Dr. Saurabh Chandra, board-certified critical care physician, is the Chief Telehealth Officer at the University of Mississippi Medical Center’s Center for Telehealth. Chandra and his team deployed a remote patient monitoring (RPM) program for chronic conditions and illnesses. Funded by the Federal Communications Commission as part of a “Connected Care” pilot project, UMMC received $2.37 million for the next 3 years to enroll 6,000 patients from rural Mississippi. We look forward to sharing program outcomes over the next few years!

This pilot project provides patients, mainly low-income or veterans, with broadband internet access and RPM technologies to decrease healthcare delivery costs routinely incurred from chronic illness care and increase one-on-one telehealth visits between providers and patients. RPM devices allow providers to capture important health data from the comfort of the patients’ home using devices such as Bluetooth enabled blood pressure cuffs, glucometer, spirometers and more. The RPM program addresses an array of critical health conditions, including diabetes and hypertension.

UMMC Center for Telehealth is one of two federally designated Centers of Excellence in Telehealth and has extensive experience in remote patient monitoring. In previous years, UMMC has successfully led RPM programs with a focus on diabetes care and hypertension management. Through the previous programs, the Center has gathered strong data showing RPM improves clinical outcomes, patient satisfaction and program retention rates.

The South Central Telehealth Resource Center and UMMC Center for Telehealth have a long-standing working relationship and look forward to continued efforts together. Presently, the UMMC Center for Telehealth and the SCTRC are collaborating with several additional National partners to develop and host the upcoming SEARCH 2021 National Telehealth Research Symposium.

For more information, please visit:
https://www.umc.edu/Research/Centers-and-Institutes/Centers/Telehealth_Center_of_Excellence/Home.html

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What is monoclonal antibody treatment?

The U.S. Food and Drug Administration (FDA) approved monoclonal antibody treatment for emergency use against COVID-19. Contrary to the initial antibody treatment introduced at the beginning of the pandemic, through convalescent plasma infusions, monoclonal antibody treatment is laboratory-made antibodies and not antibodies produced from other persons that previously had the coronavirus. This treatment does not contain any live SARS-CoV-2 (the virus that causes COVID-19)¹. It does serve to reduce the amount of SARS-CoV-2 in the body and provides the body a boost to produce more antibodies.

Who should receive this type of treatment?

Patients testing positive for COVID-19 with symptoms for 10 days or less, especially those at higher risk for hospitalization, treatment may help. In addition, the FDA has authorized the use of this treatment, for emergency use, on those exposed to COVID-19 that are immunosuppressed.

Below are a few risk factors that could increase your risk for hospitalization if you get covid-19:

• Body Mass Index of 25 or greater
• Pregnancy
• Underlying health conditions (heart disease, diabetes, sickle cell disease, chronic kidney disease, etc.)
• Immunosuppressive diseases

“While the battle against the coronavirus pandemic continues, HealthNow’s digital platform offers virtual visits allowing patients across the state of Arkansas to receive assistance with treatment. HealthNow’s nurse practitioners are working tirelessly to provide Arkansas patients with educational and emotional support through this COVID-19 health crisis.”

For more information on HealthNow, please visit: https://uamshealth.com/healthnow/

For more information on monoclonal antibody treatment, please visit: https://combatcovid.hhs.gov/i-have-covid-19-now/monoclonal-antibodies-high-risk-covid-19-positive-patients

Sources:

1. Assistant Secretary for Public Affairs (ASPA). Monoclonal antibodies for high-risk COVID-19 positive patients. combatCOVID.hhs.gov. https://combatcovid.hhs.gov/i-have-covid-19-now/monoclonal-antibodies-high-risk-covid-19-positive-patients. Published August 9, 2021. Accessed August 10, 2021.

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The SMART Research, Training, and Treatment Center is a 100% tele-behavioral health clinic that offers patients virtual counseling and psychotherapy services. The clients the SMART center serve range from 3 to 21 years of age and include children, youth, young adults, and families/ caregivers/ educators.  The SMART Center providers currently include 1 Tennessee licensed clinical social workers (LCSW), 2 Tennessee licensed master social workers, 1 bachelors level intern and 3 graduate level interns, who are organized into treatment teams led by a clinical supervisor/ faculty member.

