Before the COVID-19 pandemic, University of Colorado Health had been developing multiple virtual care systems over several years.
Aurora, Colorado-based UCHealth created its Virtual Health Center, which provided a virtual urgent care system, Safety View virtual sitter program and virtual ICU system, and centralized telemetry monitoring services.
Further, the health system was beginning to develop technologies to remotely monitor patients at home, renovare ap 2 camere specifically for diabetes care.
In addition, UCHealth was working with vendors to deploy a wearable patch that allows passive vital sign monitoring and data collection. The remote patient monitoring efforts were meant to supply support to over-stretched inpatient units by creating a means to provide care for acute patients in their home, thereby reducing length of stay while aiding in managing chronic illnesses and disease.
"On the ambulatory front, we had created a solution for home telehealth visits, had a robust tele-stroke and mobile-stroke program, and offered a small virtual specialty outreach program," said Kathy Deanda, senior director of virtual health at UCHealth. "Our hope was this technology would assist with ambulatory access and space issues, especially in our more sub-specialized clinics.
"The need for care in our rural communities also was extremely important to our health system; supporting communities across the state became an initiative of our telehealth programs," she continued. "We also were developing a solution to address our lack of behavioral health support both on the ED and ambulatory fronts."
As is the case in other states across the country, behavioral health resources are extremely lacking in Colorado, she added. The hope is that telehealth technologies would help UCHealth stretch resources a bit further, and a virtual centralized solution would provide more support with fewer resources, not because UCHealth did not want to hire more resources but because there were none to hire.
The telehealth and RPM use cases UCHealth was working on prior to the pandemic shifted gears when the health system was forced to fast-track many of the initiatives in a more controlled approach.
In the ambulatory space, where virtual home visits were meant to help relieve access and space issues, UCHealth now was faced with using technology as an alternative to in-person clinic visits. Suddenly the demand was more than the health system ever conceived it would be.
"Scaling this virtual visit capability and capacity was an extreme effort by our virtual health technology team to add on the infrastructure to support the new demand that no one could have predicted."
Kathy Deanda, UCHealth
"Our virtual care infrastructure was not meant to support the number of home visits we were predicting, and while we had the backbone and design in place, we were pressed to build upon what we designed to meet the new demands and to train many more clinicians who were not eager to jump on the telehealth train previously," Deanda explained.
"Technology we were building to meet the patients where they were suddenly became critical to many more patients isolated at home," she added.
From the Virtual Health Center perspective, technologies were meant to augment bedside care supporting both nursing and providers in these intensive care spaces.
"The RPM idea originally aimed at proving proof of concept became a necessity to decrease length of stay and a means to holistically manage patients with chronic illness and disease," said Amy Hassel, director of patient services for the UCHealth Virtual Health Center.
"Additionally, inpatient acute care and ICU units not only needed more eyes on patients from the virtual ICU or virtual sitter program perspective, but needed more hands, virtual or otherwise, all together."
Telehealth was the solution to many of these emerging issues and the health system was fortunate to have the infrastructure and trained resources in place to meet the needs. The charge became to expand it quickly.
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MEETING THE CHALLENGE
From an ambulatory perspective, demand increased from barely more than 400 visits per month to at one point more than 77,000 per month at the peak of the pandemic.
"Our virtual infrastructure needed to be scaled quickly," Deanda noted. "Working with our video vendor, we increased our infrastructure quickly and built monitors internally to watch peak concurrent users. We quickly converted more than 600 ambulatory clinics within three days to offer virtual options to patients and providers.
"While technology was certainly the shining star here, from video infrastructure to EHR build to make telehealth an integrated, seamless solution for both patients and providers, this also meant virtually educating thousands of providers and clinicians over the span of less than a week," she continued.
Many of these providers had never attempted a home telehealth visit prior to the pandemic. UCHealth created several online training sessions and spun up a command center available to address both user and technical issues.
"Scaling this virtual visit capability and capacity was an extreme effort by our virtual health technology team to add on the infrastructure to support the new demand that no one could have predicted," Deanda recalled. "Once established, we deployed technology to inpatient units as well to allow for virtual inpatient rounding.
"Our efforts to develop a solution for expanding our behavioral health offerings across the health system also was realized as we deployed technology to our EDs and ambulatory clinics as well as opened up virtual group visits and telehealth to our behavioral health clinicians and psychiatrists," she continued.
"We also were able to expand our virtual ICU capabilities and created intensive care areas where there were none before."
Amy Hassel, UCHealth
Given UCHealth expanded its video platform, it put together a project team to deploy technology in the form of iPads or carts with computers, cameras and speakers, and the EHR build, to allow staff to securely treat not only patients but staff remotely.
"The Virtual Behavioral Health Center is adjacent to our Virtual Health Center and serves our entire health system," Deanda said. "The providers all worked remotely from their home offices and our care coordinators who assist with external placements currently work on site.
"But utilizing the call management system currently used by our patient access team, we soon will allow this group to also work from home, making this a nearly 100% virtual support program, decreasing the need for office space and all that comes with it," she added.
The Virtual Health Center began to take on a much more prominent role for the organization.
"The virtual urgent care solution was now seeing primarily COVID-positive patients and, like ambulatory, the demand rose by more than 1,000%," Hassel said. "The Virtual Health Center also virtually provided support to employers who were struggling with reopening critical services to the community while managing COVID testing and isolation requirements for their employees.
"Employees were able to virtually connect with Virtual Health Center nurses who assisted with symptom management, testing protocols, and in some cases referral to virtual urgent care or local EDs," she continued. "Our Safety View and virtual ICU programs were expanded substantially across the health system to fill staffing gaps at all hospitals."
