Telehospitalist Program Reaches Rural Oklahoma Patients, Fills Statewide Clinician Shortage

Oklahoma State UMC’s telemedicine program has attracted rural critical access hospitals as customers during the pandemic

As the first wave of COVID-19 hit Oklahoma, 20 rural sites were able to connect within 120 days to a newly-built statewide network for telemedicine and hospitalist-based services through the Oklahoma State University Medical Center, part of OSU Medicine.

"We were working in close concert with 20 critical access hospitals across the state and embedding a hospitalist service that allowed them to expand their clinical capabilities and their clinical expertise for the purposes of providing an enhanced level of care locally, up to and including the care and treatment of COVID patients in their community, when and where appropriate," says Rhett Stover, MHA, FACHE, OSU Medicine's chief executive officer.

As part of the telehospitalist program, OSU Medicine deployed AGNES Connect, a cart-based platform from AMD Global Telemedicine that enables OSU Medicine-contracted hospitalists to connect through video conferencing to the on-site clinician, and to perform a medical assessment on the patient. On-site physicians capture medical device data, including from digital stethoscopes, a 12-lead EKG, and pulse oximeters, that is streamed in real time through AGNES Connect to OSU Medicine hospitalists.

"AMD was able to get us roughly 50, 55 carts in six weeks," Stover says. "That was not a small effort. They've been a great partner" through various supply chain shortages impacting the availability of technological components.

AGNES also connects with each of the rural critical access hospital's electronic health records, expediting continuity of care as patients move from emergency departments into inpatient settings, Stover says.

The success of OSU Medicine's program also rests upon providing personalized care teams to these rural patients, Stover says. This was enabled by a partnership between OSU Medicine and TeleHealth Solution, which provided telehospitalists for rural patients with rounding, admission, and care coordination for rural healthcare markets across the state.

Rhett Stover, MHA, FACHE, chief executive officer, OSU Medicine. Photo courtesy OSU Medicine.

Rural patients meeting admission criteria, based on clinical assessments by emergency department staff, have been admitted to OSU Medicine's hospitalist service.

"Probably 60% to 70% of our services are what we call nocturnal service," Stover says. "During the day, there'll be a physician on site at that particular hospital that will be involved in organizing and providing treatment and working through their care plan."

Then, overnight, OSU Medicine's telehospitalists step in and provide continuity of service while the local physicians are home.

On other occasions, Stover says, OSU Medicine telehospitalists can perform daytime admission services and assessments and even 24/7 coverage.

Whatever the arrangement, "there's a communication loop that keeps physicians engaged in coordination of care on a day-to-day basis," he says. "Collaboration is really important to the success of the program."

In some cases, that involves a local RN or nurse practitioner, instead of a local physician, communicating with OSU telehospitalists.

"We have physicians that are assigned to particular facilities so that you're not just dialing up a physician and getting someone new," he says. "You're getting one of two or three that are completely and exclusively allocated to that local facility and working with that local facility's clinical team and care management and social workers, to the extent they have those resources available."

OSU Medicine has sought to measure the effectiveness of the program through detailed evidence, such as readmission rates and patient satisfaction. Part of the challenge is that each hospital is in a different stage of gathering that data.

"We have seen a strengthened level of performance in the form of average daily census in almost all of our markets," Stover says. "What that means is, the community had an experience with the service, that they walked away from and have confidence in, or they've had members of their family, friends, or others that have had that experience. They now feel like, well, if I need to be admitted to my hospital locally, they have an enhanced level of care that can be provided in a safe, expedient, and quality-driven manner."

Measuring the Results

Some rural physicians had initially felt the service was somewhat forced on them due to COVID-19, but are now more open and accepting, Stover says.

"In some extreme examples, we've had patients tell us that telemedicine is the only way they want to interact with their physician from now on," he says. "We treat that as a positive comment, but we do not see the services that we are organizing as a replacement for the physician-patient relationship. It's always to supplement, support, and add value to the relationship."

The program was initially funded through CARES Act funds distributed to the state, but as those dollars were exhausted, OSU Medicine had to create a model that at least allowed the program to break even going forward, Stover says. Ultimately, the health system established a base fee for the service.

In one case, a rural community pays $18,000 a month for a telehospitalist to be available 24/7 to the local hospital.

"For them to accomplish that in a traditional setting would be about $350,000 a year," Stover says. "So it's an immediate savings that they're getting in that regard."

The lower cost of the telehospitalist through OSU Medicine can be recovered by enabling just a small handful of additional weekly admissions, Stover adds.

As for improving patient outcomes, Stover believes the service has elevated the health status of patients in the rural communities it is serving.

"In some cases, that enhanced level of service and that elevated and quicker attention, you could argue that yes, it's had a profound impact up to and including eliminating mortality," he says.

Longer-term prospects for continuing the program post-pandemic are a bit more of a mixed bag, Stover says.

"It is on a community by community basis," he says. "Five years from now, we'll [have] an industry with medical advances that are helping us address the workforce shortage, and precision with diagnosis, treatment, planning, and care. Hopefully, the result of that is leading to better health outcomes across the most challenging of our geographies in the United States."