In the COVID-19 partner Q&A series, we share knowledge and expertise from HRS partners across the country on how they are leveraging telehealth in response to COVID-19. Below, Emerson Home Care Telehealth Coordinator, Kathryn Castle, shares her insights into launching a telehealth program in the midst of the COVID-19 pandemic.

1. What have been the biggest challenges to launching your telehealth program during the COVID-19 outbreak?

The rapidly increased demand for telehealth has been a big challenge. When we initially launched the program in January, we outlined the high-risk patient populations that we'd focus on enrolling in the program. Due to risk of exposure, we've received an influx of requests from patients to receive a minimum number of home nurse visits which has in turn increased the number of patients we're enrolling in telehealth. Not all patients we've enrolled during COVID are ideal candidates for telehealth, but the ability to expand our enrollment and monitoring capabilities through telehealth has been a huge advantage during this time. 

2. What recommendations do you have for providers looking to increase their utilization of telehealth?
During this pandemic, the concept of integrating telehealth has become widely acceptable as healthcare organizations realize the necessity of remotely monitoring patients. Delivering care remotely, whether that be through virtual visits, symptom monitoring or other methods, has become essential for patients across the health system - not just high-risk patients. 
Both patients and providers have been almost forced to adjust due to the circumstances and I believe as they get used to the technology, and all its benefits and capabilities, they'll be asking for telehealth more frequently. I hope the trends we are seeing now with the use of telehealth continue as we settle into a "new normal."
3. Patient adherence and engagement is essential to reducing readmissions and adverse outcomes. How has your team introduced patients to the technology and what result do you think this has had on patient adherence?

The initial interaction with the patient is critical, as is routine contact via phone calls or virtual visits. Many patients are afraid of the technology because it's a method of care that is entirely new to them. Our team prioritizes educating and comforting patients. Fear of "making a mistake" or "messing up" can prevent patients from even using the device. It's important to reassure patients that they cannot "make a mistake" and that our team can “fix” anything on our end through the clinician portal.

When introducing patients to the platform, keep the approach light, explain how the program and its features will help keep them healthy and at home, and be prepared to be flexible. For example, for some patients you may need to begin with only two biometrics. You can then begin to add on as the patient becomes more comfortable with the process.

In addition, you want to explain from the beginning that a nurse will call them if anything is out of range. It's critical to ensure patients understand this as it will help them decide whether to call a doctor themselves and can prevent them from immediately rushing to the ER. 

Finally, our team really focuses on explaining the symptom surveys to patients. We view the symptom surveys as just as important, if not more important than a patient's biometric readings because we're trying to identify changes in how a patient feels as this is often their body “telling them something is wrong.” I've found that if patients understand the rationale behind what you are asking them to do, they're more inclined to follow through.

4. How have your installation and SN visit procedures changed during the pandemic from when you initially launched the program?

Installation and visit procedures have changed significantly and in several ways. Firstly, we've had to assure patients that the equipment we're bringing into their homes has been disinfected to a high standard and will not place them at risk of exposure. This has presented an additional hurdle, but our team has done an excellent job reassuring patients and building trust.

Secondly, we've had to be more flexible with equipment delivery and installation visits. For many patients, we've been able to identify a family member to be our "Technology Liaison" and assist us with device set up and an educational call to introduce patients to the program. We're continuing to improve our written instructions to patients and their family members, incorporating visuals to match each part of the instructional session.

Finally, we've trained some of our Physical Therapists to perform patient installations as demand peaked in March and April. This adjustment also helped out PTs when their patient visits decreased due to fear of exposure. It allowed our PTs to continue working a full day between deliveries, installation, and pick-up and sanitization.