Among many virtues, telehealth has helped the Westchester Medical Center Health Network (WMCHealth) grapple with patient population challenges and a relative shortage of healthcare professionals to maintain more consistent levels of care throughout its service region, says Christian Becker, MD, PhD, associate medical director, Westchester Medical Center Health Network.
Like many other parts of the country, WMCHealth’s patient population is aging. To address that, Dr. Becker and his team are working to harness the power of telemedicine to help bridge the gap between the intensivist shortage and a growing population with increased healthcare demands. “The other motivation is also to standardize the access to clinical care to specialist care across our healthcare network,” he told attendees of the Telemed Leadership Forum 2018 in Washington, D.C. March 27.
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Buoyed in part by telehealth, WMCHealth over the past several years has grown into a 1,700-bed healthcare system based in Valhalla, NY, with ten hospitals on eight campuses spread out over 6,200 square miles of the Hudson Valley.
WMCHealth employs more than 12,000 people and nearly 3,000 attending physicians. With its Level 1, Level 2 and pediatric trauma centers, WMCHealth stands as the region’s only acute care children’s hospital, an academic medical center, several community hospitals dozens of specialized institutes and centers, skilled nursing, assisted living facilities, homecare services and one of the largest mental health systems in New York State.
Dr. Becker shared some best practices and lessons learned, as WMCHealth ramped up its telehealth practice. From the very beginning, he advised, it’s important have a sense of the current on-site landscape. “Emphasize what [implementing] means to the bedside provider,” he said. Telehealth is “a disruptive technology, it will be met with resistance,” he added. Some practitioners, unfamiliar with telehealth’s possibilities, wonder if it will be effective, while others will resent it because they feel as if they are being watched. Be prepared for those and other questions, he advised.
He suggested being mindful of several potentially important implementation hurdles, including:
- Nurses in the WMCHealth ICU felt that the quality of their patient care delivery might suffer. Some worried there would be staff reduction ratios at bedside. Dr. Becker and his team were careful to reassure nurses throughout the hospital that this wouldn’t occur.
- Advice for remote care must be consistent with advice for in-person care.
- TeleICU coverage often interrupts workflows and patterns. “So, we made an extra effort to have all stakeholders involved to discuss that,” Dr. Becker said.
On the plus side, however, there are volumes of data showing ultimate acceptance of the concept from most providers, especially among the younger generation, he said. Dr. Becker offered some important tips to ensure a smooth installation and ramp-up, including:
- Involve the bedside ICU team in the design of the telemedicine system implementation. This helps to build support from staff prior to rollout.
- Make certain telehealth clinicians visit the ICU regularly. Dr. Becker and his leadership team attend rounds about once a month, in part to help better engage off-site and in-patient health professionals.
- Emphasize audio as well as visual telemedicine technologies as part of team relationship building.
- Focus on interpersonal skills when hiring staff.
- Foster agreement on best practices. “This is absolutely crucial,” he said.
It’s also savvy to build in some relatively easy “early wins,” he explained. Generate enthusiasm, and confidence, by demonstrating that the goal can be attained.
There’s another element of motivation: A sense of urgency. As WMCHealth grew, it became increasingly important to be able to skillfully maneuver patients from location to location as needed. TeleICU capabilities could often be part of the solution, he said. Conversely, access to telehealth capabilities sometimes meant it was not necessary to move a patient, which helped to assuage some of the network’s growing pains. It was incumbent upon the management team to make certain all staff understood the criticality of the situation.
During his presentation, Becker shared a number of interesting charts and other graphics demonstrating the effectiveness of the WMCHealth program. Several illustrated, via metrics, how various facilities “flowed” from mediocre performance to excellent performance.
Bottom-line: It’s critical that managers understand it is more dangerous to hold onto the status quo than it is to develop and implement new ways of doing things, Dr. Becker said.