As the COVID-19 infections began to spread in the early months of 2020, New York’s Niagara Falls Memorial Medical Center started to notice a sizable increase in the number of no-shows and cancellations of office appointments.
Once the pandemic was declared, it was clear that patients no longer felt safe coming to their appointments. Disease does not go on furlough for a global pandemic, so staff knew they had to find an alternative way to continue seeing patients in the safest possible manner for both patients and staff.
Niagara Falls Memorial chose the eClinicalWorks telemedicine system to solve the problem. The provider organization uses the outpatient electronic health records system from eClinicalWorks.
“With the telemedicine solution, we could potentially serve our patients in all of our primary care centers from the comfort and safety of their homes,” said Jeffrey M. Perry, electronic health record administrator at Niagara Falls Memorial Medical Center. “This would also minimize risk exposure to our clinic staff and reduce the frequency of cleanings and overall consumption of sanitation and personal protection equipment supplies.”
“It also was easy for our patients, as the telemedicine solution was integrated with their patient portal and electronic messaging systems that our patients already were used to.”
Jeffrey M. Perry, Niagara Falls Memorial Medical Center
Because the EHR and telehealth systems come from the same vendor, there was a clear and defined pathway for office workflows and patient access already well established, Perry said. This would make staff training very short and easy, because the organization was merely expanding the current capability rather than creating a new process entirely.
“It also was easy for our patients, as the telemedicine solution was integrated with their patient portal and electronic messaging systems that our patients already were used to, minimizing the amount of educational promotional material we would need to generate, and they would need to read, during such stressful times,” he added.
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MEETING THE CHALLENGE
The eClinicalWorks telemedicine system was integrated directly into the EHR the primary care centers already were using. This allowed staff to seamlessly schedule patients for remote visits easily. With the emergency changes by CMS in response to the pandemic, the variety of appointment types that could be served through telemedicine grew to encompass nearly every patient need, said Christopher Herndon, clinical informatics specialist at Niagara Falls Memorial Medical Center.
“Our primary rollout was to a single primary care practice to see if this technology could be embraced by both our patients and our staff,” Herndon said. “We saw an immediate success with a good experience at both ends of the call, so we expanded it to the remaining six primary care sites we operate in our surrounding community. Within a month of going live, we were operating fully with in-person and telemedicine visits, with about half the volume being remote.”
After seeing the positive community response to telemedicine in primary care, telehealth was then rolled out as the need surfaced with other services as well. The outpatient general surgery center and gastroenterology clinic quickly adopted the technology prior to the surgical freeze in a manner similar to that of the primary care center. The center and clinic also were already using the eClinicalWorks EHR. Staff got them up to speed very quickly using lessons learned during the primary care rollout.
“Watching the success the outpatient service lines were having, our emergency department was the next for telehealth expansion,” Herndon said. “The emergency room was experiencing the smallest volume it had ever seen, and there already was mounting evidence that patients were suffering in the community of current health concerns that they were too afraid to come in to have evaluated.”
Niagara Falls Memorial created a new program with the emergency room physicians where it devoted a phone number for patients to call where they would be triaged by a medical provider. Through the interview, the doctor could make a decision about the need for emergency treatment on location.
“If the patient was not in a medical emergency, they could instead have an immediate telemedicine appointment,” Perry explained. “This new phone triage algorithm gives patients a safe way to speak to a medical doctor and gave the doctors the opportunity to direct patients into the emergency room who might otherwise have stayed at home in medical danger.”
The newest telehealth rollout has been to the physical and occupational health clinic and the nutrition clinic.
“They were quite pleased to get the technology, and their patients were happy to safely continue their treatments via video,” Perry noted. “This was also in anticipation of all of our community schoolchildren who were enrolled with the occupational therapists needing to have appointments prior to school starting and the new need of services once schools reopened.”
For each office and specialty the provider organization expanded into, the results were the same. Patients were interacting with clinicians again and were reinvesting in their healthcare and wellbeing with the newfound safety of interactive, real-time audio/visual appointments from the comfort of their own homes, he added.
The goal was to improve the accessibility of services to the organization’s vulnerable population. The hospital already is in an area considered a “provider desert.” Besides having limited resources at the facility, many patients cannot afford transportation or had to confront other social determinants of health that prevented them from coming to their appointments – on top of the pandemic.
With these hurdles in mind, Niagara wanted to meet at least the same visit-attendance rate as last year.
“Knowing that we were already at a 50% visit adherence, we had a large goal ahead of us,” Herndon said. “Because of telehealth, we were able to achieve last year’s attendance rate. In fact, some clinics have actually surpassed their visit rate from last year. Patients now can attend their appointments using telehealth from their cell phones.”
Not only has overall attendance improved, but show rates have, as well, he added.
“We have been able to increase show rates by about 11% compared to last year,” he reported. “This pandemic, while tragic, has opened the door for telehealth to not only be introduced, but to have an everlasting home in outpatient care.”
USING FCC AWARD FUNDS
Earlier this year, Niagara Falls Memorial Medical Center was awarded $35,640 for laptop computers to use telehealth systems in order to provide a wide range of services in the areas of primary care, obstetrics and gynecology, and mental health. This use would allow providers to communicate with patients in real time on symptoms, mental health issues and other medical conditions while they practiced social distancing, thus slowing the spread of COVID-19.
“As the implementation and use of the telemedicine technology grew across our practices, there was an equal problem growing from a lack of good equipment capable of supporting the heavy technology burden,” Perry explained. “As the world turned to remote working and schooling, the necessary web cameras to update existing computers to be capable of servicing telemedicine appointments were unavailable.”
The FCC award funds went directly to ordering all the providers new laptops with built-in high-definition webcams and the processing power required to create a seamless telemedicine visit.
“Previously, there was a chance that the number of visits possible in a day would get limited, as the only computer capable of supporting the live video and audio already was being used,” Perry concluded. “Now, any provider can have telemedicine appointments in their daily schedule, as they all have equipment capable of performing the visit readily available.”