Providence St. Joseph Health Consortium, based in Renton, Washington, had a problem: maintaining access for its patients and needing to find creative ways to expand hospital and clinician capacity through virtual means versus traditional brick-and-mortar solutions.

THE PROBLEM

Capacity is a long-standing problem for healthcare leaders as demands for services are much more dynamic than the static nature of physical infrastructure. The pandemic exacerbated this longtime issue.

"In some care settings we experienced a surge in patient demand for care, while in others we experienced drops in service demand as people avoided healthcare altogether due to isolation and fear of exposure, even though emergency departments were safe," said Andrea Fleming, executive director of telehealth enterprise services at Providence St. Joseph Health Consortium.

"Capacity challenges were experienced across the Providence footprint in our EDs, urgent cares, acute facilities and in our ICUs in particular, whereas elective surgeries and preventative care visits were often halted."

The ability to have a flexible infrastructure that responds to varying levels of demand is key to responding to the needs of those served, and is one of the reasons Providence also is innovating by expanding acute care to the home environment, she added.

"Leveraging technology to care for our patients using sophisticated monitoring platforms, video conferencing technology and seamless communication enables us to be the best healthcare partner we can be, not only when people need our services, but also predicting and preventing healthcare emergencies before they even occur," she said.

"Providence strives to deliver the same standard of excellent, coordinated care to the communities we serve that we would want for ourselves and our loved ones," she added. "We have several technology vendors we partner with to deliver virtual care. For our highest acuity applications we leverage Teladoc/InTouchHealth technologies, and to support seamless communications and monitoring efforts we leveraged Twistle, Health Recovery Solutions, EkoHealth and Xealth."

PROPOSAL

Providence St. Joseph Health Consortium proposed a multifaceted strategy to support each of its facilities experiencing the aforementioned pain points.

"In our main entry points for those seeking care – emergency departments, urgent cares and physician practices – we stood up a home monitoring program for those patients who were well enough to be treated at home but we wanted to keep a closer watch on," Fleming explained. "Our goal was to decompress our higher-acuity facilities, leaving space for the higher acuity patient surges in need.

"The home monitoring program has not only been a comfort to our patients and families, but has also been a godsend for local hospitals in its ability to free up capacity."

Andrea Fleming, Providence St. Joseph Health Consortium

"In our acute facilities and EDs, we also partnered with our technology provider Teladoc to provide telemedicine carts that could support EDs with virtual triage, minimizing the strain on our PPE supplies as well as unnecessary exposure," she continued. "Those carts were also designed to be leveraged for admitted patients in the med/surg floors as well as for our sickest patients in our ICUs."

Leveraging these carts coupled with peripheral devices like Bluetooth-enabled e-stethoscopes acquired through Eko Health enabled staff to expand clinician capacity when needed and provide valuable access to hospitalists and intensivists across the ecosystem, she added. In addition to enabling increased physician capacity, new technology was envisioned to provide benefits through decreased PPE utilization, and to limit unnecessary exposure.

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MEETING THE CHALLENGE

The initial iteration of Providence St. Joseph Health Consortium's home monitoring program went from concept to execution in less than a week at the pilot unit – Providence Regional Medical Center in Everett, Washington, which also treated the first COVID-19 patient in the United States.

"With proof of concept two weeks after the initial implementation, the telehealth team quickly expanded the home monitoring program," Fleming said. "With lessons learned from the minimally viable product, telehealth partnered with Twistle, a program known for high patient engagement and a user interface that was simple to use for both patients and providers.

"Twistle leveraged text messages to engage patients by reminding them to report vital signs three times a day, with additional check-ins for concerning parameters," she continued. "Patients reported vital signs and subjective data by entering their data in a check-in form embedded in the text message. There was no need to login or install an application creating friction between clinician and patient, and if patients missed a check-in or didn't have access to a smartphone, the nurse was prompted to call the patient."

With the enhanced second iteration of the home monitoring program, patient compliance and adoption rose dramatically from 5% to 90% within the first week of Twistle implementation. With the workflow efficiencies gained, staff also noted nurses were able to more than triple their monitoring capacity.

By the third week, the program evolved again by partnering with Xealth to build a digital care-activity interface connecting Epic and Twistle. This interface removed manual registration steps for the nursing team and streamlined ordering and enrollment.

"The home monitoring program has not only been a comfort to our patients and families, but has also been a godsend for local hospitals in its ability to free up capacity," Fleming said. "Today, the home monitoring program successfully expanded to the six states in our footprint and has since cared for more than 18,000 patients.

"The acute telehealth carts secured from TelaDoc and peripherals from Eko Health were leveraged in EDs for triage, in acute hospital floors for tele-hospitalist applications, as well as our ICUs to provide care continuity during physician shortages and to support newly converted temporary ICUs."

Further, the staff put together program design playbooks for tele-triage programs in a "train the trainer" fashion. They were able to expand access to the TelaDoc carts to various specialties across facilities, both reducing exposure and the amount of PPE required to go in and out of patient rooms during times of severe shortages.

RESULTS

"In all of our programs, we are proud of the number of patients that have benefitted from continued access through technology, as well as the positive experience they report in their virtual interactions with our clinical team," Fleming said. "If we had to choose one program to highlight both of those metrics, it would be our home monitoring program.

"We were able to successfully monitor more than 18,000 patients since March of 2020 while driving a Net Promoter Score greater than 70," she added. "Of the responses received, 95% highly recommended the program to others, 98% rated the devices as easy to use, and 96% of the patients felt safe recovering at home. This is something we are incredibly proud of, and feel the technology significantly improved our patient's experience."

In addition to user experience, the technology also enabled Providence St. Joseph Health Consortium to improve nursing efficiency with each patient, which was the reason staff were able to care for so many patients with this setup and achieve such high nurse-to-patient ratios, she said.

USING FCC AWARD FUNDS

Providence St. Joseph Health Consortium was awarded $1,971,750 in 2020 from the FCC's telehealth funding program. Its goals for the FCC funding were to ensure continued patient access at its facilities, to continue clinician capacity by enabling providers to access various endpoints, to limit unnecessary exposure, and to conserve personal protective equipment (PPE) during the COVID-19 pandemic.

"The funds were used to purchase telemedicine carts in emergency rooms, hospital floors, as well as ICUs at 45 different Providence facilities," Fleming explained. "Additionally, the funds enabled us to equip those carts with peripheral devices – Bluetooth-enabled stethoscopes – that allowed us to leverage the technology for a wide variety of specialists.

"Lastly, the funding enabled us to stand up a home monitoring program, funding the technology that enabled us to successfully monitor more than 18,000 patients across seven states," she added.

The telemedicine program has expanded significantly. It completed 67,000 face-to-face virtual encounters across Providence in 2019, whereas in 2020 that number rose to 1.7 million. Now extending into 2021, it is seeing 200,000 per month, spanning from the home to clinics, urgent cares and acute facilities.

More than 20% of clinic visits are still being completed virtually. It's a trend the organization hopes will continue into the future as patients get accustomed to virtual care.

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