The Crossroads Partnership for Telehealth, a partnership between the Indiana Rural Health Association and three rural hospitals are working to expand services and access to care in rural Indiana by focusing on teleneurology services. 

The Georgia Health Policy Center recently spoke with Cody Mullen, Ph.D., senior advisor with the Indiana Rural Health Association and a clinical associate professor at Purdue University, about participation in the Telehealth Network Grant Program. 


To date, what has been the biggest accomplishment in your telehealth program?  

We did not design the program with a pandemic in mind, but it has been great the way that the program was able to support health care during the pandemic. Specialists were called to other facilities due to demand and telehealth was right there, ready to step in to help fulfill that hole that was created during the pandemic. We would like to think we were really wise in the design of our program, but realistically we got lucky. However, we can take those lessons learned and apply them in the post-pandemic world, as I believe telehealth will be the new normal for rural health care delivery. 

I am also proud of how our clinical partners came together. They all are focused on the mission and the vision of how to improve the health of our citizens. It is a very heartfelt mission. Technology is cool and the technology is a part of this, but health care boils down to caring. So, I think it’s powerful to see how telehealth does that. 


What is a tip you would share with an organization launching a similar telehealth program?  

Start small. If you go to your electronic health records and look at a specific disease process that can be served by telestroke, telebehavioral health, or telecardiology, it can get very daunting very quickly if you look at what the volumes could be. Remember, early win is an early win. If you can help two patients in a month that is success. You helped two patients who otherwise would have had to travel or not had access to care. So, start early. Do not spend two, three, or four months designing a program in the boardroom for 500 or 600 patients a year. You can start testing with five patients, do an assessment, what went well, what went badly? And then, expand to 15. Eventually, it is going to expand to meet the demand out there.  

It is also important to remember that every telehealth program you launch will not be successful. There is failure in life. But go into everything giving it your best. And if it does fail, try to do something differently or modify or pivot the program. 


How do you see participation in the grant program as impacting your broader health improvement efforts? 

We have a wonderful partner in the Federal Office of Rural Health Policy’s Office for Advancement of Telehealth. This grant gives us the opportunity to work with clinicians, administrators, and other ancillary health services individuals and to be able to compensate them for their time. There is not a health care worker out there right now, who’s saying, ‘I’m bored. What should I do today?’ So, for me to be able to go in and ask for help in a time like this, it helps to compensate them for their time or to allow them to add additional support to their team.  

This grant also gives us the opportunity to have a network. Sometimes things happen, like billing codes changes. Look at how many telehealth modifications there have been since the start of COVID. For a while, it was almost daily or weekly. We have a network to ask, ‘Did you see this came out?’ We all miss things. But it is great to have that network of colleagues that you can learn from that this state did this or that. It is great to bounce ideas off each other. 


How will your organization emerge stronger from the pandemic? 

I think that the pandemic changed the way we deliver health care in rural for the rest of time. It is one of those pivotal shifts that 40 or 50 years from now they will talk about in the classroom. But I think what we need to do and realize is that when designing a telehealth system, think about how it can be used in multiple different ways. If you are building a telestroke program and you are looking at solutions, there may be a really cool tool or gadget or widget out there that is really good for that, but it cannot be cross used elsewhere.  

Prior to the pandemic, the Indiana Rural Health Association had a program looking at putting telehealth in schools, both for physical health and behavioral health. I was not involved in this project, but schools shut down for at least two months and many through the end of 2020 spring semester. They were able to take those telehealth carts and put them in nursing homes and be able to do care there. The carts were not designed to go to nursing homes, but a stethoscope, an otoscope, a high-res derm cam, they could be utilized in different ways with a different patient population.  

So, if another pandemic or natural disaster occurs, we should be thinking about how we can modify this product. For an internet only solution, can you add a Wi-Fi option so you can hotspot on our phone if needed? If we are in the back of an ambulance going around the community are their other peripheral items that we can add that would benefit our existing program and would be very vitally important for other programs that may utilize the equipment in the future? 

The technology we had at the start of the pandemic now has changed. We can only imagine what technology will be in 10 years from now and we can think of how we, as an organization, can build a culture of early adoption and motivation for future evolutions in health care. 

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