Define Success

What problems is the organization facing that telehealth can help fix?  Are you looking to reduce returns to the hospital (RTH)?  Are patients unnecessarily transferred to the ER for a condition that could have been treated in place by a physician?  Are your nurses overwhelmed with staffing shortages?  Are your physicians burnt out?

Recognizing which problem(s) a telehealth program can solve should be one of the first items to consider before incorporating the technology and services into your care processes.  Establishing goals and tactics for a telehealth program should also be included.  For example, if a SNF is experiencing higher return to hospital rates than expected, they should seek a telehealth partner that can be effective in helping them reduce unnecessary transfers to acute care.  Understanding if there are peak periods when patients are being transferred may identify gaps in care where telehealth could be applied.

Once the problem is identified, it should then be decided what the expectations are with a telehealth program in place.  If it is intended to reduce returns to the hospital, goals should be set to determine if the program is successful.  Defining the desired RTH rate and putting reporting in place to track progress are logical next steps.

Operationalize

Once goals and tactics are in place, and a telehealth partner has been selected, it’s time to put the telehealth to work.  In order to do so, workflows need to be established that define when telehealth should be used.  Medical Directors and providers, Administrators, IT Administrators, Directors of Nursing, and educators should all be involved. Processes also need to be in place to guarantee the program is operating efficiently with proper follow-up and reporting in place. Ensuring the technology can be used throughout the SNF is one of the most important operational steps to consider, but oftentimes is an afterthought.  If using iPads, for example, there needs to be consistent wifi access throughout the building.  Putting protocols in place to determine if and when to use telehealth is a critical step.  Also, designating individuals who will be responsible for certain tasks, from educating the nurses on the floor, to following up on physician orders, to tracking RTH, each facet must have someone overseeing to oversee it solidify the program’s success.

Front Line Involvement

For a telehealth program to truly be successful, the front line staff must be involved from the beginning, especially since they are the ones who will be using the telehealth services. Gaining their insights as to which features would be most beneficial (or detrimental) to their work will enhance their buy-in of a program, leading them to utilize the services and help the organization reach is programmatic goals.

Champions in the Building

Appointing at least one champion is another way to create a successful telehealth program.  The champion should be familiar with the program and be available to serve as the go-to for onsite support or an educator for incoming nurses.  This helps maintain consistent utilization well after the initial installation, especially when staffing changes are a “given” in the post-acute world.

Outcomes

Just as it is important for all players to have input and understanding when implementing a telehealth program, it is equally as important for them to know the outcomes of the program, as well.  When everyone understands how telehealth is affecting the organization as a whole, they gain further appreciation and continue to advocate for the telehealth program to be in place.

Proof

One senior living community organization, CarDon & Associates, has adopted a telehealth program in several of its facilities and almost immediately experienced highly favorable outcomes, mainly from applying the tactics mentioned above.  The organization, as a whole, adopted Third Eye Health’s telehealth technology and services.  From executives to Medical Directors to clinical leadership to nurses – all had buy-in of the program from the beginning.

Read about their story, here.

The post Creating a Successful Telehealth Program appeared first on Third Eye Health.

Beyond the Scope of Work

The primary function of Third Eye Health serves to bring access to our board-certified physicians on nights, weekends, and holidays when attending physicians are on call and unable to lay eyes on patients.  Using our secure telehealth technology via an iPad, nurses connect with Third Eye Health physicians in less than two minutes who, on most occasions, treat patients in place without a transfer to the ED and the added risk of an unnecessary readmission.  While treating in place is the core objective when becoming a Third Eye Health facility, there are several additional benefits to appreciate.

Transfer Preparation

While Third Eye Health physicians do have a 90% treat in place record, there are times when our doctors will recommend an acute care transfer due to the circumstances of the consultation.  On such occasions, our physicians may stay online with the nurse through the iPad, assisting in the preparation of the transfer.  If necessary, our physicians can assist the staff nurse with additional orders that could include oxygen, nitro to mentions a few common orders.  Our physicians also can communicate directly with the paramedics when they arrive, relaying pertinent details if needed.

Risk Mitigation

Following each Third Eye Health coverage period, each facility receives a summary of every encounter, alerting the Director of Nursing and the attending physician of any activity that occurred with each patient.  Beyond a simple summary, our Care Coordination Managers, who are all nurses by trade, apply a high level of scrutiny while reviewing each case.  They take the time to look at patient medical history, especially in cases that raise flags of concern.  This is an invaluable service. Our Care Coordination Managers serve as an extra line of defense, providing a second set of eyes for DONs and nurse leaders to review patient encounters and find areas for improvement, for the center, and for the Third Eye Health physicians who are consulting patients.

