Telemedicine Pilot Project

Overview Telemedicine has long been a solution for connecting physicians with primary and specialty care patients in community health centers located in rural communities. However, it has not been used to overcome transportation and culture barriers among urban populations who may only live a few miles from a provider, but may face insurmountable barriers to accessing appropriate diagnostic and health maintenance care. The Detroit Wayne County Health Authority, charged with eliminating all barriers to access to care, identified telemedicine as a vehicle for evaluating and treating people with physical and mental health needs but who are unable to access care. Following a literature search and a site visit to Mott Childrens Health Center, the Health Authority realized that telemedicine has the same applications in urban environments as it has in long distance rural area. The challenge is to demonstrate its efficacy, identify providers willing to participate in the program, and identify an equipment provider willing to partner in the project. Dr. Michael Kobernick, director of the Physicians Who Care program at St. John Providence Hospital, agreed to coordinate the medical component. Dr. Kobernick secured the cooperation of Dr. Abdul Effendi, a Nephrologist, who agreed to provide pro bono screenings one afternoon per month, for three months. Health Net Connect (a telemedicine and telehealth solutions company) agreed to loan equipment for the pilot project and train staff. Covenant Community Care, a federally qualified health center; Joy Southfield Health Center, a free clinic; and Development Centers, Inc., a community mental health agency, served as a site hosts for the technology placement and coordinators of patient encounters. The 18 month study was conducted from September, 2011 through February, 2013. Pilot Study Findings: Primary Care-Specialist A questionnaire developed by the Wayne State University School of Medicine Department of Psychiatry examined customer service (appointment timeliness, sufficient time allocation for the encounter, advance information about the encounter), patient perceptions, and physician satisfaction. Despite the multitude of challenges present in an urban setting for aging patients with multiple morbidities, more than 50% of the patients said that the care they received during their telemedicine visits using the HNC Virtual Clinic Telemedicine products was better than or the same as an in-person visit and that they would encourage their friends and family to participate in telemedicine. Some commented that would have been unable to find reliable transportation to areas outside of their neighborhoods, where specialists are located. Others noted that they would not have even been able to make an appointment because they would have to miss another day of work in addition to the time they took off to visit the clinic. The remaining 50% of the patients maintained that while the care they received through telemedicine was the same as a traditional visit, due in large part to the video component of the Health Net Connect products and solutions, it was also different than being in the

same room as the doctor. Additionally, these patients said that they felt comfortable talking to a doctor that was not in the same room. The health care professionals and staff that were surveyed indicated that all care providers were able to efficiently collect enough data to make a diagnosis and communicate with patients. As the care model in the United States changes to emphasize preventative medicine, urban telemedicine could certainly be at the forefront. Many patients could prevent becoming chronically ill and/or disabled if they have access to the care they need before it is too late. Our study showed the effectiveness of reaching underserved patients in urban communities through telemedicine. Professionals and most patients agreed that they would eagerly use this service again. Equipment is still set up at the clinics and patients are continuing to be seen. Another planned study utilizing the same telemedicine / telehealth company, to study spanning a longer timeframe and surveying more patients in more facilities will continue to encourage the idea that there is need for telemedicine outside of rural areas. Pilot Study Findings: Community Mental Health-Primary Care This aspect of the study was challenged with multiple staffing changes, training delays, and clinical staffing resistance. Once the clinical commitment was achieved, further staffing changes at the community mental health agency created additional delays. Finally, Joy-Southfield Health Center and Development Centers, Inc., agreed to conduct patient encounters. In one example, complications occurred when Covenant Community Care declined to offer laboratory testing service. Pro bono laboratory services were obtained through St. Mary Livonia Hospital, which also services Joy-Southfield. Once the program began, Development Centers, Inc., needed to go to Joy-Southfield to get lab tests before they could undergo the telemedicine encounter effectively discounting the purpose of the telemedicine technology. On-site laboratory service would have been more efficient. In this aspect of the study, patients were seen through telemedicine technology in separate distinct phases. Each phase had differing results: Phase #1: All systems (Health Net Connect telemedicine and telehealth and clinical support) were delivered efficiently: pre-visit lab tests, telehealth equipment function, and provider assessment. Phase #2, #3: No lab tests or EKG were done in advance. However, the technology worked and the patient encounter was relatively effective. Provider comments: I was very pleased with the process with nephrology between Joy-Southfield and Covenant Community Care and felt the consultations were helpful to me as well as the patients.

Conclusions This study indicates that telemedicine, and specifically, the telemedicine solutions and products offered by Health Net Connect, is an effective tool for specialty consults, assuming that the host site prepares all appropriate diagnostic tests and manages the scheduling. There was no apparent qualitative variance, with patients and providers satisfied with the medium.