Telehealth Network Grant Program – Maury Regional Medical Center
The Georgia Health Policy Center recently spoke to Shelia Barnes, program manager for the Maury Regional EMS Mobile Integrated Community Health Program, about the value the program is bringing to the hospital.
To date, what has been the biggest win in your telehealth program?
I am proud that we have been able to build a great team. In our first cohort of community paramedics trained, 100% passed on the first attempt. In Tennessee the requirements to practice as a community paramedic include completing a TN EMS state board-approved class, having five years of paramedic experience on an advanced life support emergency medical services (EMS) unit, and successfully completing the International Board of Specialty Certification examination. This allows them to receive an endorsement as a community paramedic on their paramedic license. We conducted another class that finished in January, so we now have a total of 10 community paramedics doing amazing work in the community.
Our team assists patients that either have mobility or transportation issues and digital literacy issues — lacking the equipment or access to connect to care via telehealth platforms. Our community paramedics go to their home, assess their vital signs and EKGs, and then connect them, through our equipment, for telehealth visits with their provider. We can also obtain any labs that the provider is requesting at that visit and bring them back to our facility for processing.
We have been able to help the hospital and the care management team with readmissions. One of our goals is to help reduce preventable readmissions for heart failure, chronic obstructive pulmonary disease, and diabetes. We take these patients’ hospital discharge instructions to the patient’s home, preferably within 24 to 48 hours after discharge. One thing we discovered was that their next follow-up appointments with their primary care provider or their specialist was buried on the very back page of their discharge plan — behind all of the pages of education — and so a lot of times they had no idea that they may have a follow up visit the next day or so and they were not aware they even had an appointment scheduled. Another thing we were able to show to the Hospital Readmission Committee was many patients were not paying attention to or not understanding their medication reconciliation. As part of the hospital’s Meds to Beds programs, our pharmacy brings 30 days of their medications to the bedside prior to discharge. This can help if the patient does not have transportation to make it to their pharmacy. But, we also found patients were taking their new medicine and their old medicine, and we have been able to intervene with medication reconciliation issues. We also made a lot of headway with patient education and helping people to navigate the health system. Every patient has unique needs, and we can help in most cases.
What is a tip or early learning that you would share with an organization launching a similar telehealth program?
We had a lot of turnover issues, not only in the project manager, but also in EMS administration and in the C-suite of our community nonprofit hospital we work for. That was a big challenge. But luckily, we have had huge support from not only our senior leaders at the hospital, but also from the care managers. Our new EMS director came from within the service, and he has been very, very supportive. All appreciate the work we are doing.
Our big challenge, now, is to sustain the program. One of the obstacles we encountered is that we really needed transportation for our community paramedics to go to patients’ homes. This grant did not allow us to purchase response vehicles, so the hospital foundation bought a vehicle specifically for mobile integrated health. Going forward, we hope that we can start generating revenue from some of the activities that we are doing, so that we can sustain and grow in the future, as there is a lot more to do.
How do you see participation in the Office for the Advancement of Telehealth’s Telehealth Network Grant Program impacting your broader telehealth or health improvement efforts?
Most requests for EMS services are not true life-threatening emergencies. We tend to be the safety net. There are many requests for EMS that we are anticipating shifting to the mobile integrated health division. Our hospital is on board with that because they recognize that it is a way to help with the overcrowded emergency room and patients waiting on beds. Plus, we have a huge lack of mental health providers, and we have many substance use disorder patients that are now falling into our practice. The hospital is seeing the value of what we can bring to the health system.
What is next on the horizon for your grant-funded program?
We have been able to integrate into the electronic medical record (Cerner) in our health system, which will help us improve our data collection. We want to be able to evaluate the services and have data to inform which ones are the best fit and which ones make the biggest impact on outcomes. That will be our next big focus — being able to prove that we are valuable. We have some good patient stories, but stories need data.