得远程检查设备,”Ruschman说。“这可以与CincyKids平台集成,我们希望与民众合作,在家中为病人提供护理。 “我们的复杂护理团队为依赖技术的患者提供多种慢性疾病的治疗。该团队希望接受视频访问,但由于患者群体的脆弱性,在没有远程检查能力的情况下不愿这样做。” 这也是一个病人群体的负担最大的来诊所访问,因为所有的设备涉及,她补充说。 她回忆说:“在大流行之前,我们收到了一个演示,并讨论了TytoCare设备。”“当大流行到来时,我们为这一人群提供最佳护理的能力成为一个突出的需求。TytoCare和整合到我们的视频平台之一CincyKids Health Connect让我们开始这样做。” 最后,本组织的许多诊所包括多个学科的提供者,并且在大流行病期间和未来,本组织认为有必要提供这种护理,同时坚持保持社会距离。 她说:“我们希望允许病人和提供商根据病情或天气灵活地调整预约,使之适应远程健康。”“由于联邦通信委员会的资金,辛辛那提儿童医院还能够购买一些药片架,这些药片架现在在所有门诊和住院单位都可以买到。 “由于这些设备的可用性,我们的应用程序开发团队能够构建一些关键的工作流程,现在只要有一台平板电脑,就可以轻松连接到任何门诊或住院患者。” 她补充说,辛辛那提偏远地区的儿童护理人员每天都要参加100多次住院查房。在这些混合诊所中,每周有数以百计的门诊接诊包括一些面对面和视频护理的结合。她总结说,这改变了该组织在未来如何向病人和家庭提供护理。 推特:@siwickihealthit 电邮作者:bsiwicki@himss.org Healthcare IT News是HIMSS的媒体出版物。

以上中文文本为机器翻译,存在不同程度偏差和错误;偶尔因源网页结构局限,内容无法一次完整呈现。请理解并参考原站原文阅读。

阅读原文