Becker's Hospital Review

91 PRACTICE MANAGEMENT THOUGHT LEADERSHIP Technology is the best prescription for advancing rural care By Kevin E. Lofton, CEO, Catholic Health Initiatives A s urban- ization has d r a m a t - ically altered the demographics of our national land- scape, the health and well-being of many rural Americans has suffered significantly from poor access to much-needed care. More than half of the pregnant women living in rural areas reside farther than 30 minutes from a hospital offering obstetrical and gynecologic ser- vices. In fact, a Scientific American study found the mortality rate among rural pregnancy cases was nearly double that of metropolitan areas. At the same time, rural hospitals are closing their doors at an alarming rate. Of the roughly 1,300 critical access hospitals open today, 700 are either vulnerable or at risk of closure, according to a study by the National Rural Health Association. ese are two of the stark realities facing rural families who farm, ranch and provide the many natural resources and food staples we rely on. ankfully for the nearly 20 percent of Amer- icans who live in rural communities, advances in telemedicine are finally helping providers bridge this divide. Still, more must be done. Englewood, Co- lo.-based Catholic Health Initiatives, one of the nation's largest nonprofit health systems, oper- ates 29 critical access hospitals — more than any other system in the U.S. At CHI our mission is simple: Create and sustain healthier communi- ties. For rural communities in particular, this means identifying new solutions and investing in new pathways to better, more affordable care. Today, CHI manages more than 80 telemedicine programs that are helping provide those solu- tions. While we know more needs to be done, CHI's rural hospitals have significantly improved care and increased access by integrating more re- al-time, two-way video and audio communica- tions into the care continuum. Simply put, this is saving lives. For example: • Virtual health services: is telephar- macy program provides critical services to 48 small and rural hospitals, many not part of CHI, that don't have 24/7 pharmacist coverage. is is a critical program because many new regulations require a pharmacist to approve lifesaving medications before they can be administered. e program provides audio/visual connections so pro- viders can verify the correct medications were retrieved from the hospital's med- ication dispensary, check IV admixtures prepared by nurses, and can help identify patient medications. Today, the service re- views 3,900 medication orders daily and averages about 70 interventions per day — each representing a potential health risk from an adverse reaction. We are using the same technology to help curb the potential of overprescribing antimicrobial medica- tions as well. Since the program launched in August, we have identified 2,736 inter- ventions, of which, 2,385 were accepted by the attending physician. is program alone has saved CHI $1 million in medica- tion costs while extending expert care into rural America. • Teleradiology: is initiative enables rural providers to have their patient's X-rays and images read remotely by a fel- lowship-trained radiologist. For example, a woman getting a mammogram in rural North Dakota may have her images read by one of our radiologists in Des Moines, Iowa. Enhancing maternity care for women outside a metro area is just one of the many benefits of this effort. • Telepsychiatry: is program pro- vides physician-mandated psychiatric evaluations for continued care and men- tal health sessions to those who typically can't — or won't — seek mental health- care, sometimes with devastating conse- quences. In the first six months of the pro- gram's existence, there were 284 patients in the emergency department given men- tal health diagnoses, resulting in 36 virtual ED visits. We have seen firsthand how this program can help prevent suicides and treat substance abuse. • E-hospitalists: In recent years, CHI has introduced e-hospitalist services to our communities. is newer platform for hospitalist services provides con- sults, hospital admissions and hospital follow-up care by using technology to re- motely connect physicians, physician as- sistants, nurse practitioners and nurses. is type of program helps keep patients close to home in their community hospi- tal, yet provides them with the appropri- ate level of care their condition requires. • Tele-asthma: At our tele-asthma clinic, patients receive the same set of services available in a normal clinic setting but without what can be a two- or three-hour commute each way. Patients are inter- viewed and examined via live radio by a resident physician and/or an asthma edu- cator located at St. Alexius Health in Bis- marck, N.D., and the exams are conducted via a Jedmed digital scope that is shared virtually. Since the initial asthma clinic opened in Dickinson, N.D., in November 2017, patient satisfaction surveys have been extremely positive, with patients re- sponding that they were either "very" or "completely" satisfied with the first tele- medicine asthma clinic in the state. Each one of these programs taught us valuable lessons. First, providers need to focus on lever- age and local empowerment. For example, while we initially deployed a video-cart solution to ad- dress our pharmacist shortage, our rural teams were empowered to explore other ways these as- sets could be used to fill the care gaps they face. at led to the telepsychiatrist program. We will also use the video carts to link eight of our rural hospitals with board-certified emergency room physicians 24/7. Second, to bolster rural health access we have to be open to these and other innovative technolo- gies and encourage our providers to embrace the disruptive changes that come with their use. We are introducing e-hospitalists to help perform inpatient consults remotely. is new platform will help those in the field — whether they are a physician assistant or nurse practitioner — better serve and diagnose issues remotely. is type of program helps keep patients at home while re- ceiving the level of care their condition requires. is care innovation represents a massive change in our protocols. It requires our specialists to be open to changing how they treat their rural pa- tients. ey have to become comfortable with the electronic interface and the unique challeng- es these tools bring. Healthcare choices for rural Americans can be more difficult than for their urban neighbors who have ready access to physicians, pharma- cists and hospitals. is disparity will be reme- died only if the healthcare community at large combines its creative talents, strategic thinking and dedication to bring quality of care to all parts of our country. n

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