The University of Memphis School of Social Work SMART Research, Training and Treatment Center aims to:

• Provide evidence-based interventions for school-based mental health programming
• Increase access for school-based behavioral health programming in underserved areas
• Offer training on best practices in tele-behavioral health
• Develop opportunities to research the use of technology in practice
• Provide direct services to the states most vulnerable populations

South Central Telehealth Resource Center has worked with the University of Memphis and Dr. Elswick on many projects. Dr. Elswick stated, “SCTRC has been a valuable resource that I have shared with other local providers trying to start telehealth programming during COVID-19 and beyond. I have enjoyed the relationship I have with SCTRC and their supporting of U of M through connections in the community and grant collaborations regarding resources. Additionally, I have provided a few professional presentations on the topics of tele-behavioral health to the SCTRC programming.” SCTRC is looking forward to the continual partnership between U of M, SMART Center and Dr. Elswick.

For more information about this awesome program, visit https://www.memphis.edu/smartcenter/

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Given the public health emergency of the COVID-19 pandemic, many healthcare providers were in need of safer alternatives to deliver care. One way Associate Professor Tuhin Virmani, MD, Ph.D. and Assistant Professor Mitesh Lotia, M.D. have created safer options for their Parkinson’s patients and research participants, is by delivering care through Telehealth. Dr. Virmani and Dr. Lotia are with the Department of Neurology at the University of Arkansas for Medical Sciences (UAMS) and part of a team of co-investigators researching Parkinson’s disease in patients in rural Arkansas. Due to the rurality of the state, recruiting subjects to be involved in research can be difficult, given most would be required to travel long distances to participate. This obstacle prevents many subjects from making extra visits to UAMS to participate in Parkinson’s disease research.

Now, with the assistance of the South Central Telehealth Resource Center (SCTRC), this group is using telehealth technologies and adapting and modifying motor skill monitoring techniques to use as part of an evaluation for patients with Parkinson’s disease via a remote or digital environment. The initial idea for this project was to see patients virtually from their local healthcare center. This would prevent patients from not only traveling long distances and spending money on the associated costs of travel. Given the additional development of COVID-19 during project development, the project also keeps patients from entering a large hospital where their chance of contracting COVID-19 could increase.

Parkinson’s Research & Telehealth
The main goal for conducting Parkinson’s disease research via telehealth is to give patients in rural Arkansas more of an opportunity to participate in the research and provide them a safer alternative to being able to take part. One way the UAMS Movement Disorders group is working to collect information about each patient is by digitally collecting their handwriting on a tablet and collecting their voice through an audio message they would read aloud. Additionally, a significant portion of a patient’s movement disorders examination can be completed through telehealth video consults as well. Whether patients are at their homes or a local healthcare facility implementing telehealth video consults, it can greatly impact their safety, eligibility to participate, and financial burdens.

While telehealth implementation has been successful, there are still areas of improvement under this study. In using telehealth in patients with Parkinson’s disease, the patient population consists of older adults. Dr. Virmani stated that this population may be less likely to have the equipment, high bandwidth internet connectivity, and technological know-how to participate in telehealth video consults. The patient population in the movement disorders clinic, during COVID-19, led to increased telehealth visits. Most patients were initially participating in their clinical care by means of audio-only visits. Improving comfort with telehealth technology will also be important for larger-scale use.

Another barrier patients have faced since COVID-19 is the inability to have family members at in-person clinic visits. With telemedicine, given the relative ease of family participation at home, patients have had children and grandchildren assist them technologically with visits. Assistance ranges from support with technology set-up and troubleshooting, finding access to wireless broadband connectivity, and setting up their patient-facing Electronic Medical Record (EMR). Dr. Virmani and Dr. Lotia also mentioned that patients who do not already have appropriate wireless connectivity may be unable to shoulder the additional costs to obtain such services, especially in more rural parts of the state, to participate in clinical visits from home.

Telehealth Next Steps
Telehealth is valuable not only for patients who are required to travel long distances to obtain clinical care, but through the research part of this study. It also allows patients to feel empowered by participating in research towards improving care for people with Parkinson’s disease.
Improving broadband coverage across the state is one of the largest needs not only for this study, but also for all patients and providers needing virtual healthcare. Another major need highlighted by the increased dependence on telehealth is the development of of resources for patients to understand more about telehealth, the equipment needed and broadband required to run it as well as troubleshooting resources. Lastly, Dr. Virmani and Dr. Lotia noted that insurance providers allowing physicians to continue to utilize telehealth technology to deliver high quality clinical care in the long term will be important in the future.

