Photo: Children's Mercy
Children's Mercy Kansas City is a pediatric health system with the highest-level designations in neonatal and pediatric intensive care, trauma and emergency services, fetal health and transport services.
THE PROBLEM
Children's Mercy supports the children of Kansas and Missouri, with the next children's hospitals being hours away in all directions. This extensive geographical region has forever been a significant challenge for patients and their families to access pediatric specialty care.
"The high demand for pediatric specialty providers and the constraints many families face regarding transportation, time off from work and school, and finances, made it obvious that traditional models of outreach healthcare were not sustainable," said Morgan Waller, director of telemedicine business and operations at Children's Mercy.
"Supportive leadership and persistent visionaries decided telemedicine was the solution to this continuously growing problem of too few specialists and pediatric patients with complex healthcare needs scattered and isolated all over rural Kansas and Missouri," she added.
PROPOSAL
Because of the distance barrier to care and recognizing that the value telemedicine can provide to achieve the Triple Aim goals of improving specialist access, quality of care and affordability, Children's Mercy Kansas City began to identify telemedicine and technology options to help treat patients across the regions served.
"After assessing options, which at the time Children's Mercy began this initiative, in 2011, were very limited, it was decided that InTouch Health, a division of Teladoc Health, offered the best telemedicine platform to support regional telemedicine outreach clinics," Waller recalled. "It was the dedication to quality, reliability and patient/provider experience that set Teladoc Health apart.
"Without any doubt, the devices InTouch Health offered a decade ago, in conjunction with their proprietary network, delivered unprecedented provider and patient experiences," she continued. "To truly have a solution to the access challenges for these pediatric patients, Children's Mercy needed to be able to replicate the same standard of care virtually, as that delivered in person, up to the highest level of encounter."
That means providers hundreds of miles away must be able to listen to breath sounds; look into the eyes, nose, mouth and ears; and view the scalp and skin up close or magnified, and do so uninterrupted by poor network quality or other technology noise.
"To argue for sustainability, investing in the highest quality technology ensured early adopters within Children's Mercy would lead the way and inspire new subspecialists to leverage virtual care services to treat more complex conditions and meet the needs of more patients across the region," she explained.
MARKETPLACE
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MEETING THE CHALLENGE
Telemedicine-enabled clinics were established in two locations in Kansas and two in Missouri with plans for more. The facilities are identical to traditional healthcare clinics, with the addition of Teladoc Health real-time, two-way interactive audiovisual technology that supports the use of JedMed digital ancillary exam devices.
BSN and RN tele-facilitators trained in multiple specialty assessments support the patients in person and the providers located in Kansas City to ensure that the standards of care are met (up to level 5 clinical encounters) for these complex appointments.
RESULTS
"Telemedicine improves access to highly sought-after subspecialists," Waller stated. "Rather than traditional outreach programs where providers would fly or drive for hours to see clusters of patients in rural areas, telemedicine allows providers to see patients during the time they would otherwise be in transit, and the reach is theoretically limitless.
"Since establishing the telemedicine department in 2012, the number of subspecialty encounters via telemedicine has steadily grown," she continued. "Prior to COVID, almost 2% of all ambulatory subspecialty care was facilitated via telemedicine. Children's Mercy has continued to support the patients and families in Missouri, Kansas and the surrounding region by maintaining their commitment to telemedicine and regional outreach."
Appreciating what a critical role the specially trained BSN and RN tele-facilitators serve in meeting the hospital's standard of care, and patient and family and provider experiences, for complex care delivered over distance, Children's Mercy has continued to onboard these talented nursing professionals.
"Additionally, telemedicine has shown the ability to lessen the financial burden for families by eliminating the costs of traveling considerable distances for care, food, lodging and/or childcare," Waller noted. "Parents and children miss significantly less time from work and school when seen in a telemedicine clinic.
"Having a mature, centralized telemedicine department also allowed Children's Mercy to rapidly switch to telemedicine appointments in the home during the spring of 2020," she added. "Within three weeks, the organization had all subspecialty practices and allied health services (51 separate service lines) ready to not only care for patients and families remotely, but to schedule, document and bill these encounters (not including the limitations of some electronic solutions at the time)."
At the height of the lockdown, Children's Mercy Kansas City converted 65% of ambulatory appointments to telemedicine in the home. Still, as the pandemic wanes, demand for telemedicine continues.
ADVICE FOR OTHERS
"Many organizations still are not utilizing telemedicine to its full potential," Waller cautioned. "It is disappointing that the increased awareness and understanding of telemedicine brought to the world by way of the pandemic has been limited to the patient home experience.
"Although an equally valuable practice, direct-to-patient telemedicine has limitations," she continued. "If the country and the world is going to cope with worsening shortages of physicians and healthcare providers, going beyond the traditional models of care for all types of services is necessary."
Leaders in healthcare will be those who seek out high-quality telemedicine technologies that connect to peripheral high-definition camera-enabled exam devices and digital stethoscopes while utilizing available bandwidth efficiently to maintain connectivity, regardless of extraneous conditions, she added.
"They will enable RN tele-facilitators to practice within the full scope of their licenses to partner with physicians, advanced practice nurses and physician assistants to deliver highly specialized care for complex patient conditions in the least intrusive ways possible," she said.
"They will outfit all patient care areas with the virtual sophistication required to replicate the standard of care via telemedicine for all services offered in person," she concluded. "And leaders in healthcare will recognize that achieving a mature delivery system in 2022 and beyond requires a dedicated team of telemedicine professionals working alongside traditional experts in healthcare at every level."
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