The Georgia Health Policy Center recently spoke to key Telehealth Network Grant Program staff at Garnet Health, which runs the SMHART program, including Jonathan Schiller, CEO Garnet Health Medical Center – Catskills; program directors Ulrick Vieux, D.O. and Halana Finnie, Ph.D.; and Royce Pilkington, program coordinator. 

The Sullivan Mental Health Access and Response Telehealth (SMHART) network is initially using the Telehealth Network Grant Program to expand access to timely psychiatric evaluations and medication management for emergency department patients at Garnet Health Medical Center – Catskills after hours and on weekends. After year one, the SMHART network is looking to expand telepsychiatry consultation in the outpatient and education settings. 

What has been an early win in your telehealth program?   

Dr. Vieux: When we first started conceptualizing this program, there was a certain amount of ambivalence as to whether telepsychiatry could really work at our site. Now, it seems that people have actually bought into the advantage of telepsychiatry to the point where we’ve been asked to see if we can actually increase our services, not just from 8 pm to 8 am, but seeing ways in which we can implement telepsychiatry during the day. So, the fact that things have been able to change 180 is really powerful. 

Dr. Finnie: Prior to telemental health, our length of stay was very long because we had a major gap in coverage. So, we would have literally 12 or more hours as an average length of stay after 4 pm or 8 pm. We didn’t have the ability to do timely psychiatric evaluations. In our first report, which covered September 1 through October 31, 2020, the analysis showed that for both of those months, the average length of stay was under three hours and the only extended length of stay involved children or adolescents that needed to be transferred out of our facility to another appropriate inpatient service. 

What is a tip or early learning that you would share with an organization launching a similar telepsychiatry services program?  

Dr. Finnie: We did a lot of work before we started. We really reached out to the emergency department of both hospitals. We fashioned the protocols, and we discussed how we wanted to work together. What were some of the things that were concerning? Where were the challenges prior? Once we started, we revisited the process very early on so that everybody could give us timely feedback. From my perspective, it is important to have good preparation upfront before you implement and then continually reaching out and speaking to those stakeholders involved for their feedback. What you think might work in theory may not in practice, and it is the fine-tuning that I think has ultimately made this program successful. We want to make sure that we capture this input with as much frequency as we can, so we can, in real-time, make any adjustments or incorporate what they suggest to make it better. 

Dr. Vieux: Being able to deal effectively with the initial ambivalence will enable you to actually develop a product that will meet the culture of your specific institution. Each institution has its own unique needs. Being able to be aware of that and be able to listen to what people are saying, that is how you are able to actually have the buy-in that’s needed to have a successful project. 

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

Jonathan: We are always looking in our rural county to improve services and to improve broader access. In a rural area like ours that has a somewhat long history of being economically disadvantaged, new ideas like this are often met with skepticism — “We’ll believe it when we see it.” We happen to have the right people at the right time who have now been able to access funding to make this work possible. I think that those three things combined have really helped to engage all the stakeholders around the table and across the community to embrace the service and make it the best that we possibly can. 

How has COVID-19 impacted your plans?  

Royce: Telehealth is something that is going to keep moving forward. I think it is critical that if you are a health system that is considering implementing a broad scale telehealth approach, stay ambitious. Some may say the work plan is a little too ambitious. From our standpoint as a team, we looked at our work plan and decided to go with it. We wanted to be sure it was sustainable. We took a chance on it and ran with it. So, I think ambition and buy-in are critical to moving forward with a program like this. With the disruption that COVID-19 caused to our health system and community, I cannot tell you how important it was for us to maintain ambition and buy-in of our program. 

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