Dr. Lotia stated, “Telemedicine needed to happen yesterday, but I’m glad it’s happening today.”

SCTRC and UAMS Movement Disorders Research Group
Dr. Hari Eswaran and Terri Imus, RN, and Aaron Kemp, PhD(c), contribute to the SCTRC team in the Institute for Digital Health & Innovation and are contributing to this collaborative effort. The IDHI SCTRC team is providing advice and consultation to this research team to optimize their use of telehealth technologies and the implementation of clinical research informatics to manage the compilation of data while ensuring the privacy and security of research participant’s private information.

For more information on this research group, please visit the following:
https://tri.uams.edu/news/tri-announces-pilot-awardees-for-biomedical-informatics-studies/

Contributed by: Aaron Kemp, PhD(c), University of Arkansas for Medical Sciences

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Fig. 1: Location map for Strayhorn Family Medical Clinic

Strayhorn Clinic with the UTHSC
HRSA Advanced Nursing Education Workforce project team

The UTHSC College of Nursing faculty partnered with Strayhorn Family Medical Clinic nurse practitioners to implement and facilitate telehealth for the benefit of the clinic patients, the surrounding community, and to provide telehealth learning experiences for nurse practitioner students rotating in this clinic. “When the COVID-19 pandemic began, many health care providers didn’t know where to begin regarding telehealth. I am so glad we are able to support rural nurse practitioners and clinics to better care for their patients and community. This is the beginning of a long partnership with these clinics,” stated Sarah Rhoads, PhD, DNP, WHNP-BC, FAAN, UTHSC Professor and Primary Investigator of the grant.

Device training at Strayhorn Clinic

The clinic received a telemedicine cart in the fall of 2020 with peripheral devices to use with specialty consults into larger facilities. For example, a specialist can look into a patient’s eyes, ears, nose, and throat with a special camera on the telemedicine cart, and can also transmit heart and lung sounds to a remote specialist utilizing a digital streaming stethoscope. The clinic has hosted multiple patients so far and has several more scheduled to be seen from their homes for telemedicine visits and they are learning more every day on how the addition of technology can assist in providing care.   They are currently talking to Behavioral Health partners about how they can host patients from the clinic, especially those patients with transportation barriers or patients that are apprehensive about going into a behavioral clinic.  “We can host patients here in their hometown, so they don’t have to drive to Southaven, Mississippi or Memphis for their appointment,“ says Anita Golden, FNP. “Telemedicine gives us the ability to be able to provide that extra level of care when needed.“

While the clinic is in a remote area, providers do see quite a few trauma cases as well.  In the past 18-months, the clinic has cared for multiple trauma patients including gunshot victims and numerous farming accidents.  Ross says, “You never know what types of medical problems patients will have when they arrive at our clinic.  It’s comforting to know that with the simple dialing of a number on our telemedicine cart we can access a specialist if we need that extra level of support while triaging a patient.”

Pictured: Dr. Sarah Rhoads, Karen Nellis, and Mike Carroll from the University of Tennessee Health Science Center

In partnership with the South Central Telehealth Resource Center, UTHSC is developing a Telehealth Training Center in an effort to train, educate and assist more patients and providers with the advanced technology of Telehealth. If you would like more information regarding this project or the Telehealth Training Center, please contact Dr. Sarah Rhoads at srhoads@uthsc.edu or Karen Nellis at knellis@uthsc.edu.

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As telehealth capabilities continue to develop and grow, so does the capability to provide care to patients in underserved and rural populations. In partnership with Canvas Communities, ARcare, a federally qualified health center (FQHC), has developed a telehealth outreach program for homeless shelters within the central Arkansas community. Ms. Lauren Fields, ARcare’s Chief Nursing Officer, explained that this program was born out of serious need. There is a lack of services for the homeless population in addition to endless barriers, including travel to healthcare facilities, follow-up care, and ancillary services. Implementing telehealth in these facilities eradicates significant barriers for patients in this population to receive healthcare.

