Telehealth has enormous potential for improving health care in rural communities. With telehealth — telecommunications technology that delivers health-related services and information — patients benefit from greater access to specialists, avoid travel to a larger facility and can remain in their communities near family and friends.
At Intermountain Healthcare, a nonprofit system based in Salt Lake City, this technology includes a secure interactive audio and video system that connects patients to providers and specialists to whom they may not otherwise have access.
Intermountain, like other health care systems and hospitals across the country, implemented this innovative technology to address some formidable challenges: an aging population and an increasing number of high-need patients, a projected shortage of caregivers, reforms to the payment system and requests from rural hospitals for clinical expertise and support that allow patients to remain in their communities when appropriate.
Many health care systems have used telehealth for years, but Intermountain’s integrated approach has enabled us to implement services quickly and broadly. We have built and installed a common technology platform in more than 600 patient rooms — a number that continues to grow and includes all intensive care units, emergency departments and neonatal intensive care units. The platform connects caregivers throughout the system and enables specialists to be available on a timely basis, no matter where the patient is. More importantly, this approach aligns with the needs of our clinical programs, allowing us to bring new programs and caregivers online quickly and seamlessly.
Critical Care Services
Intermountain’s first telehealth initiative began two years ago in 12 of Intermountain’s hospitals in Utah and southern Idaho, where we installed telehealth technology in 260 beds in 19 ICUs.
Patients in hospitals that range from large urban facilities to smaller rural ones are connected to a team of 22 intensivists and 20 critical care nurses at Intermountain’s Critical Care Support Center in Midvale, Utah. These critical care specialists work directly with bedside medical teams to determine the appropriate course of action for each patient, offer real-time clinical decision support, ensure best practices and consistency of care, and provide a safety net for bedside staff and patients. The integrated telehealth platform also makes it possible for the patient to have a simultaneous consultation with an entire team of specialists from diverse locations.
Telehealth critical care services have benefited patients in all of the connected hospitals, but the smaller rural ones have seen remarkable benefits. In the first six months, the program resulted in a lower risk-of-mortality rate, a reduced length of stay for hospital patients, and higher retention of patients in their communities.
Intermountain has launched three other initiatives in a smaller number of hospitals and was on track to roll them out throughout the Intermountain system by the end of 2015. One of those initiatives focuses on newborn intensive care: Eleven rural hospitals now have access to neonatologists through telehealth. About 60 consultations have taken place so far, and at least 18 babies who would have been transferred to a larger facility have been able to remain in their communities.
Another initiative focuses on stroke diagnosis in emergency departments and underscores the importance of speedy access to specialists. Telehealth makes a neurologist rapidly available to assess the situation, respond and deliver the required care.
The fourth initiative addresses behavioral health, specifically crisis care support, in EDs. This program makes a social worker available hours faster than would normally be the case for patients in rural facilities.
These first four initiatives, and the technology we have rolled out throughout the Intermountain system, will enable us to quickly bring other programs online, including a pediatric trauma service that will use the existing platform to connect with all the EDs. Eighteen additional pediatric specialty programs are being planned, and our telehealth initiatives have been so well-received by hospital staff that clinical leaders and front-line staff members have made more than 100 additional requests for telehealth services.
As a result of these first four initiatives, we have the benefit of having key institutional assets in place:
· a substantive strategy driven by our clinical program goals that focus on improving quality of care and reducing costs;
· support at all levels of the organization;
· a willingness to make financial investments; and, of course,
· the technology that we have had installed.
Vital to putting those assets in place were support from executive leaders as well as respected clinicians who drove the change in care processes.
We also rely on a strong governance model to prioritize and operationalize initiatives. For every high-priority telehealth opportunity, Intermountain develops a business case that helps leaders to understand the costs, benefits and operational requirements. If the business case is strong and aligns with Intermountain’s population health and patient engagement strategy, it is recommended for approval. Pilots work well to prove concepts.
As population health becomes a priority at more and more hospitals across the country, telehealth will become increasingly crucial. It enhances care, avoids unnecessary costs and improves the patient experience.
Tara Larkin is the operations director of telehealth services at Intermountain Healthcare, Midvale, Utah.