The Benefits of Telemedicine That Support Quality Initiatives

Are you looking to improve your quality of care? Well, look no further than telemedicine. As several organizations have learned, the benefits of telemedicine that support quality initiatives are substantial. Telemedicine is an effective — and potentially transformative — means of improving care delivery and, with it, outcomes, patient satisfaction, clinician satisfaction, and many other key quality metrics.

Leveraging Telemedicine Technology

Let's examine a few of the ways organizations have leveraged telemedicine to enhance their quality performance.

Cleveland Clinic — A case study published in NEJM Catalyst details a partnership between Cleveland Clinic and the Online Care Group, a nationwide system of physicians who provide telemedicine services through the American Well online platform. Cleveland Clinic entered into this partnership and introduced telemedicine with three goals of this multi-year collaboration: "ensuring visit-type appropriateness, documentation completion, and appropriate antibiotic prescriptions."

In addition to the delivery of telemedicine services, the collaboration also included auditing, intense training, and overcoming barriers. The work paid off. The results of the collaboration were impressive, as the following quality improvement metrics show the rate of:

• Inappropriate pediatric visits decreased from 67% to 1% within 14 months.
• Full documentation increased from 45% to 85% within six months.
• Appropriate antibiotic prescribing increased from 69% to 97% within six months.

Read the full Cleveland Clinic case study here.

Bassett Healthcare Network — This integrated healthcare system in Oneonta, N.Y., has been leveraging telemedicine to enhance care quality for longer than many organizations. Since 2002, Bassett has benefitted from telehealth services provided by At Home Care (AHC), a non-profit, Medicare-certified home health agency formed in partnership with Bassett, according to a case study report published by Center for Health Workforce Studies at SUNY Albany. That year, AHC started using telehealth to primarily assist aging, low income, homebound individuals with chronic conditions living in rural or remote areas. This was made possible by placing telecommunication devices in patients' homes. This equipment served many purposes, including taking and monitoring vital signs, providing medication reminders, and transmitting data on matters such as heart rate, blood pressure, and weight back to AHC.

The benefits over time have been substantial, with the report highlighting examples such as extending the capacity of the home care nursing staff; providing a connection for patients, family members, and caregivers to nursing staff for urgent matters; and enhancing and expanding care quality.

The case study notes that Bassett intends to build on its success via visual and remote monitoring technology, such as by providing patients with an interactive technology application to allow for better polypharmacy management, behavioral health concerns, and palliative care, and integration of interactive video telehealth with primary care physicians' offices.

Read the full Bassett case study here (beginning on p. 28).

Dignity Health — In a case study published by Healthcare Information and Management Systems Society (HIMSS), we learn about the foray into telemedicine by Dignity Health, a San Francisco-based health system delivering services in 21 states. In 2008, Dignity, via its Dignity Health Telemedicine Network (DHTN), began supporting 40 hospitals in California, Arizona, and Nevada. Services provided by DHTN include acute care, advanced clinical care and long-term care, and transitional and home-based care.

DHTN physicians connect with patients at remote care sites using secure broadband technology through five-foot-tall equipment described as "robots." The robots include a monitor that allows physicians to conduct live patient assessments, recommend treatments, and provide ongoing support with the assistance of on-site hospital care teams. Pre-programming permits the robots to autonomously navigate to a specific room, location, or patient within any of the participating sites. 

In this case study, we learn about the benefits of using these robots for three different types of telemedicine services provided: telestroke, teleICU, and telemental health.

• For the telestroke service, the objective is based on a concept described as "555." Within five minutes, a patient entering the emergency room (ER) with a suspected non-hemorrhagic stroke is supposed to receive a rapid medical assessment, a CT scan, and have the telemedicine service activated.
• For the teleICU service, the robots round on patients twice a day. The controlling physicians work with ancillary staff for a coordinated or, if necessary, immediate response to medically manage higher acuity patients.
• For the telemental health service, attending ER physicians conduct a rapid medical assessment of patients and classify them as mild, moderate, or severe, specifically concerning current mental state. The purpose: help the ER team determine appropriate and oftentimes earlier intervention for high-risk patients.

Achievements and goals shared note improvements in areas including severe sepsis and shock, ventilator average length of stay, and decrease the length of stay in the emergency department.

Read the full Dignity case study here.

Banner Health — Our final case study examines Banner Health, the non-profit health system based in Phoenix, Ariz., that operates 28 hospitals across six states. The American Hospital Association published this case study, which highlights Banner's 2013 rollout of a teleICU model for patients with multiple chronic conditions. Banner's "Intensive Ambulatory Care (IAC)" telehealth pilot enrolled members within Banner's health network for whom the system was at-risk financially. Participating members were provided with Bluetooth-enabled remote patient monitoring tools, such as scales, glucometers, and heart monitors, as well as a tablet for video interactions.

As Banner's vice president of patient care innovation states in the study,

To support these patients, Banner formed a telehealth team comprised of physicians, pharmacists, social workers, cognitive behavioral therapists, and registered nurses, supported by certified nursing assistants.

The results of the pilot speak volumes. They include:

• reducing hospitalizations by nearly 50%;
• reducing the number of days in the hospital by 50 percent; and
• reducing the 30-day readmission rate by 75 percent.

An aspect of this case study that we particularly appreciate is the noted recognition by Banner that telehealth represents an opportunity to significantly improve medication reconciliation. During participant onboarding, the telehealth team pharmacists conducted video visits with patients to review prescribed medications. Of the more than 1,000 patients who participated in the IAC pilot over three years, not a single patient's electronic medical record matched the medications that the patient was actually taking!

Read the full Banner case study here (beginning on p. 5).

If improving medication management is on your organization's to-do list, view our recent webinar, "Medication Management with Meds 360º."