Toward the end of March, when the COVID-19 pandemic hit hard in California, Universal Community Health Center in Los Angeles needed to implement a quick-and-easy platform to get telehealth off the ground.
The health center needed a simple solution that would enable its patients to communicate with the devices and the resources it had without the complexity of having to install an application or having to create any user names, said Dr. Edgar Chavez, founder and CEO of Universal Community Health Center.
“The solution that was being offered by our HR vendor was not going to be able to do this in its current state,” he explained. “The problem for us is that we do not have a community that has good Internet connections, good devices, nor a lot of technology literacy. What they have is the ability to text and receive texts.”
Of all the platforms that Chavez reviewed, the one that would give the health center the ability to implement within a day and the simplicity to accommodate the patient population was Doxy.me. In one afternoon, he was able to set up Doxy.me with all the providers and support staff so they could engage in telehealth.
“With Doxy.me, we were able to quickly send patients a text with a clickable link, and within two clicks they would be able to be seen in a secure, HIPAA-compliant telehealth platform,” he said. “Our medical and behavioral health providers could use our current technology infrastructure to accomplish this without having to buy an excessive amount of expensive equipment to do telehealth. Within a week, we went from having zero telehealth visits to 70-80% of our consultations being telehealth.”
Training for staff took one day and for providers about one hour. It took about one week to enhance and adapt workflows to telehealth, but clinicians were able to do 60-70% of what they used to do in person using the telehealth platform.
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MEETING THE CHALLENGE
With Doxy.me, Chavez and his team created a virtual protocol where the medical assistant sends the telehealth link to the patient and does a pre-visit evaluation that gathers information that normally would be taken in person. For a telehealth call, the medical assistant does the patient health questionnaire 9 (PHQ9), reconciles medications, and evaluates the need for health-maintenance items like vaccines, mammograms and colon-cancer screens.
“A tele-assisted visit is a type of visit where the patient is seen within the four walls of the health center through connected, assisted telehealth technology that allows a provider to perform 70-80% of a physical exam without ever touching the patient.”
Dr. Edgar Chavez, Universal Community Health Center
“The medical assistant then puts the patient in the virtual waiting room and alerts the provider that the patient is ready, and the provider takes the call,” Chavez said. “For us, telehealth is not just for our providers, but for all of the support staff to be able to communicate with patients as if the patients were being seen in person.”
Universal Community Health Center’s goal with telemedicine has been to see the majority of its telehealth visits via video. Unfortunately, because of the lack of Internet access in certain areas and the right cell phone data plans on the patient side, this has been a huge challenge.
Initially, the health center wanted to see at least 50% of patients through video Doxy.me telehealth visits. Currently, it’s hovering around 30% of visits using the platform. The rest are seen, either in person, or via telephone.
USING FCC AWARD FUNDS
But then everything changed. Earlier this year, Universal Community Health Center was awarded $170,479 for phones, laptops, mobile hotspots, network upgrades, remote-monitoring equipment and a telehealth platform to help the clinic transition to virtual care in response to the COVID-19 pandemic with a goal of conducting 80% of all visits using telehealth.
“One of the greatest challenges that we see using at-home video or telephone telehealth visits long-term is the inability to perform a physical exam,” Chavez explained. “Many follow-up chronic care conditions like hypertension blood pressure checks that do not require a physical exam do very well on video or telephone telehealth visits. But when you have a kid with an earache or somebody that has a cough that requires a lung exam, video telehealth is inadequate.”
Early on in the COVID-19 pandemic, the health center decided it would, as much as possible, eliminate in-person visits, since this carried a huge risk of infection for staff. Even when the numbers of COVID-19 infections were decreasing, the health center still did not feel comfortable bringing a patient in, but it needed to do something that would get it to a safe place while still providing quality care.
“At Universal Community Health Center, we came up with tele-assisted visits,” Chavez said. “A tele-assisted visit is a type of visit where the patient is seen within the four walls of the health center through connected, assisted telehealth technology that allows a provider to perform 70-80% of a physical exam without ever touching the patient.”
The health center used the FCC grant to purchase a telehealth-assistive technology called Tytocare. Tytocare comes with an iPad, an otoscope, a stethoscope and a high-definition camera that allows a patient to do a physical exam with the guidance of a physician. From the safety of a socially distanced workspace within the health center, or even from home, the provider can be present in the exam room virtually and perform a physical exam while diminishing the chance of COVID-19 spread.
“Because we are using the health center’s Internet access, it provides the ideal, glitch-free telehealth experience for the patient and gets over the barrier and disparities of patient Internet access,” he said. “We feel that using tele-assisted visits as a pathway to meet patients halfway provides quality care while protecting everyone from the spread of COVID-19.”
Telehealth-assisted visits also help in educating patients to the benefits of telehealth in a controlled environment that’s free of frustration due to Internet access problems, he added.
“Once our patient population is educated in the benefits of telehealth and hopefully states begin to buy into the idea that telehealth is a solution that can be supported long term, we can provide tele-assisted devices, so patients can take them home,” he concluded.