Evidence-Based Telehealth Network Program 

The Georgia Health Policy Center recently spoke to Knicole Lee, D.N.P., CEO at HealtHIE Community Center in Baxley, Ga. and assistant professor at Valdosta State University, about the use of telehealth to expand access to COVID-19 and specialty care in rural Georgia. 

 

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

Our biggest accomplishment was our ability to utilize telehealth to combat COVID-19 early on. Initially, it was very devastating in rural Georgia, as it was around the country. But for us, there was a lot less access to resources and many of our providers did not have a telehealth platform and some of them did not know what Zoom or GoTo Meeting even was. Through my being faculty at Valdosta State, we were able to get graduate students to help download the app on patients’ phones and on providers’ computers to be able to start with some synchronous, face-to-face meetings that we were able to support. From there, it really expanded. 

In addition to using telehealth for monitoring and for screening, we were able to open an outpatient monoclonal antibody infusion center in rural Georgia and we have infused 1,046 patients with monoclonal antibody infusions. We do care coordination for 90 days with any patient that we diagnose with COVID-19 and ensure that they have what they need. Total, we have completed 7,687 encounters for COVID-19 since the pandemic started. 

 

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

I grew up in a town of 500 people where we actually have a small clinic now. That was one of the first out-of-the-box things we did. It is located in the middle of a huge farming and agricultural area, where people could not come into town to access care. The city was able to lease us for a dollar a year, a 600 square foot old voting hall that had a handicap accessible bathroom. We turned it into an outreach clinic where we use telehealth and a nurse to provide care to a very rural region. 

If you are not an out-of-the-box person, you are not going to survive post May 11 at the end of the public health emergency. You must get out of the box and figure out how you can make it work. We had some cardiologists that were not sure about Bluetooth stethoscopes. An Amazon speaker that costs $25 can resonate in a room 10 times the volume the sounds of the heart with that stethoscope connected to it. It was an easy fix, and it is not a million-dollar technology. 

For patients who are too sick with COVID-19 to get out to be infused, we send two nurses and take the infusion to the home out in those rural areas because it might be 20 miles to come to town. We have done what we needed to, to adapt to make it work. Are we perfect? No. But we have a great team that troubleshoots our technology and troubleshoots our devices so that when we do roll something out, we have some more than baseline knowledge to help our providers and patients. 

My biggest concern is the May 11 date when everything changes, and face-to-face requirements will be implemented for patients to continue to be able to utilize telehealth. We proactively started about 60 days ago ensuring that we were getting those people in. We provide some transportation for some of our outreach services for our patients. As a part of telehealth, you wouldn’t think that transportation would become an issue, but transportation is now an issue. This morning our transportation coordinator and social services outreach got hit with three transportation requests — one to Macon, which is 120 miles from where we are, and two to Atlanta, which is 200 miles.  

There are a lot of people out there that are in a lot worse shape than us because they don’t have a van and driver in place. But that is going to be a big challenge for everybody in rural areas. Telehealth is where it is at, but it is now going to take care coordination for brick-and-mortar visits with specialty providers. 

 

How do you see participation in the Office for the Advancement of Telehealth’s Evidence-Based Telehealth Network Grant Program impacting your broader telehealth or health improvement efforts? 

We are a hub — not only as a medical home for the patient, but to tell specialty providers to figure this out from the technology to who is going to be the presenter. It is really a process improvement for how rural health is delivered across the spectrum — from pediatric care with well-check evaluations to school health to specialty providers. 

By embracing this new concept of how care can be provided, we have been able to decrease hospitalizations of chronically ill patients who prior to telehealth were in the ER every 30 days or every 60 days. We provide care coordination for at-risk patients, and we catch things early. If somebody has a wound, we now have the ability to capture that wound with our dermatoscope, take a picture, and shoot it to a specialty provider and say, ‘What do you want me to do?’ instead of waiting until it gets worse. So, I think we improved the cost effectiveness of care and we probably saved over 50,000 miles in travel for individual patients and their families, which decreases the loss of time from work. 

 

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

The first is our ability to provide care coordination and in-home patient monitoring, which will only continue to expand. Telehealth has been the platform for that. Care coordination improves patient outcomes and quality of life of families’ health and communities. We also hope to continue to offset some of those travel costs.  

Then, secondly, our infusion center. There was an early need there for our monoclonal antibody infusion center, but soon we were known as the infusion center for the area. We partnered with oncology, which was something that we had not done previously for providing in-home fluid infusions. We began having clean day, early morning infusions for patients who are receiving chemotherapy and really expanded our ability to provide infusion services. 

 

 

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