One Rural Hospital’s COVID-19-Precipitated Shift Into Telehealth: Grand Lake Health’s Experience

May 20, 2020
The CIO and CMIO of Grand Lake Health in rural St. Marys, Ohio, share their perspectives on the experience of shifting rapidly to telehealth-based care delivery wherever possible, in the wake of the emergence of COVID-19

When the COVID-19 pandemic hit the United States earlier this spring, the leaders of all types of patient care organizations—hospitals, medical groups, health systems, and a variety of outpatient care facilities—had to scramble to shift care delivery patterns in order to minimize the risk of viral transmission, and to optimize care delivery.

Smaller and rural hospitals faced a somewhat different set of variables than did their urban and large-hospital equivalents. On the one hand, most were not initially in the hardest-hit regions in the U.S., which gave them at least a slight time advantage; on the other hand, they had and have far fewer resources—financial, human, operational.

The leaders of Grand Lake Health System, a 131-bed rural not-for-profit hospital with multiple outpatient services, located in St. Marys, in northwestern Ohio, moved quickly to make their shift. Partnering with the Chicago-based Allscripts, they were able to shift quickly into telehealth, which they had been planning to introduce this year in any case, but whose plans had to be accelerated because of the pandemic.

Recently, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Lori Miller, Grand Lake Health System’s CIO, and Michael Josey, M.D., a general-practice physician who is the hospital’s CMIO, about how everything has been progressing. Below are excerpts from that interview.

Tell me about the landscape around telehealth for you and your colleagues, going into the COVID-19 pandemic, and how the emergence of the pandemic impacted your organization?

Lori Miller: We had it on our roadmap to look into telehealth for 2020, but there are so many aspects of it to consider, that we had been thinking through them carefully. We wanted to look at it from a patient care perspective, a quality perspective, and an organizational perspective.

Then COVID-19 hit. Ohio has been a bit more proactive than some other states. And one of the questions was how we could see patients in ways to keep our patients well?

The practices were moving patients around and have the well patients coming in the morning and the sicker patients in the afternoon, trying to keep them separated. We quickly realized we would benefit from telehealth. We’ve used the FollowMyHealth patient portal from Allscripts for years. And they’ve also been proactive and started to brainstorm ways to help their customers quickly deploy telehealth. They helped us get the technology up, configured, and seeing patients, within two days.

Michael Josey, M.D.: The folks at Allscripts certainly developed a very easy product to use. And as a doctor, just being able to see your patient can be very helpful. We were able to quickly get our patients switched over to a virtual visit. A lot of patients were becoming nervous about coming in physically. Patient responses have been great.

When did you go live with your telehealth capability?

Lori Miller: On March 19.

How many patients have been seen through video visits so far?

A little over 200, and we have another 100 in the cue, scheduled. [Editor’s note: this figure was as of early April.]

Were there, or have there been, any particular challenges involved in the shift?

Josey: Sometimes, people not so technically savvy on the consumer side; but our staff will work with the patients.

Miller: Having the staff walk the patient through the process on their side has sometimes been a minor challenge. If the patient doesn’t have a computer or doesn’t know how to use their smartphone or has a flip phone. We don’t automatically buy devices with cameras in them, either. And you can hardly order devices now.

Have there been any particular learnings from the process of the transition?

Josey: It has all really gone very smoothly.

Miller: Even some people who don’t love new processes, have said it went well.

Josey: We’ve just basically adapted our new workflow to remote. Patients have the ability to take their temperatures.

There is so much potential in leveraging new and newer technologies to support patient care delivery that can minimize the potential for the spread of infection. Among the devices that some patient care organizations are beginning to use, for example, are Bluetooth-enabled stethoscopes and thermometers that can be used by patients in their homes, with providers managing them remotely. Are you considering such technologies?

Josey: Oh, definitely. And I see nurses helping patients in their homes. And being able to upload glucometer readings and weights. The future for this is huge.

Miller: And we’ve started to roll things out in the outpatient areas. And we have a pain clinic patient scheduled right now for a video visit.

What percentage of non-urgent primary care visits will switch over for now to telehealth-/remotely based care?

Josey: For now, we’re trying to switch over anybody who’s stable and well-controlled, we’re trying to switch them over to virtual, during this pandemic.

Do you have any particular advice for your colleagues in other smaller and rural hospitals, regarding making the transition to telehealth- and remotely based care delivery?

Josey: Don’t be afraid of it, it’s actually fairly easy. And a lot of providers are afraid that they’re not going to be able to touch their patient. But you can gain a lot of information via video. And additional patients can be added in, as called for.

What’s next up for your organization in this area?

Josey: We’re getting ready to set up a virtual urgent care next week, for non-emergency care. [EDITOR’S NOTE: Since the interview, virtual urgent care has gone live. Here’s a link to the description of that service on the health system’s website.]

What volume of patients are you expecting in that area?

Josey: We really don’t have any idea. We’ll see what happens.

Is there anything you’d like to share regarding the IT or data supporting this?

Miller: Our IT department was wonderful in helping to facilitate the shift to telehealth, for all of us. They really just came together and made it happen, and have been very supportive of our clinical folks, to make it happen. But really it just involved showing people how to use it. There was no heavy lift to get it up.

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