If anything good comes from the COVID-19 pandemic, telehealth will fall into that category, Hudson Headwaters Health Network Chief Medical Informatics Officer Dr. Kevin Gallagher said.
“I think this is an exciting time in health care and a really great opportunity for us to redesign our care delivery,” he said in an interview about the organization’s telehealth program, which expanded rapidly to accommodate COVID-19 concerns and social distancing guidelines.
“I think we’re just at the tip of the iceberg with how we can get creative with this.”
Hudson Headwaters Community Relations Manager Jane Hooper said the network was planning to introduce telehealth this year over a number of months, but the pandemic dramatically upped that timeline.
Gallagher joined Hudson Headwaters March 2, and just days later telehealth became the main focus of his work as the organization had to start addressing how to minimize COVID-19 exposure for patients and providers.
He and other network leaders started meeting in the main conference room and mapping out how to deploy virtual visits. They discussed information as it came, including regulation changes that made different platforms more accessible and certain services billable.
Officials said the group created and tested out the virtual appointment process, and made sure they understood the documentation requirements and that staff knew how to support the program. For example, front office staff needed to learn how to talk patients through the process of downloading apps for the telehealth appointments in case they were not familiar with those programs, and nurses and providers had to know how to interact with patients via telehealth.
Within a matter of weeks, the program was up and running across all of the network’s 19 community health centers, with behavioral health providers, social workers, primary care doctors, pediatricians and obstetrician/gynecologists doing virtual visits, Gallagher said.
Hudson Headwaters providers currently conduct telehealth appointments to monitor patients with well-controlled high blood pressure, diabetes and asthma, and to do adult medication checks and follow-up visits.
“You really can do a lot of chronic disease management, medication adjustments and some acute issues can be handled as well,” Gallagher said.
Hooper said patients who have video appointments are sent emails with links to Zoom meetings. At the appointed time, they log in and a nurse or medical assistant checks them in before the physician comes in for the meeting.
“It’s super convenient; nobody needs to leave their homes,” Hooper said.
Both Hooper and Gallagher emphasized that people should access care if they need it.
“One of the biggest things we don’t want to have happen is for people to delay care because they’re afraid to leave the house or that they’re going to get sick if they do, and then have something catastrophic happen with their chronic disease,” Gallagher said.
Telehealth visits present an alternative to in-person visits, Hooper said, adding that the organization is taking precautions at its health centers, including the use of masks and the institution of barriers that block staff off from patients.
Certain components of an examination, like taking vital signs, are limited by video visits, Gallagher said. But skin or musculoskeletal issues are still diagnoseable via video.
“We can see where they’re having a problem, you can guide them on some certain diagnostic maneuvers,” Gallagher said.
Hudson Headwaters emphasized that providers should use good clinical judgment as the outcome of a video appointment might still be an in-person visit, what they now refer to as “brick and mortar” medicine.
“There’s still a ton of value in doing a video visit if it leads to an in-person visit or if you direct someone to an urgent care center because they need a different level of evaluation,” Gallagher said.
He said patients have responded positively to the program and specifically mentioned essential workers who have been able to do their appointments during a break at work rather than losing half a day to see their providers.
Patients at all the Hudson Headwaters health centers are now able to self-schedule video appointments through the organization’s website. Staff monitors the “reason for visit” field to make sure that a video visit is appropriate for patients’ needs.
Additionally, the website includes guidance on what conditions would be appropriate for a telehealth visit versus an office visit.
Beyond COVID-19, telehealth could present opportunities to connect younger people to primary care through the technology they constantly use and help overcome barriers to care, such as transportation access or poor weather, Hooper said.
She added that college students who are away from home and snowbirds could make use of virtual visits to go over medications or check their blood pressure.
“I think this has opened up a new way of delivering health care that I think is going to change the way we do it forever,” Gallagher said. “I think that’s a good thing.”