Medically Speaking #2

Welcome, everybody, to today's edition of the Self Regional podcast, Medically Speaking. I'm excited to have today with us Graham Sullivan. Graham is the Director of Virtual Services for Self Regional Healthcare. We're going to be talking today about virtual services and telehealth and how telehealth is becoming more incorporated into medicine in general, what we're doing here in Greenwood and Self Regional and the communities that we serve to grow telehealth, and the services that we're able to provide with telehealth. So super excited to have you with us today, Graham. Why don't we start by just maybe just tell us a little bit about your background. All right. Well, thank you, Dr. Logan, for allowing me to speak with you this morning and kind of expose the community to our telehealth efforts. Started at Self Regional about 11 years ago and had an IT background working on different systems in the organization to kind of implement. In our EPIC environment and then really when the pandemic hit, we had a committee that was established to assess how are we going to continue care with some of the reductions in waiting rooms and the reduction in visitation. So with that group, we looked at what's the right way to access care from a technical standpoint, what's the easiest path for our patients, for our physicians, and supported that committee for about two years and then was able to assume the role of Director of Virtual Services. Which includes the new self-medical group virtual services office that we opened, as well as our MyChart team, because we really feel a big access point for our patients is using their MyChart to not only do some type of a telehealth experience, but also request an appointment, message their provider. So we're really, from a virtual standpoint, hoping to grow the MyChart integration along with telehealth. So we were able to establish the virtual services department. Well, I know you've done a lot of good work. I know you've done a lot of good work. And I think the pandemic kind of forced us into the telehealth world. We honestly, we were probably a little slow maybe to adopt at Self Regional, say three or four years ago, and then the pandemic hit and we all of a sudden had to figure it out. So thank you and the team that you work with for really helping us work through that. We dramatically increased the number, as you know, the number of televisits that we did during the pandemic, and it really just made a big difference for the community to have that as an option. So I just want to first thank you for the work that you and the team have done. So why don't we just kind of start at a high level, why don't you just kind of tell us a little bit about maybe the history of telehealth and virtual care and how it's used here and other places? Okay. Well, you know, recently, I was doing some some reading and saw it was an article by Thomas Nesbitt. And he wrote, what's the evolution of telehealth. And it was interesting to see that, you know, telehealth comes in a lot of different fashions and virtual care and telehealth can kind of be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. And so I think that's a really good example of how telehealth can be parallel. with our patients, not necessarily as just a way to treat during COVID, but now moving forward with our patients that'll say, hey, that's a two-hour drive for me to come and do that post-op follow-up. Or my wife's working until five, we have one car. I think my only opportunity is to go to the emergency room at night. I'd really like to see my primary care physician. How can we do this? Well, let's host a virtual video call so that we can move forward with that care and keep you out of the ER. So it's really come in a lot of different forms and it's continuing to evolve from say that, you know, very primitive, maybe just a phone call for a care consult to now we've got the video interaction and we've even are working towards, you know, remote patient monitoring so we can really manage that care from home and then also have the episodic kind of video experiences. But in general, it's just continuing to recognize that patients are, they're busy. They've got busy lives. Um, so sometimes it's just convenience. Hey, I can step out of work for five minutes or 10 minutes at home to have this video session with my provider. Um, or it's as, you know, integrated as, Hey, we really want to manage your care to prevent something from happening with some of that in-home monitoring, which we're looking, looking ahead at trying to stand up some of those systems. So, um, I know there's, there's type of several different types of, uh, like virtual visit options, for example. And, um, you know, I know that, uh, one of the big areas y'all are working on is like kind of an, almost like an urgent care type system, but then there's also other areas where it's being used in some of our practices, like say neurosurgery or in our behavioral health, uh, outpatient behavioral health options. Um, can you kind of talk to us a little bit about like, um, you know, I guess specifically like what services we're providing right now and what you see as it potentially growing into in the future here. Okay. So certainly our primary care physicians continue to lead, you know, the, the, I would say the pack, with offering, uh, virtual care. And we