Prior to 2020, Colorado’s Boulder Community Health had put the infrastructure in place to support telehealth, but struggled to gain adoption because of limited provider and patient demand. Many community members prefer face-to-face visits or a simple phone call.

While there were certainly providers and patients who would prefer more advanced telehealth, the health system’s efforts to launch a program had limited success.

COVID-19 changed everything

“That all changed when the greatest impetus for telehealth that we have ever seen came about with the arrival of COVID-19,” said Michael Jefferies, CIO at Boulder Community Health.

“During this past year, we saw a steep decline in overall visits, and we know that a lot of that was care that was necessary. Telehealth was critical to connecting with our patients to continue their health maintenance safely in their own home.”

The past year was the most trying year in healthcare since the pandemic of 1918, he said. The difference is that today providers were able to respond with the support of technology.

“In March 2020, it was clear that COVID-19 was coming to Colorado,” Jefferies said. “We immediately stood up new analytics to measure the prevalence of the virus in our community and among our patients. We configured our electronic health record to guide the most up-to-date, evidence-based medical care for COVID-19, so that nurses and doctors were guided in providing care.”

The health system moved all business support employees to work from home within a week. That same week, it stood up telehealth capabilities to ensure that the most vulnerable patients did not have to leave their home.

Working with other organizations

“I then reached out to other nearby hospitals to initiate a data sharing initiative that allowed us to see how many ventilators and ICU beds we all had available in real time so that we could transfer patients to other facilities to save their lives if we hit capacity,” Jefferies recalled.

“We created a new drive-through COVID testing clinic with mobile device technology.”

When it came time to support the vaccination rollout, Boulder Community began contacting community members when it was their turn for the vaccination, enabling online or phone registration, and then electronically scheduled their second next dose as needed.

“Now that our providers and patients have seen the advantages [of telehealth], there is no going back.”

Michael Jefferies, Boulder Community Health

“Our telehealth efforts primarily consisted of phone visits, scheduled video visits, ad-hoc visits and remote patient monitoring through connected devices,” Jefferies explained. 

“At the beginning of the pandemic, we used the Epic electronic health platform as the wrap-around technology and Vidyo as the video platform. We found that this was excellent for certain scheduled clinic visits, but it required downloading multiple apps for the patient, which created a barrier.”

The health system worked with Epic to deploy an integrated video platform rapidly, which became available through their partnership with Twilio. The experience for the patients and providers was seamless, without requiring another video app download.

Still more challenges

Even with this early success, Boulder Community still had to solve the challenge of on-demand telehealth for situations like urgent care visits and other inpatient use cases, like remote chaplain care and psychiatric rounding.

To help overcome this challenge, Boulder Community applied for and was awarded an FCC telehealth grant of $638,842 for video visit workstations for the hospital, telehealth platform software licenses and remote monitoring equipment, in order provide home monitoring for COVID-19 patients and others at high risk.

Other uses included: 

• video visits for ambulatory, primary care and urgent care clinics to screen for COVID-19.
• hospital telehealth visits that allow patients in the emergency department and inpatient units to use their own device to have a video visit with a physician.

“The FCC grant enabled us to deploy new technology that solved some of the aforementioned problems,” Jefferies said. “We partnered with doxy.me, which excelled at the ad-hoc video visits for urgent care and for other use cases such as psychiatric rounding on inpatients.

“We provide extensive behavioral healthcare, but one of our concerns was that our physicians could become infected with COVID-19 at the same time, leaving us without critical coverage for our community.”

Tablets come in handy

So the health system devised a plan where it would alternate schedules for psychiatric specialists, and one of the providers would provide virtual rounding with a behavioral health nurse using a tablet. The health system found that this worked exceptionally well, and it only avoided it in cases where the patient had a sensitivity to technology.

“We were also able to use doxy.me for urgent care visits,” Jefferies said. “We continue to use this for ad-hoc visits to screen patients for COVID-19 and limit exposure at our urgent care facilities. This allows us to provide care for the patient and refer them for testing as needed, without creating a high-risk situation at our clinics.

“In addition to these forms of telehealth, we were also able to use the FCC funds to invest in remote patient monitoring through Vivify,” he continued. “One of our concerns was that our hospital and others in the region would reach capacity. In this case, we needed a plan to provide care for patients who had contracted COVID-19 without admitting them to the hospital.”

With remote patient monitoring, Boulder Community could create hospital capacity by discharging patients to home while monitoring their oxygen levels, blood pressure, temperature and other vital signs, along with video visits to ensure that they were safe. This was preferable for the patient who would rather recover at home, and allowed health system staff to have confidence that the patient was safe without being admitted to the hospital.

New uses for RPM tech

“Now that we have a manageable volume of patients, we are able to repurpose our remote patient monitoring devices for new programs,” Jefferies explained. “We are still working through the best use of the equipment, but we believe it could help with monitoring high-risk pregnancies, managing the health of patients with chronic conditions, and helping us monitor the care of patients after they are discharged from the hospital.”

The greatest achievement of the telehealth efforts over the past year at Boulder Community has been the health system’s ability to maintain the health of patients while they remained safely at home, Jefferies said.

“While not all care can be provided remotely, we have found that many patients have appreciated the convenience of visiting our physicians from anywhere they may be,” he said. “We believe that many of our patients who travel for business or have other demands in their life that make it hard to get into the office will also appreciate this service going forward.”

However, the most important impact was the ability to connect with patients, alleviate their isolation, and ensure they were maintained in good health throughout a pandemic that made it frightening for many of them to leave their homes.

“I, like many, am looking forward to the ability to care for our patients with both an in-person human touch with the added flexibility of using telehealth going forward,” Jefferies concluded. “Now that our providers and patients have seen the advantages, there is no going back.”

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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