Issue link: https://beckershealthcare.uberflip.com/i/888081
10 Executive Briefing Sponsored by: How Telehealth and EHR Integration Deliver Complete, Effective Care While Streamlining Provider Workflows N emours Children's Health System — a nonprofit children's health system based in Jacksonville, Fla., with locations in Delaware, Florida, Georgia, New Jersey and Pennsylvania — adopted telemedicine in 2014 and became the first pediatric health system to deliver direct-to-consumer telehealth. Since launching Nemours CareConnect, we have implemented telemedicine throughout our health system with direct-to- consumer care for acute, chronic and post-surgical appointments, as well as for clinical trial assessments. We also deliver telehealth to collaborating hospitals, schools and cruise ships, and use Nemours CareConnect to bring pediatric specialists into affiliated community hospitals as well as Nemours and non-Nemours primary care physicians to remotely assess patients. If there is one piece of advice I could share with health systems looking to implement a direct-to-consumer telehealth solution of their own, it's to create a roadmap that includes EHR integration. Over 95 percent of hospitals have a certified EHR in place today, according to a 2016 report from The Office of the National Coordinator for Health Information Technology. The benefits of EHRs are incontestable — better continuity of care, lower drug interaction rates, decreased mortality rates among the chronically ill, less room for error, better physician communication, lower costs — which is why health systems continue to invest heavily in these systems. Consumerism is also changing the way healthcare is being delivered, and patients now value convenience as much as quality and cost. This is a large reason why health systems like Nemours invest in telehealth platforms, providing patients with the same high-quality care at a lower cost. Health systems, however, find that they have two different IT systems working alongside each other, but not necessarily communicating with one another. When we first launched CareConnect at Nemours, we did so without integrating the system with our system of record. While we were quick to realize the power and significance of telehealth, the lack of EHR integration remained a missing component of the care delivery model. In 2016, we integrated CareConnect with our Epic system, and by doing so, discovered that this type of integration allowed us to deliver more complete, effective care to our patients, while streamlining our provider workflows. Why integration matters Telehealth can and does provide valuable care to patients without EHR integration; providers are able to conveniently see patients over video, collect appropriate medical history before the visit and safely prescribe the appropriate medication if necessary. More patients get access to care with this type of telehealth and that's important for increasing accessibility to care. But, when you decide to move beyond urgent care encounters — just as Nemours did after launch — EHR integration can improve physician workflows and continuity of care for the patient. When Nemours began to look at other use cases, we found that as our use cases grew, our physicians' ability to treat their patients improved when they had integrated access to patients' medical records. Having CareConnect integrated with our EHR brought appropriate information right into the visit, enhancing the provider workflow while simultaneously making it easier for physicians to deliver better care to patients. Since launching with American Well, Nemours has expanded our telehealth services to include clinical research and added nonphysician healthcare providers such as nutritionists and therapists. Nemours' physician researchers are currently using EHR-integrated telehealth to access and care for patients with spinal muscular atrophy and pediatric obesity, just to name a few of our leading use cases. Why not use EHRs for telehealth? It's certainly a question that many health systems face, particularly when your EHR is offering some form of telehealth visits. Nemours itself has made a significant investment in our Epic system. In 2015 when we vetted telehealth vendors, we had to decide whether we were going to use our system of record for telehealth or look outside our EHR at other telehealth vendors. Our decision to go with American Well hinged on many factors, and their experience with EHR integration, combined with their strong emphasis on the patient experience, was a driving factor. American Well's mobile and web-facing properties to bring patients in from any modality and from anywhere was very appealing. We also felt that our EHR system of record would only have a captive audience with our existing patients, whereas American Well had the infrastructure in place to reach out to a general population of people to better grow our telehealth platform. Additionally, American Well's platform had been built for telehealth, with a By Shayan Vyas, MD, Medical Director, Nemours Children's Health System