Telemedicine and RPM transform care delivery in Alabama, racking up victories

When the University of Alabama at Birmingham Health System created a telehealth program, the main problem it was trying to solve was how to improve access to care across the state.

Problem

Alabama has some of the worst health care outcomes in the country. Telehealth technologies were adopted to address the issues and eliminate geographic excuses for these outcomes, said Dr. Eric Wallace, professor of medicine, medical director of Telehealth and UAB eMedicine medical director.

“Access to care issues were both ambulatory and inpatient,” he explained. “Videoconferencing has allowed us to redistribute care across our state. UAB has partnered with the Alabama Department of Public Health to obtain funding and purchase videoconferencing equipment for each of our county health departments. We used these county health departments as a way to provide subspecialty care throughout our state.

“Next, we launched inpatient telehealth at the rural Whitfield Regional Hospital. We implemented a tele-stroke program and general neurology to start with. Then we expanded to telenephrology, tele-critical care and telecardiology.”

The COVID-19 pandemic allowed videoconferencing to expand into the home. UAB grew from 1,000 video visits in 2019 to 280,000 video visits in 2020. Today, telehealth remains about 15% of total ambulance volume.

Also during the pandemic, UAB implemented a remote patient monitoring program to better meet the needs of its diabetes and hypertension patients.

Proposal

Telehealth was meant to ease the problem of access to care in Alabama.

“We have many hospital beds in our state, but despite this, 70% of our rural hospitals are running in the red,” Wallace said. “This is largely because patients begin to bypass the rural hospital when the hospital does not have the necessary services to care for the patient’s illness. Hospitals in urban areas have subspecialists to capacity, but hospital beds are always full. Live

“Telehealth allows us to redistribute this care,” he continued. “It was all very clear during COVID. We’ve had times where life-flight patients without critical care and telehealth subspecialty support of nephrology in rural hospitals were moved to other rural hospitals that had these subspecialties.

“Once a health care professional witnesses how telehealth can completely transform care delivery if properly organized, they understand how virtual care is not only necessary but imperative if the industry is to continue to be a health care system. is going to improve in a meaningful way.”

Economically, UAB’s inpatient telehealth services have replaced hospitals.

“One of our hospitals went from an average inpatient census of 20 to an average inpatient census of 50,” Wallace said. “His case mix index increased from 1 to 1.5 because of his case mix index of transfer to UAB.

“We’ve seen improvements in care not only in rural areas,” he said. “Even internal to UAB, we have implemented full tele-ICU capabilities in over 250 beds and have seen significant and sustained reductions in the predicted rate ratio and mortality.”

On the ambulance side, UAB has seen telehealth enable access to rare disease specialists not only in rural areas, but throughout the region and even internationally. It has seen better access to all its sub-specialty services.

“More important, we have seen a tool by which we can continue to transform care delivery,” he said.

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Result

Through its telemedicine programs, UAB has achieved several tangible successes, including:

• Increase in census and case mix index of rural hospitals.
• Increase in case mix index of patients transferred to UAB hospitals.
• Achieved over 650,000 ambulatory telehealth visits.
• Remote patient monitoring an average systolic blood pressure of 9 mmHg over 45 days.

advice for others

“To build a telehealth program, you must learn lessons from the software industry,” Wallace advised his peers. “Healthcare needs to plan for a minimum viable product. Once that’s done, you have to start with the goal of seeing one patient. Then two, then three.

“With technology implementation, there is no time for a randomized controlled trial, and by the time the trial is completed and analyzed, the technology has changed,” he continued.

Find the problem, he said, then decide if technology is a viable means to eliminate the problem.

“If so, plan just enough to see one patient and scale up from there,” he concluded. “Too often we plan so much that nothing happens. In the end, pairing a clinical lead with an outstanding executive lead has worked well for UAB.

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