This also allowed UCHealth to expand nursing and provider oversight as the Virtual Health Center staff could watch many more patients than the over-stretched bedside teams.
"From the RPM side, utilizing wearable technology, we were able to discharge patients sooner, freeing up much-needed beds by monitoring the patient's oxygen saturation, heart rate and respiratory rate from our Virtual Health Center 24 hours a day, 7 days a week," Hassel explained. "Patients were enrolled in the program over a five- to eight-day period post-discharge.
"This program and technology allowed us to respond to many 'near misses,' when patients ran into trouble at home either because they were not correctly using their oxygen or in some cases ran out of home oxygen all together," she continued.
This technology allowed the Virtual Health Center staff to catch decreasing oxygen levels quickly and get them help at home, either by calling 911 or by getting the oxygen vendor to them quickly. The values were also integrated into the EHR to allow providers to track patients' progress at home and discontinue therapy.
"We also were able to expand our virtual ICU capabilities and created intensive care areas where there were none before," Hassel said. "In the midst of all of this uncertainty, we were still able to stand up our Diabetes Home and Remote Care Center.
"Working with our endocrinology team, the Virtual Health Center used technology to monitor patients' blood glucose levels and as such were able to quickly adjust medications, dietary habits and other lifestyle habits that proved to increase patients' compliance and decrease their overall A1C levels by almost 25%," she noted. "This program continues to grow and evolve today."
As the pandemic has changed directions on multiple fronts over the last two years, the UCHealth virtual health technologies have adapted. Many programs that were mere suggestions two years ago are now part of everyday practice.
The two most compelling expansions are in the ambulatory/virtual behavioral health area and the expansion of the Virtual Health Center RPM, virtual ICU and Safety View programs within the Virtual Health Center.
"The program that struggled to provide a little more than 400 home visits per month now has leveled to an average of about 20,000 per month, with increases seen during inclement weather, which in Colorado means snow days," Deanda reported. "In the past, these patients would typically be rescheduled.
"Our virtual behavioral health center has increased from an initial nine FTEs to 23 FTEs, as well as the addition of a psychiatrist and a psychologist," she continued. "We now are working on offering virtual behavioral health outreach to rural communities within Colorado and Wyoming."
Call volumes for this service have increased from six the first month to 752 in January 2022, and those calls encompass requests for virtual ED evaluations; virtual therapy sessions for staff, providers and contractors; as well as assistance with behavioral health placements and virtual help within ambulatory specialty clinics or those that do not currently have behavioral health clinicians physically onsite.
"We now are working on an all-virtual IOP program for both our patients and our staff, and have created multiple virtual group sessions," Deanda explained. "We also are developing virtual occupational health options for many of the employers we helped with COVID testing, vaccination and consultation during the height of the pandemic.
"Our virtual outreach programs have also been a very popular topic of discussion with our rural partners, and while technology is no longer a barrier in this area, provider shortages seems to be our stumbling block for developing these programs more widely," she continued.
That said, UCHealth is launching a tele-neurology program that will provide more extensive neurology support for rural communities outside of the typical tele-stroke offering the health system developed several years ago.
USING FCC AWARD FUNDS
UCHealth was awarded $998,250 by the FCC telehealth grant program for wearable remote monitoring devices so staff in the ICU and other departments can track their own temperature and other vital signs to reduce COVID-19 infections, and for patient monitoring devices that allow staff to conduct remote patient care.
"Because of these funds, programs that were slated to take years to accomplish were realized in just a few months, launching telemedicine as an integral part of how we treat patients every day, both in the inpatient and ambulatory settings," Deanda said. "This means we now are working toward offering more extensive care at home, such as hospital at home and more extensive remote chronic disease support.
"Outreach into rural communities via telehealth is now an acceptable practice in these communities and with these funds we've been able to deploy technologies that allow us to capture and transmit pertinent data, making remote patient care more reliable and comprehensive," she added.
The use of the virtual ICU services now is possible in all of the hospitals across the health system as the funds allowed UCHealth to purchase and deploy more specialized carts and cameras.
"With the help of these funds, we also are able to deploy devices to patients at home, such as glucometers and cell phones, which has allowed us to enroll many more patients into our RPM programs reaching more of our underserved populations, which were hardest hit by the pandemic and tend to have a higher incidence of chronic illness such as diabetes and heart disease, the two areas our RPM program is now able to focus on," Deanda said.
"The Virtual Behavioral Health Center advanced from an idea to a reliable service for our entire health system, expanding our behavioral health capacity to a point that we are now actively working on offering services to hospitals outside of UCHealth that we were not able to do just a few months ago," she added.
With the FCC funds, technology is no longer a barrier for this expansion and UCHealth is able to focus on processes and hiring of resources to meet the needs of the communities it serves, she said.
"The First Call program became a reliable resource for our employees struggling with the impact of COVID-19," she noted. "As such, we have developed long-lasting programs that will allow us to continue to virtually support our employees well past the pandemic.
"While much of our work in the areas we've described are process and people, the pandemic and the funds from the FCC gave us the opportunity to focus more attention on the process and people and less on funding necessary technologies to support our multiple virtual programs," she added.
"Given our ability to develop this program quickly, we are now working on technology that allows us to detect behavioral health concerns by monitoring patients' daily activities or alterations thereof."
As such, UCHealth hopes to expand this to its RPM program, allowing staff to treat the whole patient both physically and emotionally, she added.
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