Neighborhood Family Practice moves quickly to offer telemedicine for its patients

by Chuck Hoven

Neighborhood Family Practice staff members are reaching out to let area residents know about their new telemedicine program, a program that has evolved due to necessity with the advent of the corona virus, COVID-19, pandemic. Neighborhood Family Practice President and Chief Executive Officer Jean Polster and Assistant Medical Director of Medical Informatics Dr. Chad Garven explained how the new telemedicine program is working in an April 23^rd interview with three West Side neighborhood newspapers — the Plain Press, The Tremonster and The West Park Times.

Neighborhood Family Practice President and Chief Executive Officer Jean Polster says the telemedicine is available to all patients in all their programs – behavioral health, midwifery, and for primary health care services. She said Neighborhood Family Practice also is able to provide face-to-face services when needed. We have the ability to see you safely in six locations, she said.

Dr. Garven explained that telemedicine ideally involves two-way audio and video connection with your healthcare provider. Historically, Ohio restricted such health care to patients in rural areas where there was not a lot of access to close by health care providers, he noted.

Dr. Garven said in mid-March it became “pretty clear, alarmingly fast” as the virus was spreading in Ohio that continuing having all patients coming in person would be unsafe, not only for the patients, but potentially for Neighborhood Family Practice staff as well.

The state regulations began to change. There was not a distance requirement any more for telemedicine. A patient could be near a provider, but on a virtual platform.   A new state mandate restricted in-person visits for elective care due to the corona virus pandemic. Dr. Garven said a combination of safety concerns and the need to continue to serve Near West Side residents, led Neighborhood Family Practice, by virtue of necessity, to jump into telemedicine.

President and Chief Executive Officer Polster said prior to the risk from the corona virus Neighborhood Family Practice had been looking to use telemedicine for patients who may have difficulty traveling to a specialist’s office or may need translation services. She said those patients often felt more comfortable in the Neighborhood Family Practice office, so the idea was for them to use telemedicine from the doctor’s office to receive services from a specialist. Polster says the State of Ohio began to allow reimbursement for such specialty telemedicine back in July of 2019. Even then, there were restrictions of urban vs. rural for some services, she said.

As the corona virus danger became apparent, Polster says she has to give credit to Ohio Governor Mike DeWine and Director of the Ohio Department of Health Dr. Amy Acton for allowing remote access to appointments, not only for behavioral health services which had been underway, but also for all health services for patients. “They threw all regulations aside and said, ‘go for it, serve your patients in the best way you can.’ And Chad, along with others, put his nose down to discover how we can continue to service patients,” said Polster.

Polster says when the state restricted in person visits for elective care, it took Neighborhood Family Practice a week to make the pivot to telemedicine. “It would have taken months, if not years, to make that pivot in a non-crisis situation,” she said.

Dr. Chad Garven explained how the transition to telemedicine was accomplished. Garven said Neighborhood Family Practice selected an existing health care video platform that was widely available and had the advantage of being easy software for both staff and patients to use.

“We needed an easy platform to use,” Dr. Garven said. “We didn’t want to be involved in coaching patients and staff about how to download software and applications (apps). We selected a paid platform, easy to use, and on a website. It is a video platform that is like using facetime, or skype, or zoom.” He said patients’ experience using the software is very similar to what they experience when going to the doctor’s office. There is a registration process. There is a medical assistant that talks to them about their medical issues and medications. Dr. Gavin says, “It looks like everything for the visit is the same, except the patient is not in the building.”

Dr. Garven says, it is “pretty remarkable” how quickly 90% of patient visits were able to shift to telemedicine.  This is near our previous volume expectations for patient visits.

The ideal with telemedicine is to have both an audio and video link to patients through a computer, tablet or smart phone, said Dr. Garven. He said about three out of four visits are video and audio. About 25% are audio only. He said even a high number of patients over the age of 60 had a smart phone, laptop, or tablet, or could borrow one from a family member for their appointment.

Any patient that calls in is offered an appointment. Previously, if you called your provider, you could get an appointment in a few days. There inherently was a delay in getting an appointment. Right now, anyone calling in is offered an appointment right away. If you want to talk about Corona virus – there is a platform for that. There is also a platform for people with chronic conditions. “It is interesting that we have been able to do more appointments in the last few weeks for patients with chronic conditions, like diabetes and hypertension, than we would have otherwise have been able to schedule without the telemedicine,” said Dr. Garven.

There are some advantages to telemedicine. CEO Polster noted that many patients are hourly workers and making a doctor’s appointment means taking time off work and losing pay. Others have difficulty with travel or childcare.

Dr. Garven added that, since they started doing telemedicine, the no show rate for appointments has gone down substantially. He said, while some of this is due to people staying at home because of being laid off work, some of it is due to the convenience of telemedicine.