certainly have different ways they're doing that. Most of our, um, patients are having that video experience with their primary care physician through their my chart. But then we also have, um, Dr. Baruch and his team over on behavioral health. They have a mix of treating patients remotely, or even patients coming into their office and having an experience either in the hospital or the office with a physician that's offsite. So they can keep that care model. Um, Dr. Law is, I mean, he's done a phenomenal job with, um, you know, helping these patients post-operative who they may have still a little bit of pain and some things where it makes sense to have that follow-up virtually seen some really cool experiences where he's coached a patient through a wound dressing. And, you know, that patient had just applauded him for not having to make that trip to see him, um, where he got that same level of care in their home. Um, and so we've got the behavioral health, we have neurosurgery, certainly primary care. Um, we've got some other specialists, who are considering virtual care as they've had some patients, um, ask for that depending on if they've got a compromised immune system and just don't want to come out to a healthcare facility or just to go out in general. And then recently we opened our self-medical group virtual services department and that department opened, uh, June, uh, mid June, June 13th. And the goal of that is to open up access to care for sick visits. So we recognize in the community, um, we still have opportunities for patients to find a medical home. We have people constantly, moving to the area. Um, and we also have patients that they just for, you know, they just want to see a sick visit when they get sick, they may not have a need for more of that regular type care. So with our self-medical group, virtual services department, we're open, um, seven days a week, 8 AM until six 30. And our patients, um, come through our, my chart, and we've got nurse practitioners who are waiting to respond to them within five minutes. If they want an on-demand visit, or they can schedule an appointment up to two days in advance. And with that, it is just like an evaluation of management if they were in person. So we start with that virtual experience. And then from there, if something comes out where the patient says, Hey, you know, let's move to a point of care test, like for a respiratory illness. Um, we use our drive-through services that are adjacent to us. Um, we schedule register that patient and they just simply come through and get swabbed or, you know, provide that lab specimen. Cause with that office, we're really working on, Hey, I just don't know any other place to go. Or it's a big challenge to get to an urgent care somewhere else. So we can again, do that at home or, um, it's, you know, I just want something really fast. And from there, we want to make sure that we can start virtual. If we need to take you on site to suture a wound or give an injection or get testing, we can do that too. So that all that care is taken care of very conveniently. That's awesome. Yeah. So I'll just give one example of a family friend of mine and my wife's, um, uh, recently had like a cellulitis on her arm. And, um, she, uh, reached out to me and it's like, you know, do I need to go to the emergency department with this? I'm not sure what to do. And, um, you know, thinking of the virtual services option, I said, well, why don't we try this? And I encouraged her just to pull out her my chart. It's super easy. Just pull out your, my chart and scroll to like virtual visit and clicked on that. And, um, and I said, well, just let me know how the visit goes. And she called me back about 20 minutes later and she said it was awesome. And she was raving about how easy it was. And an antibiotic was called in. She just, you know, she was like, I don't know. I don't know. I don't know. I don't know. I don't know. I just went directly from her home to pick up the antibiotic. Didn't have to go into the office or do any of that. Just cut out all those steps, saved her a lot of times, able to get back to work quicker. And, uh, and, and it was great. And also got follow-up the following day too, to, to check on her, to see how she was doing. So, um, so kudos to your team, just from a personal experience in a family friend of ours who went through your services. Um, and with that said, again, that was kind of the experience that I just shared that a friend of mine had, what would be the, uh, what would be the way, for someone if, uh, let's say they have kind of a minor, some condition going on. Are there different options? Is it, is it always a video visit? Like what my friend had or what are the other options for those, uh, like e-visits if we'll call it that. And that's a really good point. So we, we even have patients that, I mean, they're, they, they would rather just, you know, simply submit kind of a questionnaire of their symptoms and receive, you know, a treatment plan at another, you know, later time of the day, or in some capacity, they just don't even have time to get on that video experience. So we have also e-visits, which the patient goes in there, my chart, um, you see the e-visit heading, it's right there under menu. And there's about 10 questionnaires in there that cascade between different kind of top illnesses that