After the near emergency ramp-up of video visits across the organization when the COVID-19 pandemic struck, Baptist Health, a health system based in Louisville, Kentucky, that serves Kentucky and Indiana, evaluated some of its outcomes, including willingness to do more video visits in the future.
One of the challenges was with the lack of a significant physical exam. While there is quite a bit that can be gleaned by a video visit with observation and asking the patient to perform particular tests, the Baptist team was looking for a technology that would provide more.
“We sought to bridge this gap to continue down the path of alternative care models that have great patient experiences, are high quality, convenient and cost less,” said Dr. Brett A. Oliver, chief medical information officer at Baptist Health.
“Seeing someone by video alone can certainly be enough in an isolated situation, but to provide that layer of quality, we sought out a way to deliver better care virtually,” he added.
Baptist Health found telemedicine technology vendor TytoCare. The company’s telehealth technology is a hand-held medical device that allows for remote medical exams to be improved by diagnostic tools like a stethoscope, otoscope and tongue depressor.
“A clinician could remotely listen to the heart and lung sounds of a patient or look into their ears,” Oliver explained. “By getting these devices into the hands of patients and families, more complete visits with a healthcare provider could occur.
“In addition, we could use the device to enhance other video visit workflows like that in schools or an urgent care setting for patient overflow,” he noted. “And the vendor plans on adding AI to their tool. For instance, there is pending FDA approval for AI connected to breath sounds to detect wheezing. These additional modules will only enhance the quality of the remote physical exam even more.”
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MEETING THE CHALLENGE
Baptist Health has deployed the technology in a few places in its first phase.
The devices now are available in the school system of one of its markets. Instead of needing to have a provider visit each and every school in a system for kids that have a need, Baptist has provided the schools with the TytoCare device and a single provider can then cover multiple schools with an advanced virtual exam as part of the evaluation.
Baptist Health partners with local physicians if a student needs to be seen and cared for beyond what can be done virtually.
“One key for us was integrating the TytoCare device into our Epic EHR so providers did not need to change their workflow to use the device with a patient,” Oliver said. “Patients can visit Baptist Health online for more information and to purchase the device. They can also purchase the device at local Best Buy stores.
“The device purchased from our website is shipped free to their home in 3-4 days,” he continued. “A Baptist Health quick start guide is in the box and we send an email within a few days of purchase to remind patients to go ahead and log in and pair the device.”
Baptist Health also uses the devices for remote on-demand urgent care. Individuals or families can buy a device for their home and use it as needed for urgent needs.
“Earache at 9 p.m. at night, cough on the weekend, or even a minor problem that you don’t have time to leave work to seek care,” Oliver explained. “This technology allows for a detailed physical exam that enhances the diagnostic accuracy of the visit.
“One area I am excited about is placing the devices in our urgent care settings,” he continued. “At times, the wait at an urgent care gets lengthy as it is generally a walk-in kind of scheduling. We have added a TytoCare device to a few of our urgent care facilities to use to offload the demand when it becomes overwhelming for a particular facility allowing patients to be seen by our virtual care team and assisting the team on the ground at the urgent care.”
It is often hard to properly staff urgent care facilities given the walk-in nature – this “expandability” is next-level staffing, he added.
“Our next area of expansion that is underway is bringing this to primary care,” he said. “This is key for us to fully develop alternative models of care. Rather than needing to see your primary care provider for some in-person visits, the device would allow some problems, acute and chronic, to be managed at a distance and in a more convenient manner for the patient without sacrificing quality.”
In early numbers, 82% of patients say they prefer the TytoCare device visit to in-person care and to other telehealth modalities. When asked where they would have gone if not for the TytoCare visit option, 94% said they would have gone to an urgent care or doctor’s office.
“It is so encouraging to hear from patients that this technology has really helped,” Oliver said. “I spoke with a woman with an autistic son who is difficult to get to the office at times. To be able to access care virtually and be assured that the quality is high has been a game-changer for her family.
“In another instance, a parent replied, ‘I wouldn’t have been able to go to an urgent care without the service as I have three little babies. Thank you. Please keep offering for parents like me,'” he reported. “We also had a patient comment that she was buying two devices, one for herself at home and one for her daughter to take to college.”
Baptist Health providers have confirmed the quality of sounds and images is outstanding and it has gotten them excited to define more patients for which this approach would be appropriate, he added.
ADVICE FOR OTHERS
“As we discovered with video visits and other digital services during the beginning of the pandemic, patients are ready for a better and more complete virtual experience in healthcare,” Oliver said. “If you are not providing this kind of service – or it’s not even on your roadmap – you could be playing catch-up very soon.
“I would urge other organizations to think through what they want care to look like three to five years from now,” he continued. “How can they deliver the most efficient high-quality care in an industry where there are not enough providers and nurses to go around while the cost of care continues to rise. We have to think differently, and I think this is one way to approach the future.”
Oliver has wondered what the office exam of the future will look like.
“With video visits, we were able to see our patients,” he noted. “Now we are adding a virtual exam device. Soon we will have AI algorithms as a part of these and other devices.
“Will we get to a point where these remote digital tools have so many advantages that we use them in person as well?” he concluded. “While there are many hurdles to overcome, I am optimistic about the future of healthcare. But it will have to change to work for all. That’s what we’re working on.”