HIMSS23: Stanford Health Care finding success with inpatient telehealth

Left to right: Tina Cortez, Shelly Arthofer and Nerissa Amers discuss Stanford Health Care's inpatient telehealth efforts at HIMSS23 in Chicago on Tuesday.

Photo: Jeff Lagasse/Healthcare Finance News

CHICAGO – Telehealth adoption continues to increase, boosted in part by the COVID-19 pandemic, which put a spotlight on remote care technologies. But most of the focus this far has been on outpatient telehealth. As Stanford Health Care can attest, inpatient telehealth can also be a critical tool, and there's an impetus to streamline technology solutions.

Having the tech is one thing. Implementing smooth workflows around it is another.

A panel of experts from Stanford addressed the issue at one of their hospitals and shared some of the lessons learned at the 2023 HIMSS Global Health Conference & Exhibition here on Tuesday.

"Telehealth has grown lots since the COVID-19 pandemic and has been generally well-received, but it's been more accessible to certain populations," said Nerissa Ambers, senior manager, nursing innovation and informatics at Stanford Health Care. "On the telehealth side, it can be clinically equivalent if it's done the right way. We still believe it will result in operational efficiencies and reduce disparities."

Inpatient telehealth was available, in a nascent form, when Stanford opened a new hospital in 2019. The first version of this technology entailed a tablet on a cart, which was used for contacting clinicians and medical interpreters from the patient's bedside. The hospital also implemented fixed video cameras in three rooms to start with, with the capability to broadcast the tablet information onto a screen in the patient's room. The remote control for this tech was located in the room, so no one outside the room could clandestinely view video of the patient.

"By the time COVID rolled around, we realized this wasn't going to cut it for what we needed," said Shelly Arthofer, manager of nursing innovation and informatics at Stanford Health Care. 

For one, it was a challenge keeping track of charging cables for the devices. The video solution was also limited in that only three participants could take part in the call at one time, which was certainly not ideal for communication at the height of the pandemic.

In March 2019, when the virus shut the world down, staff knew it needed to iterate on existing solutions and meet unique challenges. The health system came up with what it dubbed the "hub and spoke" solution.

The solution entails a provider stationed at a centralized workstation – the "hub" – and a tablet at the bedside. The tablet at the patient's bedside auto-answers when a call comes in; the hub on the unit is meant to mirror day-to-day workflows in which someone would go into the patient's room to check on them and chit-chat. To prevent virus spread, Stanford wanted to do those interactions outside the room. 

The pilot expanded tablets into every room in the hospital, which worked well. But being nimble was of prime importance given that the hospital was at the mercy of the Centers for Disease Control and Prevention when it came to following ever-changing COVID-19 protocols.

"We had 134,000 calls from the inpatient configuration at that time," said Arthofer. "The demand was there, but fielding all these use cases and adapting that in the moment was a challenge for staff. We didn't have an easy way to share the meeting details. People were calling each other on the phone to share meeting passwords. We wanted to maintain our training materials, but with all these new cases it was challenging keeping all the staff up to date."

There were also other challenges, such as WiFi issues in certain parts of the building, troubleshooting issues and equipment malfunctions.

According to Ambers, a lot of the tech solutions that were in place were one-point solutions. That created an environment with a lot of potential error, as well as inefficient processes and duplication of work. 

To address these challenges, Stanford adopted the principle of integrating all of this tech with its core systems, putting everything into the core EHR and clinical communications. The system also standardized workflows into flexible platforms. This resulted in certain requirements: an EHR accessible from the patient's room, for example, a way to connect with an in-room camera source, two-way video and audio, handheld zoom functionality, and standard mounting and channel configuration.

Now, a provider such as a nurse will talk to a patient to make sure they're alert and in good enough condition to receive a call. Someone who pulls up the app can see into the room and also screen share, utilize an audio-only language interpretation feature and invite anyone with a phone number onto the call.

The system averaged two or three calls a week per patient at first. Now it's up to about 44 calls per week.

"The tech enhancements really made all the difference," said Ambers.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com