we see the cough, the headache, things like that. And the patient enters that e-visit and they simply answer the questions. And it kind of asks, you know, it gets a little more specific based on the chief complaint. Um, after that submitted, it goes straight to our patients. Um, they review it and we'll respond back with a question in my chart, or they'll call the patient depending on the timeline of response. Um, and then hopefully the next step is just getting that, that medicine or, or that over the counter recommendation or, um, whatever that care treatment is. And what we've seen is with our video visits, those are, um, compensated. They go out to our insurance, uh, to our patient's insurance, our payers, and we're continuing to watch, you know, the policy development with telehealth. Um, but in general, most are reimbursed similar to an office visit, but with the e-visit, it's just $20 cash payment. So once you submit your e-visit, um, you electronically pay the $20 and then, you know, that goes to our provider and they review it. If we're not able to find if based on the information, we're not able to treat, we refund that $20, same thing with our virtual. Um, and we've really seen a good, a good volume of patients who have used that experience. Um, and when I do some patient satisfaction calls and follow up with them, you know, they'll say, this was great. You know, it wasn't really super quick as far as when I needed care, but I loved, I could just do it when I wanted to, I sent it in. And when I got, you know, for a particular patient I was talking to, whenever I took a break for lunch, I had all my information in there. And my next step was to go to the pharmacy and the questionnaire took me, you know, maybe a couple minutes to fill out. So we're, we're still definitely learning on, you know, the patient's kind of consumerism. Do they really want the video experience or just a quick, um, e-visit, but we've seen a good, um, utilization of both of those. Cool. Cool. So, yeah, so it sounds like there's basically two big options for someone who's seeking, like, uh, you have an acute problem that you're concerned about. So you can either fill out a questionnaire, it gets sent in, or you can do a video visit. The questionnaire gets sent in, you get follow-up and, uh, and perhaps an antibiotic or whatever treatment that may be recommended based on the answers to the questions, or you can do an in-person video or not in person. Well, I guess live, live video visit with a, with a provider right then. So that's neat. One of the things I think is really cool about what you guys are doing and set up over there is it's, you know, when we were talking about telehealth, it's like, well, you know, a lot of times like, boy, I really kind of would like to have a strep throat swab or someone's having say urine symptoms or hurts when they pee or whatever. And you're like, well, boy, really, really nice to have a urinalysis. How do you do virtual visit without having test results? And you've touched on this already for a little bit. I just wanted to just maybe just reemphasize that a little bit. So you can do testing and you can come directly through the services area right here itself, beside the hospital and, and have those tests collected. Tell me a little bit about how that process works from ordering into test results and what, what someone could expect for like that total time to get the results back and get some follow up. Okay. I'm glad you asked the question and we can expand on our, our drive through services department is just phenomenal and they're continuing to evolve and look for ways to make the patient experience more convenient. I'll, I'll just use an example. We saw a little bit of flu last week, last Friday, it was very busy and it was patient after patient, after patient were coming in with the same symptoms and they all kind of lived around the same area. So we kind of started putting the dots together and realized, Whoa, you know, the flu is kind of jumping out there. So we start with the virtual visit, go through those symptoms and for those patients, they needed a flu swab. So what we do is we go into the drive through services department. We schedule that as we're talking to the patient, you know, which time works for you. Most of them will say, Hey, you know, I'd like to get it as soon as I can. So just depending on, you know, the schedule, usually we can have a patient get swabbed. And as soon as 30 minutes after our visit could be shorter, depending on what's open on the drive through services schedule. Um, but one particular patient, um, as soon as we had finished, uh, the encounter, they were parked at the front of the drive through line. Um, so as soon as we hit sign order, um, we had about a minute to get them scheduled and the drive through services team did a great job as we partnered. And really, they just went through and swabbed because we're taking care of them and they were able to get that scheduling and registration step from our department before they get there. Um, and then from time to take swab into the building, run the point of care tests, you know, around 20, 25 minutes. So altogether patient had a five to eight minute visit with us. They went through the drive through, got the results and say 25 minutes. So really within about a 30 minute experience, they talked to a