BMH Care Anywhere uses telemedicine technology to securely connect patient and provider via virtual visit anytime, anywhere. It was recently introduced by Beaufort Memorial Hospital (BMH) Digital Health Innovations group–-a unique, small group within the BMH system including Shauna Bishop, PMP, CSM and Director; Jonathan Lohr, Digital Health Technical Analyst; and Lisa Taylor, MBA and Manager of Telehealth Services. Shauna acted as spokesperson for our interview, with input from Jon and Lisa.

How does the Digital Health Innovations group fit into the greater BMH system?

We report directly to Russell Baxley, CEO, who pushes this group to continue to think towards the future of healthcare innovation. The organization has placed such an importance on the development of telemedicine, they created a special department to manage this and many other projects. In addition to the role out of BMH Care Anywhere, we were responsible for recently changing out the physician side electronic health records. We began in 2014 as a department of one (Shauna) bringing the project management side, then Jon on the technical side in 2016, and just recently Lisa on the practice management side.

What aspects are covered under "telemedicine"?

There are three major programs: The Harrison Peeples piece is a telemedicine center coming online in the rural Varnville area. Then, Medical University of South Carolina (MUSC) is the administer of a state grant fund promoting telemedicine in South Carolina–-a piece of that money being used for "carts". For example, if a new mother has a baby that needs a specialist that BMH doesn't have but MUSC has that specialty, then we can call MUSC. They immediately get on the cart on that side, we show the baby on this side and they can give care from a provider that we don't have here. We have an alliance from Beaufort to MUSC, then from Beaufort to Harrison Peeples. And finally, the BMH Care Anywhere piece.

What was the impetus to bring BMH Care Anywhere on board as a patient-provider tool?

As a hospital, we want to be more digital and have more data. We want to go beyond brick and mortar, to grow our footprint. Telemedicine is an opportunity for BMH to expand access to care to the residents of Beaufort County outside the four walls of the hospital or the physician's clinic. It is also a tool for connecting patients, who may not have a primary care provider, to those primary care providers. Possibly creating a relationship that we believe could improve the health of that patient. All of this happens while trying to create the most optimum patient experience for both established and new patients.

It could be great for people who are on vacation or spend six months out of the year here–-maybe they should have a primary care here. We are only advertising in South Carolina and Georgia, but you can use it anywhere. There's a whole demographic in the Bluffton area that has an option of which hospital they go to, being in-between. We're opening a micro hospital in the Bluffton area, and we'll have a telemedicine aspect there as well.

When was the idea presented and how long did it take to implement?

We presented to our CEO in September and got it done in about ninety days. We are doers. The original plan was to go the first ninety days with employees only, but because of flu season we went ahead and opened it up to the general public on December 28, 2017. Eventually, we're going to have multiple practices on the app, but right now it's just urgent care. When you log in, it's going to say OB, Telepsychiatry, Urgent Care... and you'll see providers associated with each one of them.

What infrastructure was needed?

There was really not much needed because it's a hosted app–-hosted by the vendor, American Well. It was really the branding of the app, getting ports open to point back to the vendor, and then doing some marketing and making sure our providers on the platform had the proper contracts in place. Acquiring IP addresses and licensing for the app store was on our end, and American Well handled the backend behind the scenes part of it. Jon was integral in getting this into the app store. Not to oversimplify it, we rebranded the app to be ours. Our CEO is very forward-thinking, very innovative and lets us do the right thing.

We spent evenings in meetings with our providers talking about the equipment they needed. Basically, they just had to have a PC/laptop and a webcam. A lot of them like to use dictation. As part of our Athena (electronic health records) upgrade, we went with an enterprise version of Dragon (dictation software) that is compatible with the BMH Care Anywhere software and it works very well. We did some training sessions with physicians to initiate connection from their side and see how they are going to chart, take notes, fill out prescription requests–-in the care summary they can send that prescription on and get notification in the app that it's available, ready and has been sent. The patient adds their pharmacy in the app.

Why did you choose this specific vendor?