Case Study: Initiating Plans of Correction

Extension of the Clinical Team

Each Care Coordination Manager works closely with their centers.  Following every Third Eye Health physician encounter, the Care Coordination Manager reviews the progress notes and orders conducting quality analysis checks, ensuring all orders are signed and notes are complete.  Center Directors of Nursing and attending physicians rely heavily on the daily care summaries provided by their Care Coordination Manager to understand the care their patients received while on our watch.  In addition to care summaries, the Care Coordination Manager also establishes a regular metric review, bringing together the center’s clinical leadership time to collaborate on improving care based on the metrics presented.  In some instances, they may review a particular case, or in others the Care Coordination Manager may find reoccurring issues in her metrics that may need to be addressed and work together to establish new protocols that would better serve the patient population.

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Our partners and their patients trust that our services and technology always have their best interests at heart.   Keeping patient medical records and passwords secure from attackers is our highest priority.  They only need to get it right once, which means we must get it right every single time.  To do this, we reduce the number of attack surfaces or ways they can penetrate our system.  From our applications to our hardware, everything is safeguarded.

There are two primary criteria for ensuring secure data – 1) it must be encrypted in transit (HTTPS) and 2) it must be encrypted at rest.  Often times a company will claim to “whole disk encrypt” the database claiming encryption at rest.  The problem with this method lies in the possibility of accessibility to the database directly, virtually or physically.  If one exists, it really is not encrypted at rest.  We eliminate this threat by encrypting each record of data individually with its own initialization vector, or unique encryption, eliminating a common key to decrypt all the data. We also don’t store our data on internal servers or internal hard drives.  Everything is kept in a highly secure cloud-based data centers.

When it comes to the iPads used for our telehealth consults with Third Eye Health physicians, similar measures are in place.  Nothing is stored on the iPads, photos are sent to the device as a transmitted image file called a byte array and displayed directly on the screen, so no files are saved on the device. Texts or medical records viewed during the patient consult are gone as soon as it is complete.

Perhaps the best way to understand how we keep patient records and corresponding data secure, is by following the data through the workflow of one of our consultations.  Third Eye Health works with some of the leading EHR providers for post-acute care, PointClickCare and MatrixCare, creating secure integrations with SNF EHRs.  When a nurse is requesting a consult, the integration allows for the nurse to select the patient which loads encrypted data from the EHR directly in our application. During the consultation, any details shared (photos, text conversations) and metrics pertaining to the consult are then securely transferred with encryption to our cloud-based storage, where the data points are encrypted there, as well.

Of course, our workflow does not stop with the end of the consultation. We’ve found that patients experience better outcomes when there are not gaps in care, and so every encounter is reviewed by a Care Coordination Manager in Third Eye Health’s dashboard.  Once again, the dashboard connects with each facility’s EHR in a similar fashion as when accessing and connecting the patient’s name through the iPad by encrypting the data.  It is here where Third Eye Health physicians make notes and submit orders, sending them directly to the EHR. Care Coordination Managers can review this documentation in our system for quality assurance and provide care summaries to the SNF through our secure care coordination messaging platform, even providing links directly to the medical record.

Not all telehealth is created equal when it comes to security.  During the pandemic, some physicians were using Zoom and other unsecure video conferencing platforms to conduct virtual patient visits. Being able to consult with patients in a secure digital environment ensures HIPAA compliance with The Security Rule, preventing unauthorized individuals from accessing health records.  By partnering with Third Eye Health for your telehealth needs you can be certain your patients and their records are safe.

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Originally, to highlight the compounding issues for post-acute clinicians, this article was meant to have a funny tag line like, “Doctors are People, too,” an attempt to tease out the fact that physicians have regular lives like the rest of us.  An allusion to the idea that in order to be better physicians, they should have the time to tend to those lives – just like when we mortals clock out from work each day.

However, when researching the current literature behind subjects like burnout and the national physician and nursing shortage we are currently experiencing, the topic suddenly became less humorous. Not only is this subject not funny, neither has been our cultural reaction to it – nurses are simply encouraged to work more and physicians operate by day and take call at night.

Booming Issues

Let’s start with the source of our collective challenge: World War II. In our country’s understandable exuberance in the climactic suppression of global fascism, we procreated at an exponential rate, producing that aptly named Baby Boomer generation. That generation now makes up our venerated grandparents and parents who are aging into the post-acute portion of the medical complex in the United States. According to the Association of American Medical Colleges, “The population of individuals 65 years and older is projected to increase by 42.4 percent between 2019 and 2034, outpacing general population growth at 10.6 percent during that period.” Among those 65 year-olds are going to be an accelerating group of retiring physicians, exacerbating the challenge of how we plan to care for this aging population. It is also from this age range of patients we see an ever increasing rate of the diseases which are the leading causes of death in the United States: heart disease, stroke, cancer, diabetes, COPD, and dementia.

This convergence of increasing and decreasing populations (patients vs. clinicians) does rationalize many of our current conversations with Skilled Nursing Facility (SNF) leaders who explain shortages in personnel to cover their daytime clinical needs. With these compounding issues, it is routine for SNF buildings to have a clinician physically present only 3-4 days a week. None have physicians present at night, when many change of condition events occur.

