- Case Study -

COVID-19 Telemedicine Coverage.

Rapid Deployment of a Financially Viable Telemedicine Program for Smaller Hospitals Responding to the COVID-19 Pandemic.

Beam Consulting COVID-19 Response

 

Background

As the COVID-19 Pandemic creates sizable shifts in our economy, how we work, and healthcare operations, it remains important to remind ourselves of one of the most vital responses to the outbreak: working together. The current situation requires a community-wide response. From both within and beyond the healthcare sector, we must work together to create realistic and sustainable solutions to the pandemic. Telemedicine has been touted repeatedly as one such solution.

Although aware of the benefits of telemedicine, smaller healthcare systems may struggle to develop and implement telemedicine programs. These systems and the rural communities they served already face challenges: shortages in the healthcare workforce, hospital closures, and limited access to subspecialty care. Compounded by financial stressors, now only exacerbated by the COVID-19 pandemic, these challenges force small hospitals to focus energy and spending on priorities beyond creating telemedicine resources. Additionally, the barriers for implementing telemedicine programs for smaller hospitals extend beyond economics to logistical and sociological issues.

Program Assessment: Consulting Services

In response to our clients’ needs and requests from other institutions, Beam Healthcare created the Beam Inpatient Telemedicine Scale-Up Program. Rather than developing a new or extended business model, we framed the program as an opportunity to help institutions and communities in need while educating the importance of telemedicine moving forward.

One pillar of the program is to limit costly technological investments given the estimated 60-70% revenue downturn experienced by healthcare institutions during the time. A second pillar focuses on pragmatic, team based approach that introduces feasibility and sustainability into already stressed systems. The divisions of hospital and pulmonary medicine at Beam were able to operationalize two such systems within three weeks’ time and augment two existing systems simultaneously. Relying on lean methodologies, this novel program assessed and utilized existing equipment for telehealth capability; expanded clinical services to include subspecialty care; established remote ventilator management systems; created telemedicine supported physician surge scheduling and backup models; ensured care coordination was sufficient; and enhanced clinical and implementation education programs. The outcome was the deployment of novel, site-specific telemedicine systems that radically increased COVID-19 response capacity at multiple, smaller hospitals.

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Hospitals Covered Simultaneously

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Tech Expenses

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Days To Go Live

Solution: Inpatient Scale-Up Program

I. Assessing Technical Resources & Implementation

New and shifting clinical and economic demands do not allow for a one size fits all approach to developing telemedicine systems. Avoiding overspending on the deployment of telemedicine hardware and software solutions is just as important as the deployment itself when epidemiological outcomes, technology ROI, and more general financial forecasting remain uncertain.  As a result, our assessment efforts evaluate the immediate needs of healthcare institutions, incorporate its existing resources, and offer a means to transition to a long term telemedicine program should these institutions choose. 

When utilizing a client’s existing computers, tablets, and carts the Beam Inpatient Scale-Up Program devised telemedicine hardware solutions for COVID-19 and surge response systems costing under $1,000. This telehealth unit included the purchase of new digital stethoscopes, a peripheral device fundamental to inpatient telemedicine care. To optimize cost and functionality of new telemedicine systems, the Beam Inpatient Scale-Up Program surveyed the local environment, resources, and needs. First, hardware selection varies based on the level of care capacity and need (e.g., outpatient clinics, inpatient wards, and intensive care units). Peripheral devices for patient assessment, such as digital stethoscopes, are then combined with selected hardware, often pre existing hospital hardware to create telehealth units. By integrating these units with existing Beam Healthcare virtual care software, we created functional telemedicine systems with low technological, logistical, and economic barriers to adoption. Finally, Beam created facility specific training materials for hospital staff to ensure effective adoptions and implementation.

