Telehealth has been operationally implemented within Intermountain Healthcare since 2015, with pilots running for several years prior.

As a centralized service, it was possible to engage with a broad consortium of departments such as legal, finance, marketing, compliance and physician affairs to develop models, learn about the nuances of implementing telehealth as an embedded service and engage with clinical leadership on the opportunities.

As a result, clinical services continued to consider telehealth delivery options and expand access for patients into rural locations.

Embracing the telehealth opportunity

Core acute services such as crisis care, critical care, hospitalists, neurology and newborn embraced the opportunity and found success in providing care while reducing unnecessary patient transfers and mortality, and improving access to these services.

These services initially used an internally developed telehealth platform with TV room kits and mobile carts as patient care connection points.

In 2016, the Salt Lake City-based health system launched Connect Care Urgent Care on the Amwell Direct to Consumer platform to help patients receive low-acuity care 24/7 instead of going to the emergency room or waiting until other care options were available.

This type of service was new to Utah and required extensive communications with communities and caregivers. Over time, it has become Intermountain's largest urgent care service and now is adding behavioral health and other care options.

Expanding collaborations with other hospitals

"In 2020, we converted the internal acute care services to the Amwell Hospital platform," said Brian Wayling, telehealth services associate vice president at Intermountain Healthcare. 

"The conversion allowed Intermountain to focus on healthcare delivery across all 25 hospitals and expand our collaborations with critical access hospitals across the Intermountain West," he explained.

"The patient experience was completely rethought to add a white-glove onboarding process that included improved communication, education materials and pre-visit dedicated technical outreach."

Brian Wayling, Intermountain Healthcare

"The platform is a single integrated technology that all services can use to provide inpatient care to almost 1,500 rooms and locations. 

"It allows the critical care team to round on patients with an average daily census of approximately 180 patients across multiple facilities, gives the neurology team immediate access into emergency rooms for stroke care, and allows crisis care to serve patients experiencing mental health concerns," Wayling said.

The caregiver has full control over a powerful high-definition PTZ (pan-tilt-zoom) camera, audio controls and night vision capabilities to facilitate direct patient engagement. Additionally, cultural and language services are easily added to any visit to ensure patients receive care in any of 200 languages.

"Fundamentally, the wide dispersion of telehealth has helped Intermountain build upon our core tenets of care delivery – increased access, reduced costs, consistent patient care and improved caregiver engagement – regardless of patient location," Wayling stated.

Getting care closer to home

"With more than 500 clinicians accessing the platform on a regular basis to provide care to almost 70 hospitals in nine states, Intermountain has helped tens of thousands of patients receive care closer to home, assisted local care teams in learning new skills while caring for higher acuity patients, and expanded care standards to ensure appropriate, cost-effective care is provided," he continued.

Telehealth has been cited as one of the reasons Utah has one of the lowest rates of critical access hospital closure across the U.S., he added.

In addition to these core types of services, Intermountain has enabled all clinical services with an EHR-embedded telehealth platform for outpatient care. The visits are conducted via personal devices and can be dynamic or scheduled to improve patient access.

At this point, Intermountain uses Amwell exclusively for all video-based telehealth services. The platform works in conjunction with the Cerner EHR. The health system is exploring options on how to best align with several other EHRs now used within Intermountain Healthcare.

Secured and protected

"The platform also works with a credit card merchant for payment processing, multiple payers for insurance verification and our revenue cycle platform for claims processing," Wayling explained. 

"Over the years, telehealth services have also worked extensively with Intermountain Technology Services – most notably with cybersecurity and networking – to ensure our patient data is secure and protected.

"Our network team has secured access to bandwidth to ensure all sites of care are fully capable of providing and receiving care without disruption or fragmentation of audio and video," he added.

As of the second quarter of 2022, Intermountain has earned a Press Ganey Top Box Score of more than 80% for its scheduled video visit service, with patients requesting more digital engagement as they learn about the option. For behavioral health outpatient visits, the Top Box Score is 89%.

"These results were achieved by focusing on platform stability, patient education, and provider training and support," Wayling said. 

"Specific improvements to the platform included increasing the overall network bandwidth by 10 times to support the demand for scheduled visits and implementing a robust network monitoring solution that allowed us to pinpoint trouble spots and address with configuration improvements and equipment updates.

"The patient experience was completely rethought to add a white-glove onboarding process that included improved communication, education materials and pre-visit dedicated technical outreach," he continued.

Support line for providers

Provider support also was a focus as Intermountain implemented a dedicated provider technical support line for video visit troubleshooting. Additional training on best practices and "web-side manner" also is provided as an ongoing service for new and existing providers in the form of one-on-one coaching.

Intermountain was awarded $730,008 from the FCC telehealth grant program for smartphones, tablets, video conferencing equipment, and various monitoring and telehealth platforms and applications with which providers can remotely assess COVID-19 patients, conduct remote monitoring for high-risk patients by using specially configured technology kits, offer patients access to medical care and opinions from providers anywhere, and educate people and answer questions about COVID-19.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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