In the COVID-19 partner Q&A series, we will share knowledge and expertise from HRS partners across the country on how they are leveraging telehealth in response to COVID-19. Below, ProMedica Home Care Telehealth Supervisor, Kim Putnam, shares her insights into patient adherence, coordinating across providers, and how ProMedica is preparing now for a second wave this fall.

1. Has your patient population shifted since the COVID-19 outbreak? How is this relieving strain across the health system?

We are screening all referrals from the acute care arena to identify COVID-positive patients. If a patient referred to home care was intubated on a ventilator and/or requires home oxygen, we’re enrolling them in the telehealth program.

On the telehealth program, all patients are being initially screened for COVID via the telehealth platform and patients that we confirm to be COVID-positive are being assigned to the COVID-confirmed module provided by HRS.

Many of our COVID patients are scared when they come home and have voiced how grateful they are for the added support and service of our telehealth program. Many of them continue to be quarantined and thus appreciate the additional calls or virtual visits to check on them.

2. 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 phone contact between our support coordinator and the patient to schedule installation is very important. Many times the patients will ask “what’s this all about?” We've provided our staff with scripting to help explain telehealth and benefits so patients are more open to the program.
Another key component is the initial contact with our installers. I feel our installers do an excellent job of establishing rapport, trying to put the patient "at ease” with the telehealth technology. They utilize scripting that we have found helpful, they explain to the patient what telehealth is, they show the patient how to use it, and lastly, they have the patient complete a return demonstration. For example, a patient will have to demonstrate to the installer two BP readings. Our nurses then reiterate the process during that initial virtual visit during installation.
The day after installation, our team calls each patient to let them know they’ve done a great job with their recordings or to help them if they are struggling. Many of them are very appreciative of that follow up call, as they “wonder” whether they did it correctly for not. This is a great customer satisfaction intervention. Our goal with these calls is to provide reassurance and build each patient's confidence with using the equipment. At day ten, we’re calling them again, to remind them to view the educational videos on the tablet, if they haven’t already.

A patient’s success on the telehealth program is determined by several factors: the patient's engagement and confidence, follow-up from the clinicians going to the patient's home, and coordination with the telehealth team and the PCC (Patient Care Coordinator) in the office.

3. What have been your biggest challenges in managing patients with fewer in-person visits?

Our telehealth nurses regularly perform and thoroughly understand the value and benefits of virtual visits and were able to transition easily. However, overall our field staff did not initially decrease the number of scheduled visits with some of our COVID patients. This presents us with an opportunity for improvement moving forward.

As we all anticipate another wave of COVID in the fall we will be better prepared to educate our staff on the advantages of utilizing telehealth virtual visits as opposed to in-person visits, a safer alternative for patients as well as staff. We may also consider the use of virtual visits for PT visits, as many of these patients were debilitated upon discharge from the hospital. For these patients, continued physical therapy upon acute care discharge is essential to their recovery and there may be an opportunity to use telehealth to extend the necessary care.  

4. Advice to organizations looking to operationalize telehealth during the COVID outbreak?

There are so many opportunities to utilize telehealth right now to keep patients and healthcare providers safe. At ProMedica, we work with leadership across the system and with our cardiologists to identify high-risk heart failure patients who are unable to receive in-person care or appointments at Heart Failure Clinics due to the COVID outbreak. In response, we have enrolled some of these high-risk patients in a Telehealth-only program. We are monitoring their daily health and working directly with the MDs and Nurse Practitioners to help these patients manage their symptoms, remain at home, and out of the ER.