Analyzing the Challenges and Benefits of an Inpatient Telehealth Platform

A robust in-patient telehealth platform can save a health system millions of dollars, reduce workload stresses for care providers and, most importantly, improve care outcomes.

That’s the take-away from officials at the Yale New Haven Health System, which deployed more than 1,800 connected health devices across the seven-hospital system and studied the effects between March and August.

From handheld and bedside mHealth devices and enables providers to talk to each other and to patients, to telehealth carts that facilitated improved care management and coordination, the project not only helped the system take on the stresses of the coronavirus pandemic but gave officials a blueprint for future care strategies.

“With what we’ve learned and been able to use telehealth for with COVID, we’ve learned and seen firsthand how effective and useful a tool it is,” says Allen Hsiao, MD, the health system’s vice president and chief medical information officer.  “Telemedicine is now simply just medicine, and neither physicians nor patients will want it to go away. It shouldn’t replace all face to face visits, but it is a powerful complementary option when weighing convenience, other benefits, and risks.”

Hsiao and several colleagues detailed their experiences in a study published earlier this year in Applied Clinical Informatics. The report describes how the New Haven, CT-based health system, with sites in Connecticut and Rhode Island, treated almost 4,300 patients affected by COVID-19 over a five-month span, including more than 700 needing ICU care.

According to the report, health system administrators adopted a coordinated strategy to do as much as they could with the technology they had, adapting various clinical and consumer devices to meet the needs of departments tested by the surge in cases. They also took advantage of a robust telemedicine platform already in place for telestroke, tele-ICU and teleconsultation services, repositioning carts and other devices to treat COVID-19 patients.

The paper describes 13 uses cases and eight device options for in-patient telehealth, and maps out how the tech platforms address privacy and security, device setup and availability, functionality, physical setup and workflow and device use.

“Our health system built many video carts from existing inventory and purchased consumer products,” says Shawn Ong, MD, a clinical informatics Fellow at Yale New Haven. “Therefore, Information Technology Services (ITS) estimates this program saved approximately $19 million in technology purchasing costs when compared to procuring industry-offered audio/video carts. There were undoubtedly cost savings realized from front-line workers who were not infected, and thus did not have to quarantine and miss work, but it is difficult to estimate those costs.”

Beyond that, Ong says the platform, which enabled the health system to save more than 630,000 items of PPE, also protected providers. The asymptomatic COVID-19 positivity rate among providers over that time period was .3 percent, far below that of the general population.

“The technology also undoubtedly improved clinical care because it facilitated patient-clinician contact,” says Hsiao. “Instead of having to go through the time and pains of donning an entire set of PPE, a nurse or physician could simply initiate contact within seconds and ascertain what a patient needed, how they physically looked (work of breathing, toxicity, etc.) and when needed, then don the PPE and physically enter the room. Without telemedicine we would have had to waste much more PPE, or worse, have clinicians subconsciously avoiding entering rooms to conserve PPE and time.”

“The feedback we received from clinicians across the health system was overwhelmingly positive,” Ong notes. “For example, nurses felt an increased sense of comfort knowing they could easily communicate with colleagues. Physicians appreciated reducing direct contact or exposure to the virus while still being able to communicate audibly and visually with patients. For nurses who were isolated within a patient room for many hours, they could even have the pleasure of listening to music through the Alexa devices.”

With the pandemic continuing to put pressure on hospitals, both Ong and Hsiao say they’re learning almost every day about how to use technology to improve outcomes and workflows.

“Being nimble is also something we think is very important and valuable,” Hsiao says. “In the quality and innovation worlds they call it ‘fail fast.’ With the crisis upon us we were willing to nimbly try things and fail fast if necessary to identify solutions and things that could help our patients and clinicians.”

“The burdens of caring for patients with COVID-19 are enormous and unprecedented,” adds Ong. “The work risks the lives and well-being of front-line healthcare workers around the world. … Also important is the extreme isolation of patients in the hospital, which has profound negative effects on healing and recovery. Technology from both the healthcare industry and consumer arenas can be rapidly scaled and deployed to address the current challenges, especially when driven by strong relationships between physician informaticists and IT specialists. It is our hope that other health systems can learn from the insights gained from our experience and detailed in our paper.”

Those experiences will also help Yale New Haven Health define its telehealth strategy beyond the pandemic.

Ong says the health system can adapt the telehealth carts for use in other departments in the future, such as virtual consults in in-patient and ambulatory sites and even for translation services. And the handheld devices will continue to be used for communication between providers, or allowing patients to connect with their friends and relatives once visiting restrictions are eased. Tablets, meanwhile, sand be used to convey information, care instructions, images and updates, as well as consumer-facing applications that promote comfort and entertainment during hospital stays.

“Our first priority must be to care for current patients by leveraging our existing innovative technological efforts, during the subsequent waves of both COVID and influenza viruses,” he says. “With cases on the rise at record-setting levels, there is indication to believe that the public health emergency will be prolonged, even after the release of a vaccine. The pandemic has demonstrated a clear role for telehealth as an integral component of health care delivery, which should be appropriately recognized by policymakers and fully accounted for in reimbursement structures. The future healthcare landscape remains unclear as we face the increasing spread of COVID, a new presidential administration, and potential vaccines, all of which will influence the health system's plans as we navigate through the uncertainty of the pandemic.”