provider, had their flu. And then we already had the letter to them for school. Um, you know, that they, um, uh, that they were flu positive. And then of course, they needed that for, for the exemption at school. So the patient, uh, and their family were really, really pleased with the, the quickness of it. Um, and the child was, um, was indicating, oh, I don't have to go sit in a waiting room. You know, I don't feel good. And it was really cool to see that we were able to get them through that quickly. So we start virtually and then we order those point of care tests. And right now we, we are testing for strep RSV flu COVID. And, um, to your point, we have a lot of urinary, uh, infections that come through. And we'll do the same process and they'll provide the specimen in our building. Um, it's right off the end of the drive-through line. And then, um, if we have a patient that we start virtually and, you know, it's just a little more complex or something comes out that we just weren't originally aware of, we do have multiple exam rooms. So we, from time to time, we'll bring a patient on, on site. If we need to do a little more scoping in the ear or if a physical exam is really required, um, or in the, the, um, in some situations where we'll do like a steroid injection suit or a really minor wound. Um, cause our, really our goal is if these patients feel like their only opportunity for some of those things is just to go to the ER. We really want to try to capture that experience first, if we can, um, to help with some of those acuity patients in the ER. Well, that, that brings up a good thought. So maybe we could talk briefly and you've already touched on it. Like what are the types of conditions or symptoms that patients have that would be appropriate for a virtual care visit or an e-visit versus, like what you'd like? Oh, no, you really should go to the ER and not even bother with virtual visits. Can you, can you talk about that a little bit? Well, that's a great point because certainly we'll have some folks that will, um, kind of arrive in the virtual queue, the request appointment with us. And they're a little bit more acute than really, they probably should even have an on-site visit. Um, usually those are your sinus stroke, dehydration. If anyone's got chest pain, um, if major anxiety attack, things like that. Um, we've had a handful of patients who've started virtually and our process from there is to call the ER and say, Hey, we've got patient X who isn't in a very acute situation. We're working with them to get transportation to the ER, or we've called, you know, um, EMS to come assist. Luckily very few, but generally it's those, um, it's those sicknesses or those chief complaints that, um, are really, are going to need more in-depth care. Mm-hmm . Um, and then I would say probably 99% of the patients that we've, uh, that we received in the self medical group virtual services, um, fortunately we've been able to treat or we've brought them on site to take care of it. Um, but for the few that have been pretty emergent, it's, it's been a, you know, a little bit, a little bit of an interesting situation to, to get them that care from home if they didn't have a loved one, et cetera. But, um, really feel like our strong partnership with the ER and, uh, with those providers to kind of give that insight, Hey, they're coming. That process, um, further makes that a, a, a better experience for them. Yeah. For sure. So, yeah, certainly. So things like, uh, severe chest pain, stroke-like symptoms where something's not working right. Um, you know, you know, high fever with confusion or things like that, that would kind of maybe, maybe indicate something more severe. Sounds like the probably shouldn't start with virtual care, but if they ended up there, then we have a good plan in place to get them where they need to go to get acute treatment. So that's, that's awesome. Um, well, good. Um, you know, I think I've kind of covered like the highlights a little bit. One, I guess on one other, one other note on the, you know, we talked about behavioral health, um, mental health options as well as what we're doing in neurosurgery. Um, you know, that's not something that necessarily every patient could just access the neurosurgery via virtual health without going through their practice. Well, let's talk about, so we talked about the acute visit. What about, how are we using a virtual care services in our practices right now? And I know you've touched on it some, but let's talk about that a little bit more. And then, um, uh, where do you see virtual services going into the future at self regional? Okay. Um, I think really what we see in the primary care area is when I've been able to, when they've been great to allow me to observe and talking with some of the self-medical group leadership, um, is, you know, it could be as simple as patient was COVID positive and they wanted to do the followup with them because they had more chronic illnesses. And of course we didn't want to bring that patient on site if they're still symptomatic, still testing positive. Um, we see a lot of the patients that, um, they may have a controlled substance like a ADHD medicine, you know, by the, you know, the regulation, you need to have that face-to-face visit within say 90 days or 60 days, you know, having that virtually, especially, um, we've got