The Allegheny Health Network (AHN) is working to improve access to emergency care specialists in rural areas of Pennsylvania and western New York by expanding its telehealth network to include emergency stroke and critical care services through partnerships with rural hospital emergency departments and local emergency medical services.

The Georgia Health Policy Center recently spoke to Jack Protetch, senior program manager for telehealth at the Allegheny Health Network about implementation. 

To date, what has been the biggest accomplishment of your tele-emergency program?  

Most people are probably familiar with telestroke projects as a TNGP program, but our virtual intensive care unit (virtual ICU) project may be a little more unique. As part of this grant, both projects went live within days of each other at one of our community hospitals, AHN Grove City, on March 30 and April 1. This is somewhat of a feat because not even two months prior, we implemented a new electronic health record system at the facility. (Grove City Hospital became part of AHN in early 2020.)

While it has only been a few months, the launch has been very successful. We have served over 130 ICU patients and so far, none of them have been transferred to other facilities within the health network. For telestroke, we have evaluated over 30 patients with acute stroke symptoms and treated three with the clot busting drug tPA (IV alteplase). Two were treated in the emergency department and one was treated while admitted for another medical issue. In each case, stroke symptoms were quickly recognized and AHN telestroke protocols were rapidly implemented. While the programs are distinct, they do complement one another particularly following admission to the hospital.

What is a tip or early learning that you would share with an organization launching similar telestroke and virtual critical care services?   

I know there is a big focus on technology and implementing the technology, but telehealth is about the people at the community hospitals, change management, and making them feel comfortable with what is being proposed. We need their early and ongoing buy-in to succeed. Though it might sound cliché, we focus on building trust and relationships with the project managers and clinical experts who bring the programs to the community facility. Ultimately, it will help local providers be more comfortable and competent in caring for sicker patients, which is the real goal here. Having local clinical and medical champions at the nursing and physician level working with their distant site colleagues to disseminate information so that everyone is on the same page early on, helps to make sure there are no surprises through implementation.   

It also helps if you have the ability to be on-site and in person to make introductions and review workflows. We learned through COVID-19 that a lot can be well done virtually. But, at least for those kickoff meetings and for establishing that interpersonal relationship and rapport, it is important to put boots on the ground and meet face-to-face, when possible.  

Lastly, it is important to share data after a program goes live, so that there is good feedback about not just volumes of patients being seen, but the actual impacts on length of stay, case mix index, and other metrics. Very shortly after virtual ICU went live, there was a patient who presented following a drug overdose that was intubated and required to stay in the ICU for a couple of days. Without this program, the patient would have likely been transferred to one of our tertiary hospitals in Pittsburgh; yet with the added clinical expertise, the patient was able to receive the necessary critical care locally while having a successful recovery. That is a really good story to share across the team and celebrate the success the program had for that patient staying in the community and doing well. 

How do you see participation in the Telehealth Network Grant Program impacting your broader telehealth efforts?  

Participation helped us accelerate our goals and support the long-term growth of the programs. We created a single standard of care for both telestroke and virtual ICU that we are proliferating across our enterprise. The grant brought this to some hospitals sooner than perhaps would have occurred otherwise. Ultimately, tele-emergency care permits us to keep the care local and allows the patients and their families to feel comfortable that they are receiving the best care in their community. 

What will your organization be doing more of or differently to emerge stronger from the pandemic?

COVID-19 came along shortly after the beginning of our virtual ICU launch in January 2020. Despite the pandemic, there were still on-site trainings that occurred, and vendors present to install the equipment, taking precautions as needed. The thing that stuck with us is that we needed to flex how we provide care, particularly in the hospital critical care units because of the overflow needs associated with COVID-19 surges. We had planned the virtual ICU to work through a hard-wired video conferencing solution in each patient room that can be activated with a touch of a button to get a response from the critical care nurse practitioner and physician at the distant site. In addition, patients are being monitored 24/7 for physiologic parameters and other laboratory findings to predict if a deterioration might occur and intervene beforehand. You have this third set of eyes looking at the patient virtually and algorithms assisting the providers.  

But, with COVID-19, the ICUs were full. So, we looked to create more flexibility in how we can manage those patients in overflow situations. We purchased portable solutions that are not hardwired into the room, but rather an upscale tablet that is housed on a stand that can be deployed to different rooms. It helped us early in the pandemic to reduce unnecessary in and out of the room when we were trying to conserve personal protective equipment. We could have eyes on the patient and talk with them without having to walk in there. These solutions have become very important to us during COVID-19 and beyond.  

Lastly, we continue to advocate for reimbursement and coverage — making permanent many of the flexibilities that occurred during the public health emergency. We are encouraged by recently passed legislation in Congress that extends benefits for behavioral health counseling to occur virtually and recognizes rural health clinics as originating sites. We are hopeful efforts will continue to go forth so that when we return to more normalcy, the proven benefits of telehealth will persist for patients and providers.

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