Mount Sinai Hospital in New York City has had a serious challenge throughout 2020: to keep in touch with patients who do not have COVID-19 during the pandemic.
At the beginning, during the first surge, people were too scared to get out of their homes – let alone come to the hospital – and the Mount Sinai clinics emptied almost overnight. But of course, patients continue to have healthcare needs that do require doctor visits.
“Mount Sinai’s truly remarkable IT department was able to step up to the challenge and – in record time – roll out technology solutions to keep us in contact with our patients even as the pandemic was raging,” said Dr. Eyal Shemesh, professor of pediatrics and psychiatry and chief of the division of behavioral and developmental health in the department of pediatrics at Kravis Children’s Hospital at the Icahn School of Medicine at Mount Sinai.
But the healthcare organization’s efforts were subject to challenges on the patient side. Some patients did not have devices to connect with Mount Sinai, did not know how to use the various connectivity platforms, did not have WiFi connection, or did not have “minutes allocation” for broadband connectivity.
“Unfortunately, the patients who found it hard to connect with us were also the most vulnerable patients,” Shemesh remarked. “So our best efforts fell somewhat short because of patient-side barriers that are not traditionally within the scope of healthcare providers.”
Mount Sinai decided to select technology from vendor PadInMotion to solve its problems.
“We partnered with the vendor to provide connectivity devices, a pad, to patients who are identified as in need of those devices,” Shemesh said. “The devices are customized according to the specification of our various provider groups. They come preloaded with telehealth applications, as well as links to educational materials that are specific to the patient group – for example, our transplant program.”
Mount Sinai includes a broadband connectivity allowance. It chose PadInMotion devices because they are familiar to the health system, having been used successfully in the past.
“The vendor set up a dedicated support line,” Shemesh explained. “The device setup is simple and very straightforward, and the interfaces are multilingual. I lead a weekly meeting with the vendor and our IT leadership to review new specifications, review use data and assess the need for further device modifications – constantly trying to make these devices more user-friendly, using patient and provider feedback.”
“I lead a weekly meeting with the vendor and our IT leadership to review new specifications, review use data, and assess the need for further device modifications – constantly trying to make these devices more user-friendly, using patient and provider feedback.”
Dr. Eyal Shemesh, Icahn School of Medicine at Mount Sinai
This program is an example of patient-centered care in that Mount Sinai customizes it to specific patient populations’ needs using provider specifications, and then continues to modify and customize the service/device based on patient feedback once they are using it.
“These efforts have led to a unique program that addresses the relevant barriers,” Shemesh said. “Lack of devices? We provide the devices. Lack of technological savvy? We preload the applications. The device is very easy to use. There is a dedicated help line. The software is multilingual. We have prior experience with it. Lack of connectivity? We provide broadband allowance.”
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MEETING THE CHALLENGE
Mount Sinai created a workgroup that is responsible for identifying provider groups, customizing the devices, and deploying them according to the providers’ specifications. Some devices are sent directly to patients and some are given in clinic. The workgroup tracks devices for usage, but does not have any access to the patients’ medical charts or to unique patient characteristics or use patterns.
“We do not allow integration with other systems at this point. The issue is mainly HIPAA compliance, but patients can have access to their health information via an embedded app if they wish,” Shemesh explained. “The devices include apps that can bridge healthcare services, for example, laboratory and prescription fulfillment.”
One of those apps is “real-time clinic,” for example, which provides integration with healthcare providers. But the extent to which services beyond telehealth encounters with providers have been accessed and used is not known at this point, and such access is not necessary for the program to achieve its goals.
“I can only share very preliminary pilot results, which only pertain to the first 21 devices, going only two months into the program,” Shemesh said. “These results may not be the same as the final results from the program. For this initial pilot group we did not have even one call to tech support, and yet all devices have been used, which means that the devices, as intended, were straightforward and easy to use.”
For these 21 devices, Mount Sinai recorded 571 interactions over two months, of which 239 were with unique telehealth applications. (The rest were with less specific interactions, such as linking to educational materials that may have been related to telehealth.) The organization does not allow unrestricted Internet access – so all interactions are related to healthcare in some fashion.
“We still do not know the final results for usage and satisfaction,” Shemesh said. “Those will be reported when the program ends. However, our assessment of the preliminary results that we do have is that, as far as we know at this point, the program has been incredibly successful and that it successfully addresses the barriers that it was set out to address.”
Following, Shemesh noted, are some of the parameters Mount Sinai is tracking:
- Usability: number of unique clicks stratified by core telehealth and “other” (for example, educational materials).
- Patient satisfaction: level of satisfaction with this device/service as gauged by a questionnaire embedded into the devices.
- Provider satisfaction: also a questionnaire, which will be administered at the end of the program.
- Impact on health outcomes: Mount Sinai plans to ask providers to try to help it gain insight into actual impact.
USING FCC AWARD FUNDS
Earlier this year, Mount Sinai Hospital was awarded $860,000 to fund this computer pad program.
“Our hope is for the program to allow us to keep connecting with our patients so as to provide care even to those who are most challenged – those who need us most but cannot or would not get the level of care that they require because they are afraid to come to see us,” Shemesh explained. “We also hope to learn through this process about the best ways to connect with our most vulnerable patients and identify remaining barriers.”
Patient engagement is a subject that Shemesh is particularly interested in, both as a clinician and as a researcher, and he hopes that through this program staff will be able to, not just provide essential care, but also continue to learn from patients how to serve their needs in the best possible way.
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