He noted that previously when people made in-person appointments, they had to make a trip to the office where often they end up waiting in the waiting room for the doctor to be available. This could involve up to three hours. Now with telemedicine, patients can often be connected with their doctor right away. Dr. Garven said, “It is a lot more convenient to have health care delivered to a space where patients already are. Particularly when we believe the health care delivered is at least equal.”

There are also some drawbacks to telemedicine. Dr. Garven said the ideal is to have both audio and video connections. He says Neighborhood Family Practice will be examining ways to get all patients to have both an audio and video. Polster added that it is unclear how long regulations will allow audio only services, since video and audio combined is the goal for telemedicine.

Another problem is that some patients experience problems with wifi connectivity. Their internet feed is sometimes overwhelmed by the size of the video transmission. This in another issue that needs to be addressed.

In addition to internet connectivity sometimes being spotty, another drawback to in home service involves patients finding a quiet private space in their homes where they can talk with a doctor. Patients have discovered that they may not want to be in their living room while talking to the doctor. Some patients seeking quiet or privacy while talking to the doctor have gone out to their car to talk, said Polster.

Polster said Neighborhood Family Practice was one of only six agencies in the nation to receive a Federal Communication Commission (FCC) Grant to provide resources for telemedicine. She said the grant has enabled Neighborhood Family to purchase hundreds of blue-tooth-enabled medical devices.

Dr. Garven explained that the devices can help to monitor patients’ acute respiratory conditions in their homes, something of concern for those experiencing symptoms that are indicators of possible corona virus, COVID-19, infection.

The devices can also help with the monitoring of chronic conditions such as diabetes and hypertension that if left untreated would result in severe problems later. Dr. Garven says the blue tooth enabled devices can be dropped off in peoples’ homes. The devices can be used by patients to relay directly to their doctor’s computer information such as blood pressure, temperature and oxygen levels at the time they are talking with the doctor. When patients are finished using the device, it can be picked up, sanitized and cleaned up, and moved to another patient who needs it, he said.

Dr. Garven says that technology is outpacing medical care now. He said that there are applications where you can use a laptop to look inside a patient’s ear and get a live feed of what the eardrum looks like, or have the ability to send sound from a stethoscope directly to a doctor so the doctor can listen to your breath or heartbeat from a remote location. Garven said the same type of medical technology available to Amazon owner Jeff Bezos and his pals, should be available to Neighborhood Family Practice patients.

CEO Polster says, Neighborhood Family Practice doesn’t see a lot of patients wearing Fitbits. Being able to monitor patients in their homes has some real benefits.  She said Neighborhood Family Practice is contacting people with chronic conditions at home with the goal of monitoring their condition and keeping them healthy and out of the hospital. She praised Case Western Reserve Medical students who are currently going to patients’ homes to help set up the medical tool kits.

Dr. Garven noted there are situations where patients still need to come into the office. Initially Neighborhood Family Practice called all patients and told them if it is an elective visit, it was not a good idea to come in. Now systems are in place to screen patients via telemedicine to determine if they need to come into a clinic. Some we are required to see in person, he said. Noting you can’t give a patient a shot of cortisone in a shoulder remotely, for example, and there are also some patients that have difficulty using telemedicine. For these patients, Neighborhood Family Practice has made every effort to improve the comfort level and safety of all patients and staff when people are coming to the office, he said.

CEO Polster said, “We do have face-to-face visits when it is urgent. If you need to come in for care, we can do that… We have created an environment that is safe… If things are needed, we do have the ability to see you safely in six locations that are still open to see patients in person.” She noted that the Tremont location on Professor Avenue has closed, and the staff has moved to other locations.

CEO Polster says Neighborhood Family Practice is excited to accept new patients. New patients can be walked through all the steps of signing up remotely. “We want to serve new patients, and we have the capacity,” she said.

Polster said being a federally qualified health center provides Neighborhood Family Practice with a peer group that has local, regional, state and federal members that participate jointly in a number of weekly calls.  “We share resources with each other,” she said.

She said that Dr. Garven participated in a year-long training in electronic health records with OCHIN, a national organization to which also has a large membership that shares their experiences. Sharing information between peer organizations has been invaluable, said Polster.

Dr. Garven said OCHIN started on the West Coast, so many of the established members are community health centers from cities such as Spokane and Seattle that are doing similar outreach and are in regular communication. “The idea of the culture of innovation has been helpful,” he said.

Polster said some of the organizations in OCHIN have a long experience with telemedicine. Neighborhood Family Practice has learned from their shared knowledge with telemedicine, she said.

Editor’s Note: For more information about Neighborhood Family Practice or to access their services call their main office at 216-281-0872 or visit their website at: www.nfpmedcenter.org.