Q&A: Program helps patients set up telehealth services amid COVID-19

A hospital system in Philadelphia launched a new task force to help patients set up technology for telehealth services and access patient portals.

Under the CARES Act, Jefferson Health received funding from the Federal Communications Commission (FCC) to help expand telehealth services. It used those funds to purchase and distribute iPads and remote monitoring devices to patients.

Recognizing that many patients have difficulty with the new technology, Jefferson launched the Digital Onboarding Taskforce to help them set up these devices and learn how to use them.

Healio Primary Care spoke with Kristin Rising, MD, MS, associate professor in the department of emergency medicine and director of the center for connected care at the Thomas Jefferson University Hospital, to learn more about the program and how it has helped patients.

Healio: What does this program entail?

Rising: The Digital Onboarding Taskforce, or the DOT, entails a close partnership with the Master in Public Health program at Jefferson College of Population Health. Students working as part of the DOT provide individualized support to patients across the Jefferson enterprise to help them use devices that they have for engaging in telehealth visits, accessing their patient portal online or hooking up various remote patient monitoring devices. Remote patient monitoring devices measure common things like weight, BP and oxygen levels. They connect via Bluetooth into a phone or other device and transmit data directly to the medical record. So, if a patient stands on the weight scale, simultaneously, a provider can see the weight pop through into the patient’s medical record. It’s super helpful for providers to be able to real-time monitor patients, and it takes the burden off of patients to have to report the readings to their providers.

Early on in the pandemic, I submitted, on behalf of Jefferson, an application for funding from the FCC. They had issued a call for proposals after receiving funding from the CARES Act to provide financial support to institutions for the purchase of devices that were needed to enable patients to receive remote health care. We received approximately $922,000 from the FCC to buy iPads and remote patient monitoring devices for underserved patients who have medical conditions for which they have an ongoing need for medical care. This was a programmatic grant, so it just funded the provision of the devices. I was really concerned going into this, saying “This is amazing, but we are now going to provide thousands of devices to probably about 1,000 patients. How on earth do we think that they’re all going to know immediately how to use them?” These were patients who were identified as not having devices to engage in telehealth, or are otherwise particularly vulnerable related to their health. In talking with Rosie Frasso, PhD, professor of population health and director of the public health program, we decided to put together this Direct Onboarding Taskforce to provide support to patients. Since launching the DOT, we have also been joined by my colleague in emergency medicine, Geoff Hayden, MD, who has been essential in helping to manage the overall programmatic needs of this initiative.

Healio: How have students helped contribute to this program? How will they benefit from their participation?

Rising: Students have been contributing to the program by giving immense time to reach out to these patients. It has certainly not been a fast process, by any means. Patients are not answering the phone a lot of the time, and I think this is related to a number of things, including spam calls and people not wanting to deal with those. That’s actually been the first big barrier. Students have switched between using Google Voice to using Doximity and different dialing platforms to see which they can get the best response rate from, and whether it helps to send a text message before calling. Once they get patients on the phone, for some of these patients, it has taken hours to help them get set up because of the struggles along the way, such as not knowing passwords for their wireless service or for their AppleID. In the busy clinical department, particularly during COVID-19, staff everywhere were overstressed. Certainly, clinical practices did not have the bandwidth to add that big layer of time to support these patients who needed extra help with device set up. So, the students spent a lot of time troubleshooting. One student in particular — Amanda Guth — deserves special attention in all this as well. She has worked as a project coordinator for the DOT since its inception and has spent countless hours developing the workflows and training her fellow students to conduct these outreach calls.

Overall, I think it’s been a really valuable experience for the students. People have been eager to meaningfully contribute to helping others during this unprecedented time. Public health students are committed to serving the public — they have strong communication skills and they were primed to meet this challenge. It gave them firsthand knowledge of the digital divide and how it contributes to health inequities. They connected with some of our most vulnerable patients and they reported really impactful social interactions with people. You don’t help people for hours and not have side chatter about life and stories about different things. On our DOT team check-in calls, the students’ faces would light up. Students shared that their patients would joke a little bit about being sad when their set up was done, saying, “Oh, we don’t get to have any more calls from you,” or “We don’t get to chat anymore.” The calls helped students and patients feel less isolated.

Healio: How have patients benefited from the program?

Rising: Patients have certainly benefited from the program — those who have been able to be reached and assisted — in gaining some knowledge and skills and being able to use their devices to actually engage more with the health system. Secondly, the social outreach and the fact that someone, somewhere, is taking the time to talk with them and help them in a time when everyone is feeling isolated and probably a little forgotten has been certainly impactful for a number of patients. And then third — I lack data on this — but I think one of the barriers to people using telehealth is concern over trust. Maybe not trusting that it’s safe or right, or maybe they don’t understand why they might use it. I hope that this personal touch and outreach and all the time that’s given into onboarding patients helps alleviate some of that concern. Or, that it helps patients understand how much the health system is committed to being an important part of their care — that we were taking this much time to assist them through the process.

Healio: Will the program continue after the COVID-19 pandemic?

Rising: Certainly, we plan to. I have to still figure out, coming out of the pandemic, where the need is greatest and how the process will be, whether it’s direct outreach or if we set up a means of clinicians or others in the Jefferson enterprise to refer patients to the program. I need to figure out what would be most helpful to patients, but I certainly do plan to continue having this partnership with the MPH program and figuring out how we can best serve our patients. So yes, in some form it will certainly continue to exist.

Healio: Can other practices implement this or similar programs?

Rising: I certainly think that they can, and I imagine that in many places, they have in different ways. Other health systems and practices can and should be continuing to address the need to ensure that people have the digital readiness to engage in health care. I think that telehealth actually has the potential to decrease the health care divide that existed before COVID-19, but we need to give significant attention to the factors that influence people’s digital readiness, and that’s so much more than access. Beyond that, it is knowledge, which is mostly what we’re addressing, but then also other things like trust. We will see an increasing health care divide in outcomes if we don’t proactively address that. Systems must figure out how to assist the most vulnerable patients in using telehealth.

References:

Healio Interview

Newswise. Patients Get Essential Support for Telehealth through Student-Driven Program. https://www.newswise.com/articles/patients-get-essential-support-for-telehealth-through-student-driven-program. Accessed March 8, 2021.