The humor vanishes because the patients involved are our grandparents. They will soon be our parents. Eventually, we all are destined to become patients of an environment in which we are estimated to have a lack of up to 124,000 physicians by 2034. Juxtaposed against this are the recommendations made by Lockley, et al in 2007, in which they published their recommendation in the Joint Commission Journal of Quality and Patient Safety for the United States to strongly consider the establishment and enforcement of safe work-hour limits for clinicians due to the preponderance of evidence linking performance decline to fatigue.

Fighting Fatigue

Our doctors and nurses are tired.

Turns out, Europe agrees, and their agreement predates the Lockley conclusions by 9 years in a law passed in 1998, becoming 100% enforced by 2009. Their policy even has a snappy, yet benevolent title: The European Work-Time Directive. Here is how its policy is applied to physicians. In it are what would be groundbreaking concepts within the United States healthcare apparatus – 11 hours of rest per day, a day off each week, and a requirement on the employer to keep records of hours worked.

And then there is the pandemic. In all the chatter about how businesses are disrupted, schools turned upside down, and so much more white-collar work now getting done in pajamas, did we forget about the most vulnerable among us – the elderly and infirmed? ,It was the nursing homes in this country which bore the brunt of COVID-19, compounding even more issues for post-acute clinicians. They were the most vulnerable prior to the pandemic and they will remain so in the its waning days and beyond if we don’t move to address some of the glaring gaps in care. What should we do for this population at the beginning of what is predicted to be hockey-stick growth? Also, do we have anything to offer the post-acute clinicians who have chosen to dedicate their professional lives, caring for our vulnerable?

Let’s hope so.

Doing Better for Our Clinicians

If not groundbreaking for the post-acute space, perhaps measures such as those from Europe mentioned above would simply be … a relief?  Warranted? Deserved? To the Director of Nursing doing night shift due to lack of staff.  To the contracted nurse practitioner working all day and then manning the pager at night.  To the primary care physician doing the yeoman’s work of driving from building to building in effort to reach all the patients under your care while knowing with the certainty of arithmetic that you can’t reach them all. We have something for you – a pillow.

At Third Eye Health we are a physician practice, focusing exclusively on the post-acute space during periods of time where providers typically take call but should really be sleeping. Our typical coverage hours are 7pm – 7am weekdays and 24/7 on the weekend. What did that EU law say clinicians should have?

11 hours of rest – we provide 12

1 day off per week – we provide 2

Documentation of hours worked – no problem. We provide custom integration with post-acute EHRs, including leaders in this space, PointClickCare and MatrixCare. Everything is documented in your system of record.

As the saying goes, necessity is the mother of all invention…

Relief for Post-Acute Clinicians

When we made the determination to become an exclusively after-hours practice (in so doing becoming Third Eye Health), it was with expressed purpose to create an environment in which post-acute clinicians can sleep through night and have their weekends back – just like every other person in a “typical” job. Afterall, doctors are people, too, right? We leverage our proprietary telemedicine technology to receive calls from SNF nurses, treating patients in place +90% of the time. Our team of board certified physicians do this with an average response time of less than 2 minutes per call. To date, Third Eye Health provides this service to +800 clients, and has fielded +500,000 encounters.

Those who continue in their pursuit of clinical improvement on behalf of the vulnerable are to be praised. However, in the pursuit of the level of care wished for ones own family members, the privilege of sleeping through the night simply should not be on anyone’s list of concerns. There are much larger fish to fry as we all work to bridge the ever-growing gap between the number of patients needing our attention and the clinicians who strive to meet that need.

written by:

Joshua Streit

Director of Growth

Third Eye Health

The post Compounding Issues for Post-Acute Clinicians appeared first on Third Eye Health.

The Difference

Every site with access to Third Eye Health telehealth technology and physician services receives a dedicated Care Coordination Manager, who is fundamental in providing warm hand-offs back to the primary care team following all Third Eye Health encounters.  Every day, Care Coordination Managers, who are nurses by trade, review the details of each consult for quality assurance, looking at notes and orders.  As the primary care team and providers are just beginning their days, they receive a secure, custom care summary from the Care Coordination Manager.

The Care Coordination team reviews all Third Eye Health physician encounters, serving as a second set of eyes and ensuring the proper treatment and care of each beneficiary.  They also recognize areas where protocols and procedures may need to be tightened up and work with post-acute and long-term care leadership to improve those procedures and enhance quality initiatives affecting care 24/7, not just when Third Eye Health is on call.

Much like physician access and telehealth technology, long-term care facilities qualifying for LTC ACO sponsorship will have the added benefit of Third Eye Health’s care coordination services available to all residents, not just LTC ACO beneficiaries.  With these extensions of Third Eye Health in place, it is certain that outcomes will improve for all involved, while returns to the hospital and unnecessary readmissions will diminish.

To understand the full impact Third Eye Health and LTC ACO could have on your center, fill out the form below.  A member of our team will reach out.

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