Timely access to mental healthcare, especially in rural areas, has long been a concern. There is not only a scarcity of providers as fewer people are going into the profession, but emergency departments in rural areas have limited expertise and experience in treating mental illness.

THE PROBLEM

With the Joint Commission's recommendation that patient boarding times not exceed four hours in the interest of patient safety and quality of care, CommonSpirit Health, the nation's second largest nonprofit health system, knew it needed a program that could enable patients in crisis to receive the assessment and care they need within the comfort and convenience of their own communities whenever possible.

This led the health system to add telebehavioral health services in its hospitals to both increase access to behavioral health professionals and meet standards of care recommended by the Joint Commission.

PROPOSAL

Teladoc Health, a telemedicine technology and services vendor, has been the health system's telemedicine technology of choice since the inception of the CommonSpirit Telehealth Network.

"A lot of investigation and work was put into choosing a platform that is reliable, invisible to the patient and easy to use for the provider," said John Mackenzie, telemedicine network clinical program manager and telebehavioral health specialist at CommonSpirit Health. "The technology had to help us meet our goals of the Quadruple Aim of care, that is cost-effective, high-quality care that meets both patient and provider satisfaction.

"Teladoc Health provided us with the software and devices enabling us to extend behavioral health services to those areas of need," he added. "The technology not only helped connect patients with providers, but was able to do so in the most effective and seamless way, without any disruption."

Ultimately, the technology eliminates the challenges of space and time when the health system has reduced access to specialty providers. It enables the health system to leverage a single provider across multiple locations to reduce wait times for patients needing to be seen.

"We can provide specialty services as fast as possible, render the appropriate clinical opinion and enable physicians at the bedside to make high quality decisions on behalf of the patient," Mackenzie said.

MARKETPLACE

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MEETING THE CHALLENGE

The Common Spirit Telehealth Network implemented a "round and respond" model to improve access to behavioral health specialists in several hospital emergency departments.

"We scheduled telebehavioral health rounds and rapid response to provide a disposition recommendation, usually to discharge or transfer the patient," Mackenzie explained. "The emergency department physician is able to complete a rapid medical assessment and triage the patients as mild, moderate or severe based on patient risk.

"This allows the telehealth network to provide 24/7 consultative support services to meet all behavioral health needs," he added.

Additional telebehavioral health services were added as a consultation-liaison service. The health system also provides psychiatric services including geropsychiatric, child and adolescent treatment, opioid crisis management, chronic comorbid conditions, and crisis intervention with medication-assisted treatment.

"Currently, the solution integrates with our native EHR," Mackenzie noted. "Integrating data and utilization with our native EHR enables a seamless process, both on the patient side and on the local provider side. The more we are able to integrate, the more seamless it is for the remote provider's experience."

RESULTS

Based on previous models, CommonSpirit Health created a mental health evaluation timeline that mirrors a stroke response timeline, which tracks time from request to consult.

"Analyzing these metrics, we found the benefits of telebehavioral health satisfied our main objectives: a decrease in length of stay, a decrease in cost, an increase in satisfaction and expectations of care met," Mackenzie reported. "Additionally, high adoption and utilization rates were achieved resulting in 1,200 telebehavioral health consultations per month, through three states and across 25 hospitals.

"The telehealth network standard of care is to respond to all emergency department behavioral health consult requests within 60 minutes, have actionable recommendations within 90 minutes and empower local providers to create an ED disposition plan within the first four hours," he continued. "We hold ourselves to very high standards."

These services allowed for 61% of cases to be seen within 30 minutes and 79% of patients to be seen within 60 minutes. The average response time is 42 minutes. The health system also reported a 65% rate for discharge recommendations and a 35% rate for transfer at specific locations.

"The front-end integration of the Teladoc Health software and hardware has been key in achieving some of these metrics," Mackenzie noted. "It is very simple for the providers to use; they have a single log-in they use for both documentation and to visualize the patient, and this allows us to speed up the response and documentation time.

"We are reducing the total amount of clicks and different systems the provider has to log in to," he continued. "This has contributed greatly to provider satisfaction, as well."

ADVICE FOR OTHERS

"Patients will always be at the center of what we do," Mackenzie said. "When using telebehavioral health, it is vital to find a method that can quickly and seamlessly connect providers with patients. The technology should be, for a lack of a better word, invisible from the patient's perspective and as user-friendly as possible for both patients and providers.

"In the end, telehealth should be indistinguishable from bedside care," he added. "And it should be reliable, with no question that it will work every time."

Mackenzie said he can't emphasize enough the need and importance for local staff to be involved.

"Because of the dynamics with behavioral health, people tend to shy away and expect technology itself to be the silver bullet," he said. "The reality is, they need to really fine-tune their program on the ground first, and then add technology and telemedicine as a method to increase and improve access to care.

"Telebehavioral health is not less work, but better work," he said.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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