a lot of students who went back to school, you know, and they're at a distance and that's missing class, et cetera. If they've got to travel all the way back. Um, uh, it's a lot of the chronic care management, um, is also where if that patient's diabetic and if there's something going on, you know, that they need some of that tracking again, they can't get to the office. Um, primary care has been awesome to, extend an opportunity for a virtual visit. Um, so they're really, I think using a plethora of, of patient types, um, to, to make sure that access to care continues, um, around some of those patient specific situations. Um, but in general, I think we certainly have patients that ask that they'll say, Hey, you know, um, a recent poll I was, I was reading from a forms magazine, um, from prosper analytics and insights indicated that 36% of adults had a virtual visit during the pandemic. So I think now we've got patients who are kind of aware of, Hey, I can do this, this worked great before. So I think they're getting a lot of requests from patients that'll say, can we just do this virtually? Um, and I think depending on probably the providers, um, kind of judgment on, is that the right thing, um, from some of their protocols, they'll do that virtually. But, um, from what I've seen just in general, it's, it's usually, is there a patient challenge to get into the office or is it a specific, you know, treatment option that can be managed virtually? Um, and I think that's, I think that's, I think that's, I think that's like a, you know, a followup visit or something like that. Um, and they're, they're using that technology to create that best patient experience. So Graham, tell me for a second, um, the, uh, the ages that you, uh, can take care of through the virtual services. I know, I think some of the youngest of the children that we may not do. Tell me about that for a second. So, um, the population that we serve is five years and older. Okay. Um, and then of course we've had, you know, folks that have used our services that are in their eighties, you know, so we, um, we, from a five years and older, we felt like that was the best age to be able to have the patient really explain some of the symptoms they're having with the parent. And through that process, the patient, um, within their, my chart, uh, their parent will have proxy access and can schedule that, um, that youth in our office. So, um, five years and older for all of our family medicine type, you know, issues, um, is our current population. Okay. Well, good. So, you know, I think that's, that's a good point. Um, I think that's, I think that's a good point. Um, tell us what you have to do to access telehealth. Um, if I know we've touched on it, but it sounds kind of complicated if you've never done it before, what do you have to have to access telehealth? I believe just a cell phone, um, or a computer access. So walk us through the steps. So let's say I'm at home and I have a condition and I want to access telehealth services. What do I do? So, uh, having connectivity to really cellular or the internet is, is really the basic foundation of it. So, um, I think that's a good point. I think that's a good point. I think that's a good point. So, um, we're, we're working to continue to assess what is the, you know, how do we get to a more, I would say appropriate tool, um, that is the most convenient for our providers and for our patients. But most of our patients, um, we work and as just in general in our community, we're really working hard to expand our my chart activation because we've got not only the ability to do virtual care, but a lot of the great patient engagement tools, you know, messaging the provider, seeing your lab results, seeing your, your physician's note. So really trying to leverage that. And I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. I think that's a good point. But for most of our virtual, um, opportunities, um, you simply having my chart and then the practice scheduling you, um, for that visit and then onboarding into what that experience is going to be those instructions. Um, and then with that, our patients do an e-check in. So what that experience is, is our patients basically confirm their insurance, um, their clinical, some of their clinical questions. Are you still, you know, taking that medicine or do you still have that problem? Do you still have that allergy? Um, and then there's some specific, you know, questionnaires depending on if they're Medicare, et cetera. Um, and then they simply join the video and they can do it from their cell phone or from their laptop. Um, we, we've seen all kinds of, of interesting scenarios, you know, a lot of people driving and we'll, we'll say, Hey, please drive, please pull over, um, people out, you know, um, on vacation, people that are out by their pool. And then we have, of course, folks that are, you know, on their sofa and their living room and their office. So we've really seen a cool, blend of how the patients are using whatever technology they have to access that care. Um, but in general, most folks use their smartphone or their, their computer. And, um, I realized that I need to go back to that previous question of where is telehealth kind of going forward. And I think, um, a lot of that's going to be that investment in our, my chart expansion, um, and having just more