Amid efforts to improve access to convenient and affordable care and offer a superior patient experience, many health systems are turning to telehealth to enhance their long-term strategic objectives. For Jacksonville, Fla.-based Nemours Children's Health System, this meant using virtual care to advance its mission in pediatrics.
"It's what Nemours is all about: improving the lives of children, from the time that they're born to the age of 18," said Carey Officer, administrator of telehealth at Nemours.
In a webinar sponsored by American Well and presented by Becker's Hospital Review, Ms. Officer, Nemours Telehealth Medical Director Shayan Vyas, MD, and American Well Health System Solutions Director Mike Lemovitz, discussed how the nonprofit health system uses telehealth to expand access to pediatric care, while also improving outcomes and quality.
"How do we take technology, adopt it and then improve the goals that we want?" Dr. Vyas explained. "As we expanded our strategic goals for the future, we realized telehealth was essential."
How telehealth fit into Nemours' strategic plan
Nemours strives to continuously infuse modern technology into children's healthcare. For example, the health system has provided patients and families with online pediatric health education content through its Nemours Center for Children's Health Media over the past 25 years. The center oversees KidsHealth.org, which boasts more than 260 million visits each year.
"We realized very early using technology to grow and expand our services was essential," Dr. Vyas said. "Today, we know healthcare consumers are adapting to telemedicine." Not only have patients and their families become more accustomed to virtual care, they actively seek it out as an alternative to inpatient care, which doesn't offer the same level of accessibility and convenience.
In February 2017, Nemours conducted a survey of 500 parental guardians in the United States, and found the majority (64 percent) plan to use pediatric telehealth within the next year. These digital adopters tend to value telehealth for its convenience (80.7 percent), immediacy (53.4 percent) and after-hours accessibility (52.3 percent).
When Nemours first launched Nemours CareConnect — its comprehensive telehealth program — it was one of American Well's first pediatric partnerships, according to Mr. Lemovitz. "Pediatric organizations tend to have a really good idea of where telehealth could benefit their patients," he said. "I think that's why we're seeing this area grow so rapidly."
Ms. Officer and Dr. Vyas detailed four ways the health system successfully deployed telehealth.
1. Store and forward. Unlike live video consultations, "store-and-forward" telehealth describes a service in which a patient's healthcare data and images are delivered to a remote physician, who can help diagnose and prescribe a treatment plan.
This asynchronous form of physician consultation marked Nemours' entry into telehealth, which the health system used to support radiology, neurology and cardiology patients who lack access to specialty care. "We're meeting the needs of some of these patients and families in more rural settings, where they just don't have the access to, say, cardiologists to read their study," Ms. Officer said.
2. Clinician-to-clinician. Nemours uses live video consultations to connect its general pediatric and critical care clinicians with outside providers who seek a second opinion. These external clinicians might be from partner hospitals or critical-care transport teams in another state. In a partner emergency room, for example, a specialist who does not typically treat children might need the input of a pediatric critical care provider.
As another example, Dr. Vyas shared how Nemours brought its clinician-to-clinician video solution offshore by partnering with a popular cruise line. "When the cruise ships are out at sea, if they get a sick child, they really need help," he said. "A telephone call just doesn't do justice." With video consultations, Nemours providers have the opportunity to directly see a pediatric patient's condition and guide a cruise clinician through an exam or diagnosis.
3. Clinician-to-family. Nemours also connects its primary care providers with the families of pediatric patients who present at partner hospitals, clinics and school nurses' offices. For school-based care, Nemours uses American Well's Telemed Tablet.
The clinician-to-family services proved especially useful for specialty care, like Nemours' obesity clinic in Wilmington, Del. The clinic brings together specialists, dieticians and psychologists to treat patients across the state. "In many cases, [patients were] driving from southern Delaware, which is about an hour and 45 minutes, to get to Wilmington," Ms. Officer said. To address this issue, Nemours began conducting follow-up appointments at patients' local primary care offices, connecting them with remote obesity clinic specialists via video. "We're meeting patients and families exactly where they are."
4. 24/7 on-demand. Nemours also uses its telehealth infrastructure to provide direct-to-consumer video consultations for urgent care, which Dr. Vyas described as "one of the hardest use cases in pediatrics." For this service, which most patients access via smartphone, six of the health system's pediatricians gained practice license across four states so they could treat patients at a range of Nemours facilities.
Through American Well's The Exchange platform, Nemours is also partnering with outside hospitals to enable its pediatricians to participate in the care delivery of new patient populations. "Our partners in Delaware and Florida are adult health systems that might not have pediatricians, so we populate their [telehealth] platform," Dr. Vyas said.
Listen to the webinar recording here.