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Steven Martel, M.D., CMIO at Central Maine Healthcare, describes his organization’s journey into telehealth during the pandemic, and what needs to happen for usage rates to remain high going forward.

It’s been very well-documented that COVID-19 has forced patient care organizations to turn to alternative ways to provide care while limiting exposure to the virus. In this capacity, telehealth has emerged as one obvious way to limit patient displacement in hospitals and keep people at home as much as possible.

Like most organizations during the pandemic, Central Maine Healthcare (CMH), an integrated healthcare delivery system that serves over 400,000 people in the central, western, and mid-coast regions of the state, has adopted telehealth technology to care for their patients via real-time virtual visits and remote consultation experiences during the crisis.

The health system specifically tapped into a virtual care solution from Innovaccer, a Silicon Valley-based healthcare solutions company, allowing care teams at CMH to streamline their workflows with the platform’s automated bulk messaging and outreach capabilities. Providers at CMH use the virtual care solution to provide educational material for their patients, conduct smart outreach and enable pre-visit planning with accurate patient self-assessments, according to officials.

Recently, Steven Martel, M.D., chief medical information officer (CMIO) at Central Maine Healthcare, detailed these efforts while weighing in on other important telehealth considerations during the pandemic and beyond. Below are excerpts of that interview.

Can you describe your organization’s transition to telehealth at the onset of the pandemic? What has that journey been like?

Prior to March, we had very limited telehealth presence within our organization. Like most others, we quickly had to pivot and implement a solution in order to continue to meet the needs of our patients. One key driver of that was CMS’ relaxing of their rules around telehealth. Without that, it would have been much more difficult for organizations to justify the necessary tools and time to develop these new ways of delivering care. So I think that was essential in helping to move us along on our telehealth journey. We partnered early with Innovacer to help develop their platform, and we recognized that in order for us to stand up an effective solution, we really needed a platform that was intuitively easy for both our providers and team members, as well as our patients. So we went from from having essentially no telehealth footprint to doing more than 27,000 telehealth visits since March. That has been a remarkable reflection of our organization’s resiliency and ability to adapt quickly to changing circumstances. 

What are things like now in terms of visit volume and patients coming back in?

We are fortunate in Maine to either be the 49th or 50th state in terms of COVID-19 prevalence, meaning we currently have a very low burden of COVID. In that sense, for our organization, in recent months I think people have become much more comfortable with returning to in-person visits. So we have seen a bit of a drop-off of in interest in telehealth from our patients as a replacement for routine visits.

But we’re finding that there are still some specific opportunities that many of our patients are leveraging for these types of visits, particularly for us as a predominantly rural state since it’s not uncommon for patients to have to travel a few hours, especially when they are in need of specialty care. Having the option to have that visit as a telehealth visit has been a significant patient pleaser, saving them many hours of time.

What have been the core infrastructure challenges involved?

We all know that when the pandemic was really starting to get a foothold, and when store shelves were depleted of sanitizer and toilet paper, we quickly discovered that everyone was gearing up for telehealth, and the same thing was happening with the hardware needed to be able to conduct those visits. So we approached it first from the perspective of deploying dozens of iPads that we had in stock and had leveraged for other projects that we have planned. So we repurposed those as a way to allow for some flexibility within a practice with regard to telehealth visits.

iPads are easily portable, and they could be handed off very easily to whichever provider or staff member was going to be involved with a particular telehealth visit. We placed orders for cameras early on in the process, and we planned for an increased interest among our practices in able to offer this technology. We tried to be somewhat aggressive in our ordering so that we would have those supplies on hand, and then we were very careful in how we distributed the hardware throughout our organization. We did both a provider and staff count, and then dispensed hardware based on the number of providers and staff in the office, with the idea that this would be a shared resource within the office. That has allowed us to roll out that capability to all of our practices without having to struggle with some of the supply chain issues that have occurred as a result of the increased demand across the country.

How important is it that some of the government-granted flexibilities that previously served as barriers to telehealth access and adoption stay in place? Which of the specific regulatory elements do you view as most important?

The reimbursement that organizations can expect from telehealth visits is the most important. Prior to the CMS ruling, a telehealth visit was a small percentage of reimbursement compared to an in-person visit. [Those] economics would not drive a successful telehealth universal approach within an organization. For the time being, now these visits are being treated on par with in-person visits, and that’s been extremely helpful to driving the adoption of this technology. In order for us to continue, we would need to see significant improvement in what telehealth services can be reimbursed for, in order to make sure we’re able to cover the cost of care delivery to patients. If we return back to the pre-COVID status, telehealth use will likely fall quickly as a routine replacement for in-person visits. That’s not to say that there isn’t a role for telehealth in that environment; I believe there will be regardless of the payment structure. The payment structure is what determines how broadly telehealth can be applied within the organization.

How has patient satisfaction with telehealth changed over time at your health system?

The feedback we have received, both through patient experience surveys and anecdotal reports, has been very favorable. Being a rural state, one challenge for us is that not all of our patients live in areas that have a strong cell phone signals or access to high-speed internet. Those are two pre-requisites in order to have a really successful telehealth visit. So part of our screening with regard to identifying patients who are suitable for those visits is to incorporate these questions into the planning process for the visit. When patients are offered the option of an in-person or telehealth visit, they are also asked if they have high-speed internet access, or if they have a strong cell phone signal that will allow them to conduct the visit.

One key feature is the feedback we provided Innovaccer around the difficulty in determining if the failure of a telehealth call was due to circumstances on our side of the phone call, or on the patient’s side. And they built in technology that actually presented a message letting us know that the signal on the patient side was compromising  the visit, and they would also incorporate some automated tools that tried to salvage the quality of the connection by slowing it down somewhat. Having that awareness during the call has been really helpful since it helps us identify what the failure was due to.

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