Like many health systems, the Allentown, Pennsylvania-based Lehigh Valley Health Network has faced the problem of long wait times in emergency departments.
To address this, Lehigh Valley has begun using telehealth and telecommunications technologies to mobilize resources to optimize patient wait times – while reducing patient numbers. The individual leaves the ED without being seen.
Virtual nurses and virtual document classification
To accomplish this, the health system has implemented a virtual nurse and virtual doctor triage program designed to help patients transition through the ED process early. During this process, the patient is virtually triage with appropriate tests ordered and usually completed before the patient is admitted to the emergency room.
Joe Tracy, vice president, Connected Care and Innovation, Aeronautical Product Center for Connected Care and Innovation, at Lehigh Valley, notes: “Audio/video connections for service This was built in-house many years ago, with many technologies combined.
“The goal is to facilitate emergency patient care by speeding up time from door to triage, reducing ED hospital stays where appropriate, and improving patient experience and satisfaction.” patient, while also making sure all patient data is included in the patient’s EHR,” he continued. “We may also add other people to the virtual triage meeting as appropriate – for example, spoken and sign language interpreters.”
“This helps needed services start earlier and are often completed before the patient is admitted to the emergency room.”
Joe Tracy, Lehigh Valley Health Network
Having done this for nearly 30 years, Tracy doesn’t think of the technology as “telemedicine technology.” Instead, he said, it includes telecommunications technologies, which in some cases are combined with FDA-approved medical devices.
Much improved technology
“This combination of technology allows providers to better assess patients than before over a blind phone call,” he explains. “These technologies also eliminate geographic distance, reduce disparities in service access, and deliver valuable services to patients, especially in underserved urban and rural areas.” served.
He continued: “In the case of the patient triage programs at Lehigh Valley ED, a nurse, nursing practitioner, or physician in one central location can triage virtual patients, whether those are patient in our urban or rural emergency department.” “This helps needed services start earlier and are often completed before the patient is admitted to the emergency room.”
Workflows were developed to reflect as closely as possible the classification process that was performed prior to deployment. From a central location, nurses and doctors use a telecommunications system (interactive audio and video) that was developed in-house many years ago, using commercially available products.
Sorted patients are typically sent for testing (eg, labs, imaging, etc.) before being seen and booked by an on-site ED doctor. The telecommunications technologies are separate from the EHR in this case, but the documentation still takes place in the EHR, as if the patient was being directly triaged.
“In short, telehealth-enabled telecommunications technologies are used in tandem with our EHR,” says Tracy.
Bring together key stakeholders
To start, Tracy and others engaged a group of key stakeholders, then conducted small-scale experiments to quickly determine the best workflow model for the environment. Tests include doctors, nurses, technicians, scribes, EKG technicians, etc., to help arrive at the final model.
Lehigh Valley has seen a decrease in the rate of patients walking away without being seen.
For others transitioning to telemedicine or looking to improve existing programs, Tracy offers a variety of tips:
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Working on the notion that telehealth is a clinical program powered by technology. There’s probably nothing the tech team can’t build these days, but if it wasn’t supported by medical staff, the program wouldn’t be successful.
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Do your homework and learn from the lessons of others. Most programs today simply build on programs and technology that have been around for years. For example, Hospital @ Home programs today are building on structures that were developed for home care and remote patient monitoring years ago. Therefore, learning from those who have gone before you is very important.
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Access to federally funded regional leadership Telehealth Resource Center. They are very informative and can help you connect with people who may already be running a program you are looking to develop and implement.
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Consider your options around building a service versus buying it. In today’s financial environment, the chief financial officer and other executives in your organization will most likely want to see the comparison.
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It also needs a village to create these programs. So make sure you involve key stakeholders as you move forward. This includes doctors, nurses, other providers, IT staff, billing staff, legal staff/managers, your medical staff’s office, nursing managers, finance , etc
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Develop the metrics you want to capture first (e.g. quality, satisfaction, P&L, uptime, productivity, efficiency, etc.).
Finally, Tracy advises not to let perfection be the enemy of good as you develop your program. At some point, you have to hit the start button – and then make adjustments along the way. This allows you to crawl, walk, run and move a program from good to great.
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Healthcare IT News is a publication of HIMSS Media.
