Dr. Bradley Anderson, medical director, virtual care, at Oklahoma State University Medicine
Photo: Oklahoma State University Medicine
Oklahoma's healthcare system is unusual because while the Sooner State boasts two large metropolitan cities – Tulsa and Oklahoma City – the rest of the state is predominantly rural. Most healthcare access in these areas comes from rural clinics and critical access hospitals.
THE CHALLENGE
As these rural community health organizations are essential to Oklahoma's overall healthcare system, it is imperative they remain open. Their vital role includes serving as a healthcare resource for their communities by providing emergency services to stabilize patients and offering primary care close to home.
The Oklahoma State University Center for Health Sciences operates under a land-grant mission, which means it is committed to serving all citizens of Oklahoma – especially those in rural, underserved areas.
"We offer a broad range of service lines designed to expand access to care for these communities," said Dr. Bradley Anderson, medical director, virtual care, at Oklahoma State University Medicine. "However, these rural areas have struggled for years to maintain consistent healthcare access and keep their clinics and hospitals operational.
"They face challenges such as limited access to qualified providers and insufficient resources to maintain their infrastructure," he continued. "With OSU taking the lead in primary care in rural Oklahoma through both a medical school and a PA program, we are uniquely positioned to supply highly qualified providers to these communities."
However, sending providers in person is difficult due to the vast distances between locations. Instead, the healthcare organization has used virtual care and technology to connect its providers with patients across Oklahoma – not only in clinics but also in hospitals.
"Telemedicine enhances services for these communities by enabling primary and specialty care in local clinics, which allows for follow-up care closer to home," Anderson explained. "It also improves care within community hospitals, making it possible to keep more complex patients in rural critical access hospitals.
"This approach allows hospitals to retain reimbursement and patients to remain near their families and reduces transportation costs – resulting in overall lower healthcare expenses," he continued. "It's a win-win-win for everyone involved. We needed a telemedicine tool that allowed our physicians to conduct medical-grade exams from afar, replicating an in-house visit, which most telemedicine tools could not provide."
PROPOSAL
Telehealth technology vendor Tytocare has enabled OSU CHS to see a patient anywhere while conducting a medical-grade exam using its technology and handheld device, which allows providers to examine patients' throat, ears and more.
"If I have an individual who can act as a telehealth presenter, I can see a patient and make a healthcare plan," Anderson explained. "This device puts the provider in command from any location in the U.S. and walks the telehealth presenter through seeing a patient.
"From listening to the heart, lungs and abdomen, to seeing in the mouth and ears, and seeing complex wounds or rash, I can truly perform a complex physical exam virtually with this device," he continued. "Here at OSU Virtual Care, we have used a variety of other telehealth devices, but the ease of use for the provider and nurse/telehealth presenter is how we have been able to scale at an exponential rate across 40 locations, that include hospitals, clinics and schools."
MEETING THE CHALLENGE
OSU CHS initially implemented the TytoCare technology within its school-based care program, there finding its effectiveness as a valuable resource. Subsequently, it expanded the technology's use across all service lines.
"Its chief advantages are straightforward instructions, intuitive operation and the capacity for providers to guide telehealth presenters through examinations," Anderson noted. "At OSU, we developed a web-based EHR platform customized to our needs. Early challenges in deploying virtual care include limited integration with partner hospitals and clinics – all of our partners are unassociated with OSU and use a variety of EHR systems such as Cerner or Meditech.
"Therefore, we needed a web-based EHR accessible for OSU providers and a device familiar to them, integrated with the partners' EHR platforms to streamline patient care," he continued. "I also needed a device to see the patient that would easily integrate into the EHR system. TytoCare met these requirements, allowing us to scale the program efficiently and support a wide array of patients, clinics and hospitals."
When it comes to the school-based program, there are many schools across Oklahoma that do not have a nurse. A secretary, front-office worker, teacher or counselor acts as the nurse.
"We wanted to have the ability to use whatever resource the school had, thus we do not require the school to have a nurse in order for us to provide services," he said. "We do provide training to multiple staff members at each site on how to be a telehealth presenter. It was paramount that the equipment be easy to use and the vendor fit this bill.
"Its compact size allowed it to be placed in small offices all over Oklahoma schools but also allowed it to be placed in a backpack and when combined with a hotspot we can carry to schools throughout a district," he added. "We have found that an effective program is a program that is adaptable and malleable to the partner that it is trying to help."
RESULTS
Anderson reported telehealth success among all OSU CHS service lines.
"Certainly, we have had moments where we have struggled and moments where we made the wrong steps, but in the end, we have had great success in improving access to care in rural communities," he said. "There are several numbers that have made me proud to be a leader of this program, one being the 80% reduction in unnecessary transfers to higher level of care.
"This allows patients to stay near their hometowns and in rural community hospitals that allow for these facilities to keep their lights on, keep jobs in the communities and make patients happier," he continued. "With a hospitalist or cardiologist consult from OSU Virtual Care at one of our 24/7 critical access sites with swing-bed admissions, we see an average increase in revenue of $25,000 to $35,000 per patient stay. Swing bed admits typically stay longer than a normal acute care admission."
Rural hospitals often face significant challenges of recruiting clinical talent. Through the virtually enabled care model, OSU CHS has helped eliminate this barrier, saving partner hospitals an estimated $200,000 to $350,000 in recruitment costs while still ensuring patients receive timely, high-quality care locally through the virtual access model, he added.
"When a cardiologist sees the patient virtually at these facilities, the patient is able to stay at that rural hospital for the remainder of their hospitalization 50% of the time," Anderson reported. "This again allows us to prioritize the patients who need to be transferred but still get patients the necessary specialty care in their local hospital.
"With the school program, we have seen a return to class rate of 54%, improving overall classroom attendance and time to treatment for children," he continued. "This has led to 240 hours of preserved education time – roughly 37 school days – for the children in these communities."
Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
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