The COVID-19 pandemic introduced new challenges for all healthcare provider organizations. At Maple Knoll Communities in Cincinnati, staff faced the challenge of protecting their residents from the virus while also providing high-quality medical care.

THE PROBLEM

Limiting access to the skilled care and assisted living areas was one of the greatest challenges. How could staff continue to provide excellent care while limiting physical interaction?

“Among the many challenges presented by COVID-19, ensuring our residents had timely access to their healthcare providers was our main priority,” said Mark Plunkett, director of information technology at Maple Knoll Communities.

“Like clinicians at many healthcare providers across the nation, our doctors faced a dilemma. Physically assessing patients can potentially increase the risk of spreading the virus, especially if doctors visit more than one facility.”

However, leveraging technology and providing telemedicine can allow residents to receive the care they need while also reducing the risk of contracting COVID-19, he added.

The Centers for Medicare and Medicaid Services earlier this year temporarily lifted restrictions on the technology that could be used during the pandemic. So there were many options to choose from.

"With a larger number of aging seniors having one or more chronic conditions, eliminating the need for frequent office visits greatly improves convenience and satisfaction."

Mark Plunkett, Maple Knoll Communities

“We began leveraging Cisco WebEx and Skype to deliver virtual visits and care, using tablets as endpoints,” Plunkett explained. “This solution was a good start and allowed for our doctors to deliver the beginnings of telehealth at Maple Knoll. As time progressed, our doctors from UC Health also began using a third solution, Doximity, to deliver virtual visits.”

All three systems worked. But they were three separate systems that did not integrate with the EHR platform. This resulted in many manual processes that still were needed, such as filling orders.

PROPOSAL

The proposed telemedicine technology is from Netsmart partnering with American Well and promises a more consistent and robust platform, Plunkett said. It is a single platform that allows for the use of smartphones, tablets, computers and medical carts dedicated specifically for telehealth purposes.

“The telehealth solution allows for us to schedule initial intake or reoccurring appointments with residents who already exist in our EHR system,” he added. “We gain access to launch telehealth sessions from within our EHR system and streamline billing. Within the system, our clinicians can set their availability, monitor the virtual waiting room and be notified when residents arrive.”

In addition, the platform allows for multiple doctors, specialists and family members to join on a visit. Having the right people in the same room together allows for greater efficiency and resident satisfaction, and yields better outcomes, he said.

MARKETPLACE

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MEETING THE CHALLENGE

There are three parts to the overarching solution being put in place: a pharmacy integration, Carequality/CareConnect and telehealth. These parts require clinical staff and the pharmacy to work together to achieve success.

“The first solution is a pharmacy integration between the skilled care pharmacy and our EHR system, Netsmart Vision/MyUnity,” Plunkett explained. “This integration will improve efficiency and reduce risk for our doctors and staff. This is accomplished by our doctors submitting orders electronically directly from our EHR system to the pharmacy. No additional staff interaction is required.”

The second solution underway is a combination of health data exchange technologies from Carequality, including CareConnect. These solutions will further aid in the efficiency and effectiveness of the telehealth program, Plunkett asserted. With these integrations, the organization will be able to electronically receive continuity of care records from outside providers directly into the EHR.

“The third solution in the works is the telehealth solution itself,” he said. “This solution, provided by Netsmart and American Well, will offer several advantages. First and foremost, it gives us a HIPAA-compliant, secure platform that we can use for virtual visits. Building on this foundation, we will be leveraging medical carts designed specifically for telehealth.”

The carts include pan/tilt/zoom cameras that doctors can control remotely, tablets for ease of use to allow visits to get going quickly, and diagnostic and peripheral devices that connect to the tablet. These peripherals include a Bluetooth stethoscope, a dermatoscope and an otoscope.

RESULTS

“From this more robust telehealth system, we expect to see improved patient outcomes,” Plunkett said of the three-pronged set-up that is still in implementation. “Telehealth provides the opportunity for greater access to our physicians. A resident not only will have the ability to speak to their primary care physician, but also the ability to pull in specialists and other caregivers to help ensure the entire picture of their health is realized and addressed accordingly.”

Maple Knoll Communities also expects to see increased patient engagement and satisfaction. This will be accomplished, Plunkett said, through creating a more convenient, one-stop-shop experience. This saves time and effort that goes into the process of making the appointment. And it includes everything from transportation to reduced risk of exposure simply by leveraging technology. The resident also benefits from fewer distractions by avoiding the busy offices.

“Residents also benefit from telehealth’s ability for follow-ups and treatment of chronic conditions,” he added. “Post-hospital, doctors can follow up without the need for the resident to revisit, depending on the condition. Also, with a larger number of aging seniors having one or more chronic conditions, eliminating the need for frequent office visits greatly improves convenience and satisfaction.”

USING FCC AWARD FUNDS

Earlier this year, Maple Knoll Communities was awarded $98,984 for a telehealth platform, remote diagnostic equipment and other professional medical services to provide remote diagnosis, treatment and monitoring, voice and video consultations, and pharmaceutical services for vulnerable older adults, while also increasing efficiency and expanding the number of patient visits during the COVID-19 crisis.

“Among the many things we are doing here at Maple Knoll Communities, telehealth is one area where we are heavily focused,” Plunkett emphasized. “With the FCC funds, we are introducing the aforementioned solutions that will greatly enhance our telehealth abilities.”

Once implemented, staff first will focus on the skilled and assisted living residents and then hope to open the platform up to the entire continuum of care. Allowing independent living residents to gain access to doctors through telehealth stands to improve resident satisfaction and convenience by leveraging additional options for care. Independent residents will be able to join from their smartphones, computers or tablets.

“The COVID-19 pandemic has brought telehealth to the forefront,” Plunkett stated. “We at Maple Knoll Communities want to ensure we are meeting the demands of today, but also those of the future. Adopting a robust telehealth program now will help us do just that.”

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