By BETSY TAYLOR
A subsidiary of Englewood, Colo.-based Catholic Health Initiatives is drawing from the health system's successes in its telepharmacy program to expand and commercialize that and other virtual health services.
CHI created the not-for-profit subsidiary called Virtual Health Services in July 2012 to increase the scale of successful telehealth programs so that they can be offered at other sites, said Win Vaughan, Virtual Health Services' vice president for operations.
CHI hospitals and facilities have developed dozens of telehealth offerings. Many of those provide local or short-term solutions to a regional need. Virtual Health Services isn't looking to expand on all of those, rather it is determining which ones would meet a broader demand, save money for CHI hospitals, or generate revenue from hospitals outside of CHI, Vaughan explained.
So far, Virtual Health Services has expanded a telepharmacy program to new markets, and it is in the early stages of developing a tele-mental health service. Virtual Health Services also studied the possibility of creating an eICU program, but decided that, while such programs work well for some sites, it would be difficult to find a significant target market across many facilities. Smaller facilities often don't need a remote ICU service, and large ones already have on-site clinical resources for intensive care.
CHI began its involvement with tele-pharmacy programs about five years ago, said Chris Jones, vice president for strategic planning and business development with CHI's Fargo, N.D., division, which has seven critical access hospitals in North Dakota and five in Minnesota. To provide better care in rural areas and to make pharmacists available to coordinate with their hospital staffs around the clock, CHI created a telepharmacy program with a hub in Fargo. Typically, a nurse or pharmacy technician transmits a physician's order for a patient to the telepharmacy hub. A pharmacist reviews the order, making sure the right medication is going to the right patient at the right dose and time. When the order is approved, the nurse or a pharmacy technician at the hospital pulls the correct medicine for visual review by the pharmacist. Some states require such visual checks by a pharmacist; CHI applies the practice beyond those states, because system leaders believe it's the right thing to do for patients, said Jones.
CHI has expanded the telepharmacy program to 13 CHI sites and 10 outside of CHI, Vaughan said. With telepharmacy, hospitals or other facilities receive a monthly invoice for the hours they use the telepharmacy service. The volume, or how many orders the pharmacists review, determines the hourly rate, Vaughan explained.
Now, Virtual Health Services is exploring ways to provide telepharmacy services to patients beyond the hospital's walls. Vaughan explained, "We're looking at ways that (telepharmacy) can support hospitals that have patients that are at risk of readmission when they transition out of the facility back to their home or community. We're looking at medication adherence beyond the inpatient stay."
Vaughan said a number of virtual technology methods could be used to connect the pharmacists and other health care providers with patients. For instance, a care provider could send a text message to a patient once the patient is at home to see if the patient has questions, or to remind the person to take a medication. Perhaps in some cases, a patient or a designated family member could bring medications in front of a camera to show they are taking or administering the proper medications and doses.
Virtual Health Services also is looking to expand a virtual service for patients needing mental health screening or treatment. Vaughan said CHI leaders know there's a pressing need in emergency rooms for some patients to meet with mental health clinicians. Under one application CHI is exploring, a facility would keep a cart with a camera and a monitor in a private area so a patient could consult remotely with a mental health care provider. In some settings, mounted cameras and monitors in exam rooms could allow for such consultations. CHI is considering creating patient access points at kiosks in schools or perhaps at oil rigs where workers do not have ready access to mental health clinicians.
Jones said, "Virtual Health Services is just a way to connect; the service is successful based on the people on the other end of the line, not the technology itself."
Jones said human interaction and touch are an important part of medical diagnosis, treatment and care. But in the rural areas where he works and where Virtual Health Services is providing some services, hospitals are far apart and sometimes hard to reach, because of geography and weather. In those cases, cutting wait times and getting patients to the right specialists when care is needed makes a real difference. "We have to balance all of those things at the same time," Jones said.