The Beam Inpatient Scale-Up Program technical resources assessment evaluates:

  • Building & Inpatient Unit Information Technology
  • Network Uptime and Connectivity Mapping
  • Functionality & Modification of Existing Hardware for short-term telemedicine
  • Current Software Suites and System Requirements
  • Technical Logistics, Compatibility and Agnostic Functionality
II. Meeting the Surge: Telehospitalist Planning for Over Capacity

Census surge, regardless of etiology, has the potential to double, if not triple, occupied bed capacity at small healthcare facilities. Telehospitalists can address the need for increased physician coverage while mitigating contagion in several ways. First, hybrid models of onsite and telemedicine hospitalists can create both overlapping and non-overlapping layers of patient care cohorts based on level of acuity, location, or infection status. Second, stand alone telehospitalists can serve as triage officers conducting admissions and emergency room consultations at multiple institutions simultaneously, improving patient flow and safety. These split workflows can also accommodate supervision of Advanced Practice Providers (APPs) and assistance to non-hospitalist physicians joining the effort. Lastly, telehospitalists can provide a vital role in backup systems, work while quarantine, and layered cross coverage at multiple institutions during evening shifts. These interventions incorporate local resources, expand limited resources, induce flexibility, and create opportunities for infection control.

III. Providing Leadership and Care: Telemedicine Infectious Disease

Securing access to Infectious Disease (ID) specialists can support local hospitals in developing infection control measures, personal protective equipment (PPE) protocols, and clinical care guidelines. Beam Telemedicine ID specialists responded to client needs for both administrative support and clinical care requirements. Providing evidence-based PPE recommendations for proper utilization and conservation can help prevent disease transmission, sustain supplies, and limit unnecessary expenses. Creating opportunities for speciality-limited facilities for ID consultation and antibiotic stewardship remains a high-yield resource for effective clinical care. Finally, telemedicine methodologies allow for multisite ID specialist coverage, strengthening infection control measures and maximizing expert patient care resources.

IV. Expanding Pulmonary Support: Telemedicine Pulmonology and Respiratory Therapy

A community approach to managing COVID-19 requires expanded access to pulmonary care and expertise. Specifically, it requires introducing advanced respiratory support and ventilator management into clinical settings with limited pulmonary resources and experience. Using telemedicine pulmonologists, pulmonary APPs, and respiratory therapists, Beam Healthcare created remote ventilatory and respiratory management teams for its community partners.

Pulmonary and RT Team tasks include:

  • Attend multidisciplinary rounds remotely
  • Remote spontaneous breathing trial supervision
  • Routine and expanded critical care assessments, as needed 
  • Invasive/Non-Invasive ventilator setting recommendations
  • Medication adjustments
  • Patient education
  • Supporting onsite team during proning

These telespeciality resources supplement existing staff, extend backup coverage, and provide new services where none previously existed

V. Coordinating Care: Grounded Telemedicine Systems

When adopting telemedicine systems, care coordination remains an essential part of care delivery for both on-site and remote staff. Effective communications, scheduling, and training create positive inroads for patient safety, hospital throughput, and discharge planning. The Beam Inpatient Scale-Up Program created new workflows, leveraging online scheduling and HIPAA-compliant messaging to merge traditional care and telemedicine operations, support novel models of care delivery, and enhance linkages between providers and allied health staff. Finally, engaging community partners through mock drills and town hall meetings are effective late stage interventions. These activities both enhance team building between onsite and remote team members while providing opportunity to troubleshoot new communication tools and telehealth devices.

Summary

Beam Healthcare provides clinical telemedicine services, offering access to multiple subspecialties and team based care. The Inpatient Telemedicine Scale-Up Program represents our commitment to creating enduring partnerships with clients and community members. This program assesses and prioritizes the needs of healthcare facilities to create individualized telemedicine responses to the COVID-19 pandemic. By doing so, our community partners can employ telemedicine to provide direct patient care, maximize provider coverage, and access cost effective subspecialty resources. With a reasonable investment and help from Beam Healthcare, smaller hospitals can develop similar inpatient telemedicine programs within weeks.

 

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