Since the implementation of this program, ARcare has been able to connect this population to multiple services and providers including established patient visits, medication refills, diabetes education, medical nutrition therapy, behavioral health services, and pharmacy consults. By bringing the nurse and front office personnel directly to the patients at the homeless shelters and directly connecting them to a provider at a distant site, patients are able to receive much-needed care without the worry of transportation and scheduling barriers that exist for face-to-face visits. Not only have telehealth capabilities allowed ARcare to continue providing care to underserved, rural areas throughout the global pandemic but also a historical weather event where many patients were unable to leave their homes. Many patients who would have gone without medication refills, consults, behavioral health, diabetes education or acute care were able to receive that care with no delay thanks to telehealth.

While telehealth has been a major benefit for this population, there are still a few limitations, including imaging and diagnostic care. In response to this, ARcare has arranged transportation to patients in need of imaging or in-house lab work. Eliminating these barriers ensures that more patients will follow through with their care. Another obstacle faced with this program has been reimbursement for services, but ARcare attempts to assist uninsured patients with finding a representative that can meet their insurance needs.

The response from patients and providers using telehealth services has been very positive. Patients are embracing telehealth and want to be certain that they can do their follow-up visits via telehealth. The biggest question patients have is surrounding diagnostic testing and want to be certain they can receive their results by telehealth rather than in-person. In addition to COVID-19 safety reasons, many patients in the homeless population of central Arkansas have a fear of healthcare facilities and waiting rooms but also want to make sure they can receive the same level of care they would if they were to go in person.

Most of the providers, on the other hand, were comfortable with telehealth and introduced to the service prior to the pandemic. Providers have gained even more familiarity with the service throughout the course of the pandemic and have incorporated it into their daily work schedules. Telehealth is truly essential in making certain that patients have continuity of care regardless of fear, snowstorms or transportation barriers that keep them from receiving face-to-face healthcare.

The South Central Telehealth Resource Center (SCTRC) has assisted ARcare with the implementation of telehealth over the past few years.  The SCTRC has provided education, billing guidance, and conferences that have been helpful in navigating this new service line. SCTRC has assisted ARcare in the launch of telehealth in both school and shelter sites to provide care to underserved populations.

If you’d like to learn more about ARcare, visit the program website at http://www.arcare.net.

Have a Real World Example of your own?

Do you have a time in which telehealth has impacted your life? We’d love to hear your story! Please complete the form below to share your Real World Telehealth Example with the SCTRC team.

The post Homeless Facility Partners with Arkansas FQHC to Provide Better Access to Care appeared first on LearnTelehealth.

Ms. Donna Robinson is the Wellness Coordinator at Magazine School District’s School-Based Health Center (SBHC) in Magazine, Arkansas. Magazine is a small, rural town with a population size of approximately 800 people. Magazine SBHC began using telehealth in 2016 through the University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health & Innovation: Public Schools Program (formerly called STAR), and they continue to enhance and develop their telehealth services. This program focuses on mental health, physical health, nutrition, and dental health through telemedicine.

Overall, the implementation of telehealth services has significantly improved access to health care in this area. Ms. Robinson stated that by using telehealth services their mental health providers have been able to make better, more consistent connections with the students and their families. Medication management and yearly assessments were extremely difficult to complete in-person on a timely basis, especially during the COVID-19 crisis. The largest area of need for the SBHC is mental health support, emphasized during the COVID-19 pandemic. Without telehealth services, students were not able to receive their mental health services due to the school closing.

Many students have asked about beginning or continuing telehealth services through the UAMS Public Schools Program. Parents of students using telehealth have mentioned to Ms. Robinson that their children prefer telehealth to in-person consults because they feel they can open up more, and get more out of their sessions.

While telehealth has proven to be extremely useful in Magazine, the largest setback is the lack of broadband within this area. Many students lack appropriate connectivity in their homes. Robinson also stated that providers are in desperate need of more telehealth education, including telehealth etiquette and equipment training. Telehealth has significantly changed the way students and providers communicate, but there are still major improvements needed.

Candace Lewis, program manager for the Public Schools Program added, “I am excited to be a part of this program. As we continue to build relationships with students, parents, teachers, and SBHCs in the districts that we currently serve, it is our hope that we can expand this program to many other school districts throughout the state.”

If you’d like to learn more about the Public Schools Program, contact Mrs. Lewis directly at CJLewis2@uams.edu or visit the program website at http://uamsstar.com/.

Have a Real World Example of your own?

Do you have a time in which telehealth has impacted your life? We’d love to hear your story! Please complete the form below to share your Real World Telehealth Example with the SCTRC team.

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