The COVID-19 pandemic highlights a large number of opportunities for the future of telehealth. Hospitals and health systems are expanding beyond their traditional four walls and using telemedicine to bridge communications gaps using mobile technology.
Becker's Hospital Review recently spoke with James Woodson, MD, CEO and Founder of Pulsara, about telemedicine and real-time communication among healthcare providers. As a mobile health (mHealth) expert, he shared where there's room for growth for telemedicine in the acute care space and how mobile tech can streamline communication for providers in chaotic and unpredictable environments.
Mobile tech, an untapped resource to unite care teams
When CMS lifted state licensing requirements and expanded telemedicine reimbursement for Medicare members in response to the COVID-19 pandemic, hospitals in many regions of the country weren't prepared for the changes. These providers focused on using telehealth solutions they already had in place, which were built under pre-COVID-19 reimbursement and regulatory requirements.
"Most telemedicine solutions in the acute care space are designed for patients who are stable or stationary," Dr. Woodson said. "Pulsara is really designed for patients who are unstable, or who are transitioning between organizations or departments. We work for the stationary patients as well, but it's a unique thing to be designed for patients specifically who are in transition."
Most telehealth solutions aren't designed to meet the needs of acute care patients in transition. This challenge was highlighted with the surge of COVID-19 cases because the situation requires individuals to mobilize and form care teams in an unpredictable and chaotic environment, which can be difficult if the telehealth solution isn't calibrated for such situations.
"Telemedicine should not be limited to outpatient or specific disease states, or super rigid interactions based exclusively on expensive, proprietary hardware," Dr. Woodson said. "It's important for us to look at mobile technology as a powerful tool that we all carry and is in our hands. This offers a huge untapped opportunity to unite teams."
Built for time-sensitive emergency care
Pulsara's telehealth and communication network specifically focuses on uniting team members who are mobile and practice in chaotic environments, such as the acute care space. The company offers telemedicine and communication solutions that are designed to connect teams, through audio, video, images and more.
Given Pulsara's core focus, the pandemic has reinforced the need for telemedicine usage during events like pandemics or natural or manmade disasters. In these situations, it is important for healthcare organizations to adopt an emergency preparedness mindset, which relies on principles such as flexibility, standardization and collaboration. Emergency situations often call on developing care teams with individuals from many different organizations. When communicating, they should leverage the same intuitive, digital communication tools they use in their daily lives.
In addition to uniting team members practicing in chaotic environments, Dr. Woodson said, "Pulsara can also unite a care team around an event … and then can bring in the correct consultants or organizations as the patient's case evolves."
Bridge clinical communication gaps to decrease treatment times
Studies have shown that hospitals and health systems that have leveraged Pulsara's clinical communication and telehealth network have shown an average decreased treatment time of 30 percent. While Pulsara's communication and telehealth network has traditionally been used in emergency settings, the company's expansion to support COVID-19 care has been relatively seamless.
A health system in a major metropolitan area recently partnered with Pulsara to streamline care for COVID-19 and better manage patient surge, according to Pulsara's recent "Improving COVID-19 Response Together" case study. Prior to tapping Pulsara, the organization used separate lines of communication across multiple technologies and facilities, resulting in the transfer of incomplete information relating to COVID-19 patients.
Ineffective communication tools caused various challenges for the health system, particularly patient triage. In one example, a patient thought they were experiencing COVID-19 symptoms and didn't know where to seek care. The patient called an urgent care facility that was able to evaluate them and contacted a transfer center at a hospital, which then directed the patient to call 911. Emergency dispatch reviewed the report and identified the patient as a possible COVID-19 case and sent out a special response ambulance. However, once EMS arrived on scene, they determined the patient was stable enough to remain at home and receive treatment there. This specific instance caused frustration for the health system.
Case study authors concluded that the time spent on the situation could have been used to respond to other urgent cases. The situation also resulted in the wasteful use of valuable personal protective equipment and potential exposure to multiple providers.
After implementing Pulsara, the health system immediately realized a reduction in avoidable exposures and consumption of PPE. With the telehealth platform, clinicians are now able to use live video to remotely assess patients and communicate with other providers. All providers at the health system are now connected on a single patient channel, allowing clinicians to triage patients to the necessary care option via virtual communication to limit clinician and community exposure.
Pulsara also helps streamline other emergency care, which further limits provider exposures throughout the duration of the COVID-19 pandemic, Dr. Woodson said.
When treating a stroke patient, for example, many different people across various organizations must come together to collectively serve the patient. Previously, when a patient presents with stroke-like symptoms and has a fever, EMS typically alerts the hospital, which then mobilizes its radiology team and ensures the patient can be transported directly to the CT scanner. With Pulsara, EMS can send a multimedia, telemedicine-based report instead of traditional radio to alert the downstream care team members such as the radiologist, radiology technicians, emergency department, neurologist and responding stroke team.
But, with the fever and other COVID-19 symptoms, everything gets more complicated.
"They can all be activated and alerted that this is an inbound patient with suspected stroke who may even have COVID-19," Dr. Woodson said. "A neurologist, even before COVID-19, had to make an average of 17 phone calls to coordinate care around this stroke patient. Now they're able to leverage a tool like Pulsara that's designed to unite teams across organizations and truly simplify care and decrease these treatment times."
Boost stroke care team coordination times
CHRISTUS Good Shepherd Medical Center in Longview, Texas, has experienced the benefit that a streamlined communication process can have on stroke care. The hospital, which responds to an average of 60 time-sensitive stroke cases per month, implemented Pulsara's mobile communication platform in 2013 to improve door-to-needle times.
Before deploying Pulsara, CHRISTUS Good Shepherd Medical Center's EMS, ED, nursing, CT, and neurology departments used multiple communication channels, often resulting in missing information and miscommunication during time-sensitive emergencies. Further, staff struggled with a lack of team coordination and found themselves out of sync when providing stroke care.
"One challenge we found was that everybody providing care was looking at their own clocks, which weren’t necessarily in sync," said Jennifer Reeves, RN, Stroke Program Coordinator at CHRISTUS. "I may be looking at the time on my watch and the charge nurse could be looking at the one on the computer."
After replacing legacy communication tools such as pagers and phone calls, CHRISTUS providers tapped into a centralized, mobile app that housed all critical patient information needed to coordinate stroke care. With Pulsara's solution, the entire care team began to communicate on a single patient channel that provided real-time video and audio calling, alerts, a universal clock, vital signs, and other multimedia to help streamline care team communications.
In 2019, the CHRISTUS Health System and its EMS partners successfully treated 472 stroke cases while using Pulsara. CHRISTUS discovered when EMS used Pulsara, the stroke team was activated an average of eight minutes before patient arrival versus 12 minutes after the patient arrived when Pulsara was not used. The collaboration between EMS and the hospital also led to a 59 percent decrease in door-to-needle time for patients receiving tPA. Later that year, in recognition of the strides made to improve care for time-sensitive stroke cases, the American Stroke Association honored CHRISTUS Good Shepherd with the Target Stroke Elite Plus Quality Achievement Award.
Click here to read the full case study.
Telemedicine is the future
Pre-COVID-19, the future of telemedicine was complicated and riddled with varying regulatory and reimbursement requirements that served as barriers to widespread usage. But if there's one silver lining to this pandemic, it has been the growth of telemedicine and alignment of incentives to allow it to truly take off, Dr. Woodson said.
"We knew there would eventually be a decentralization as well as a consumerization of healthcare, we just didn't know that it would happen overnight like this," he said.