awareness of that tool and continuing to support our medical providers with, um, enhancements to those tools so that, you know, they can continue to, you know, continue to be as, as efficient as, as we can with our virtual tools. Um, as well as how do we take not only the video experience, but more of that patient monitoring experience and more of that, more of that management of care outside of episodic care, um, which I think is going to be that investment in more data tracking and working with our home health, um, you know, folks, as we really, um, help a lot of these chronic care patients, um, stay out of the hospital and, and hopefully avoid an acute episode because we caught it on the front end. Sure. Yeah. And, uh, you just mentioned my chart. Um, I think it's important people know how easy that is. So it literally is just a, on your phone, going to the app store and looking for my chart and downloading that app onto your phone. And then, um, when you click on that, the first time it walks you through a registration process, you choose self-regional healthcare. You really just put in your date of birth, your name, those types of things. And it automatically will pull up any records that you have and pull it right in there. I help my parents with that. I help my parents with it recently. And I was kind of surprised how easy it was. And my parents are in their seventies and, um, within probably about five minutes, I had them up and going on my chart, really just downloading the app on the phone. And I showed them where the virtual visits are. It's just, you just scroll right down and it's right there. Just tap it virtual visit. And it takes you right to the, uh, virtual visit. And it's, it's really become very easy for folks. The other really cool thing about my chart is an instant access to your lab results, lab results, pathology results, x-ray reports, um, office notes, those types of things, which are just auto populated in there. And you get a little ding on your phone when those tests are back and, uh, and you can see it. And, uh, and it's really, it's helpful. And I think it's really, uh, getting patients more engaged with their care. And, um, you know, sometimes labs may be a little confusing to someone if they don't, haven't looked at them before, maybe not understand like what they mean. Um, as you know, um, we're required by federal law under the cures act to instantly give them to them as soon as we'd need to. But we just ask everybody to just, if you're not sure, talk to your doctor about what that means. Cause sometimes something might look real scary, but really it's not that big of a deal or really clinically significant at all. So always talk to your doctor as something comes back on there and you're not sure what it is. But, um, I just wanted to just point out how easy it is to get my chart. And that's one of our big goals for this year at the hospital, as you know, is to get more people on my chart so we can get more engagement with our, with our community. Um, and, and the cool thing is it's not just getting your results back. It's about ability to communicate with your, your healthcare provider. So it's about being able to communicate over the, my chart where you can send a message to your provider team and they can give messages back to you, refill your medicines, do all that thing right there. Um, so, uh, so such a great tool opens up the virtual options for folks. Um, and, uh, as far as, uh, you know, long-term wise, um, the more people we can get on our electronic medical record through the, my chart on your phone, the more access and the more, uh, convenience and also, uh, just that engagement with your own health, I think is, which is going to be so important. So, well, Graham, listen, uh, thank you so much for visiting with me today. Uh, this has been real helpful for me, uh, hopefully for our listeners, you have anything else that you want to add today or share with our community? Um, just gonna, again, thank you, Dr. Logan, for allowing me to speak on our virtual, uh, services and our virtual tools. And we're really excited about continuing to hopefully act, you know, grow our access to care, especially in our rural areas. Um, and again, you know, it's very important to sign up for my chart, it's a great, great tool to stay connected in our community. You can go to my chart.selfregional.org and sign up. You can go to our virtual services, selfregional.virtual, uh, selfregional.com slash virtual care. You can also in, um, find a way to sign up there or see more on our virtual services. And then, um, our, we have a phone number with a team who's waiting to help with my chart support or enrollment. And that's 864-725-2737 also on our website. So, um, we're really, again, excited. As our organization is going to continue to try to expand my chart and layer in telehealth along with other tools to keep that patient connected to our health system. Awesome. Graham, we are so excited about the work you and your team are doing. And I think going forward, this is just opens up so many new opportunities for our patients to be able to get convenient access, um, that quick turnaround service that we want to be able to provide and, uh, really take our services up, up a couple levels. So listen, thank you for the work and thank you for your time today. Thank you, Dr. Logan. Absolutely. ♪ ♪