East Carolina University
The Georgia Health Policy Center recently spoke to Jill Jennings, M.S., R.D., and Doyle Cummings, Pharm.D., from East Carolina University (ECU), about the potential to use telehealth for a broad range of primary care applications, including school-based and at-home telehealth.
To date, what has been the biggest accomplishment of your telehealth program?
Jill: Hiring a full-time telehealth nurse and full-time community health worker, both of whom were born and raised in the areas that they are serving, to support us going into the homes of patients and connecting them to virtual medical, dental, nutrition, and behavioral health care. They have made a tremendous difference in our ability to successfully do this. It is a big win for our project to have two people who are so committed to helping us further expand access to care, who understand their communities intimately, and who know of the various resources available. For example, because they are from the area, they may well know the owner of the local pharmacy or where and when to pick up food boxes for their food insecure patients. With this shared connection to the community, there is increased likelihood of trust and confidence when going into the homes of patients and connecting them to their health care team.
What is a tip you would share with an organization launching a similar telehealth program?
Jill: The first thing that comes to mind is to allow your partners to hire who they feel would be the best fit for their organization versus us selecting for them. Your partners understand the needs and flow of their organization best and would therefore be better equipped to set things up in a way that promotes program success. Along those same lines, I would also advise that you provide your partners the autonomy to create the initial workflow of patient care services as they know how their operations on a day-to-day basis work best. They are the ones bringing telehealth into their organization, so why not have them be the ones to say how it can best fit for them?
Doyle: You really have to understand what the challenges are that they, as an organization, are facing on a day-to-day basis when trying to deliver telehealth care to their patient population. One of the big challenges that they face, and many other grantees across the nation, is broadband access or access to internet services. So, part of our strategy has been to work closely with the director of IT services for that clinical practice. We also have joined with that person to meet with broadband purveyors in the local area as well as other vendors who have a range of technological solutions for the access challenges. Therefore, a suggestion is to own the problem at the level that they understand it and that they experience it, and to share that problem with them and agree to work together to get to a common and shared solution to the problem.
How does participation in the Office for the Advancement of Telehealth’s Evidence-Based Telehealth Network Grant Program impact your broader health improvement efforts?
Doyle: As a university, we are absolutely committed to improving the health status of people in the region. For the last 20 years, we have viewed telehealth as a growing component of that commitment. Obviously, during the pandemic it became an even more critical infrastructure piece, and we want to continue to be a part of the cutting edge to identify what the most relevant strategies are so that we can address, in collaboration with the community, how the use of telehealth enabled services can help get us there. In other words, how can we help identify patient care options that can be effectively delivered, especially via home telehealth, in order to minimize the challenges that many of our patients face with transportation.
We think telehealth is going to evolve and we are trying to utilize telehealth in different ways. There are still many patients who want, and frankly need, to have that traditional office visit and the touch of their provider. However, there will continue to also be a growing percentage of people that will value the way that telehealth can be efficiently delivered in their home setting. So, I see it as a strategy that we still need to figure out exactly who fits into what box and when.
We also are providing care to kids, teachers, and staff in rural school settings, particularly for kids that do not have a medical home and cannot get services in other ways. That includes acute minor medical care, but also nutrition and behavioral health counseling. We are working to expand a fantastic telepsychiatry program here at ECU that is providing behavioral health counseling now in addition to medical psychiatry services. We are partnering to do remote patient monitoring and working with chronic disease patients in the home.
The last part is health economics. Running a private practice these days is incredibly expensive. How can we help to take the pressure off of those practices by using telehealth to deliver care more efficiently. I think that is a win-win, too. We believe telehealth is a critically important vehicle and infrastructure.
What will your organization be doing more of or differently to emerge stronger from the pandemic?
Doyle: When the pandemic started, we were very concerned about people coming into the office, so, all the care that was planned had to be delivered via telehealth. At that point, we had providers who had no idea how to do telehealth. Very quickly, we had to adapt and train these providers. And many times, we were unsuccessful with a patient because they could not download an app onto their phone or there was a connection problem, so the encounter ended up being telephone only.
Since then, we have learned of different strategies and different equipment that we can use to better facilitate those encounters. We also created telehealth training for health science learners, so that we ensure when they leave our hallowed university halls, that they actually have had some exposure to using this technology to deliver care. We will continue to look at how we can train the next generation to be even more facile and think creatively about how to deliver care.
Jill: The pandemic, in addition to other states of emergency over time, has taught us that we have to be able to change on a dime, that we have to be flexible and able to pivot our carefully laid plans to accommodate unpredictable and evolving conditions. Through that, I think our service delivery in rural communities has been enhanced and strengthened.