As Massachusetts continues efforts to promote inclusivity, it has had to take a hard look at Boston’s many hospitals. Boston Medical Center specifically serves a significantly disproportionate number of disadvantaged patients living in the Greater Boston community.
Approximately 59% of BMC’s patients come from underserved populations, it reported. In addition, 32% of its patients do not speak English as their primary language, creating significant language barriers.
Those language barriers can discourage patients from making appointments and addressing their health concerns, as well as those of their children.
The Telehealth Epilepsy Care Collaborative, or TECC, at Boston Medical Center was developed out of the charge led by the federal government’s Maternal and Child Health Bureau to improve access to high-quality care for children and youth with epilepsy, especially those facing health disparities or living in rural regions.
After assessing the needs of BMC’s patient population and referring providers in the community, staff members realized there were a few problems they needed to look for in their referring providers.
First, they needed to make care more accessible for patients, so they needed a service that implemented telehealth into the home, school or workplace, they determined.
“There were significant barriers to patients coming in,” said Dr. Laurie Douglass, director of pediatric epilepsy and EEG at Boston Medical Center and associate professor of pediatrics and neurology at Boston University School of Medicine.
“Parents who did not have paid time off or sick days could not afford to take a day off and address the health concerns of themselves and/or their children. Another barrier was transportation. For many of our patients, they are unable to drive because of seizures; for others, they do not have access to transportation.”
BMC also needed to improve communication between the medical center, the patient/family, and all the caregivers on the patient’s team – school nurses, VNA, early intervention and any other member of their care team.
“For the current generation of youth, they do not like to make phone calls. They live in a virtual world, so this app and the ability to access their care team through text messages [are] much more comfortable.”
Dr. Laurie Douglass, Boston Medical Center
Staff also needed to make seizure action plans more accessible to the patient’s caregiver community. They also needed to screen for seizures in high-risk populations, as well as improve their transition planning.
BMC opted to go with integrated health and social care solutions from vendor Activate Care.
“The technology offered to resolve all those problems through one platform,” Douglass said. “They proposed creating a virtual patient-centered medical home – what we call the Virtual PCMH, or V-PCMH – for the patient/family and their healthcare team. The vendor proposed their services could provide easy communication for patients, video visit capabilities, and collaborative goal-setting between the entire care team.”
The vendor also proposed its services could be used to store patient data and share essential patient documents and data between care team members. And it proposed that the Activate CareHub could be used for patient seizure screenings.
MEETING THE CHALLENGE
“The technology was a great solution for the needs of our patients,” Douglass said. “We used the Activate CareHub to accomplish all of our challenges in one platform that was easy to use for patients and care teams. Activate Care is integrated with Zoom for Telehealth, which increased accessibility through new telehealth options.”
It had a place to save essential documents and gave staff tools to easily communicate to a patient’s entire care team, to collaboratively set up goals and to provide seizure screenings, she added.
The technology also generated analytics, so program metrics can match up with results – that is a key component to this, the ability to generate and use analytics, she explained.
“For the current generation of youth, they do not like to make phone calls,” said Douglass. “They live in a virtual world, so this app and the ability to access their care team through text messages [are] much more comfortable. On this platform, youth were far more likely to reach out with questions in order to address their health concerns and needs.”
The application also has done more than staff expected. It has helped eliminate phone tag by providing a secure place to message. It also has helped to keep doctors and care team members organized and focused on the same goals by implementing similar plans.
“We have been able to reduce no-shows as well as decrease emergency department visits,” Douglass reported. “We have seen a 40% reduction in avoidable inpatient visits, as well as a 29% reduction in length of stay. When we look at individual cases we are able to identify the true successes with qualitative results.”
The platform has seen success in increasing access to care, she added.
“A specific example of that is when we were caring for three boys with intellectual disability, autism, and impulsive and, at times, unsafe behavior,” said Douglass. “For these reasons, they were unable to be seen in the clinic safely, which was distressing to the patients’ family. Through Activate Care, I can have meetings over Zoom with the epilepsy dietician and patient/family in their home. We can also communicate over the platform with messaging in-between visits.”
Another success BMC is seeing is with patients receiving hospice care at home.
“Through the platform, we are able to coordinate team meetings with the patient/family and the hospice care team, palliative care team and PCP to determine the best plan of action to increase the comfort and quality of life for our patients,” she said.
Another success story Douglass points to is one child who was on a ventilator at home and had increasing seizures with any transportation to the hospital. Activate Care helped BMC to eliminate that transportation requirement and staff was able to provide virtual care in the home. The patient’s local PCP examined the child for Douglass, and staff could develop a plan together virtually.
ADVICE FOR OTHERS
“There is no one solution for every health system,” Douglass advised. “You should choose a platform that can be tailored to meet your needs, but they need to have the experience to make it effective. I would also recommend that the service that you choose should be patient-friendly and easy to implement.”
These systems are used with the goal to improve care, she said, so it’s important to choose one that can provide the metrics to show the impact.