We interviewed five vendors to figure out who we wanted to go with. It boiled down to the one we chose, American Well, and one other. A lot of medical systems have their own homegrown telemedicine, which is a great concept, but you don't have the number of providers available twenty-four hours a day, seven days a week. We chose to go with the vendor and not a homegrown app because the vendor solutions have infrastructure with hundreds of doctors.

Another reason is the next big thing the three of us are going to work on is kiosks at Publix grocery stores where patients will be able to have a virtual visit right there at the pharmacy. For example, let's say it's Thanksgiving and you burn yourself really bad and you don't want to sit in the emergency room. You don't want to wait until Monday when your provider is available, but you need a prescription and you might need more than just a virtual visit. You can go into the pharmacy and into our booth that will be branded BMH Care Anywhere Beaufort, and all the peripherals will be there: a thermometer, stethoscope, otoscope... but it will be private. The provider will come on and they'll have more hands-on information than just a virtual visit.

How did the doctors adjust/react?

Some of the busiest doctors were the ones that wanted to do it. They wanted to get up on Saturday morning outside of their office hours and do these calls because they think it's really cool. It wasn't the group we thought were going to sign up. To start, we only had eight providers, but again–-this is only a few months. We will have a "lessons learned" with these providers to talk about opportunities and ways we can improve and get more on board.

You're not going to do anything on the app as a provider that you wouldn't do physically in your office. If you're the kind of doctor that has to run a test before you can do an antibiotic, then you need to triage this call and say, "I don't think your baby needs an antibiotic; you can give them baby aspirin" (or whatever you do) "and you'll be fine." Or, "I think he needs an antibiotic, but in order to do that I'd like you to come into my office tomorrow and see me," and do more of a triage. They are going to be the same person on the app as they are in their office. The primary care provider sees the value of not taking up a thirty-minute slot at their clinic for somebody who just has a sniffle. They're encouraging these acute patients to use telemedicine.

How have the patients reacted? Is use as good as expected?

Over a thousand patients registered (as of March 1, 2018), far exceeding our goal of three-hundred-and-fifty downloads. Circling back with some of the first patients who used the app to get their one on one opinion: It's awesome–-within ten minutes you download the app, you see a doctor, and you're out the door to the pharmacy. We have not had one patient complaint, and every one of them has given the providers a five-star. There is data acquisition and questions as you close out of the app, quick and easy; not an intrusive survey.

How does insurance come into play?

BMH is ahead of the game. Right now, you can't use insurance with it. They all say it's on their road map for 2018 once the insurance companies come up with their standards and then start building their interfaces onto the individual apps, and they're still working on standards. It's about building those integration points, and there is no competition because we're all using a common vendor with common doctors. It's their way of getting those claims automated. In the end, the $59 will go toward the deductible.

If you have a flexible spending card or health savings account, you can use that to pay the $59. No copay, no additional fee. It's ideal for new moms that have to get babies out the door, or for the elderly who have to find a ride. However, we have found the demographic that is using the app is thirty to forty-year olds because of the convenience.

Are other regional medical facilities using similar technology?

In South Carolina there are only a couple of hospitals using American Well, but there are thousands of hospitals using it across the country. Besides the deep database of doctors, the big reason we chose this vendor was because they have peripherals, particularly the kiosks that we're going to use at Publix, as part of their operating system.

**How has it impacted the number and type of in-person visits? **

Over two hundred visits have been completed (as of March 1, 2018). The primary reason these patients used BMH Care Anywhere was the flu. The nice thing about that was they didn't go to the physician practice and get anyone else sick. They didn't go to an urgent care and lose that business, and they didn't sit in the emergency room and get somebody else sick.

**What is the nature of issues encountered? **

There are not a lot of issues, and Jon has had to handle only mild troubleshooting on our end. The only trouble on the app is if they don't see the list of physicians right away and there is a service key they have to type in. The app is cloud-based, and we as an organization are moving towards cloud-based apps just because we think it's more secure.

What other innovation is in the works or already exists?

We just started the new patient portal for the physician practices, so you can log in and see exactly what happened at your appointment. We have the portal for the hospital. We've got the new occupational medical clinic urgent care as part of our population health plan where we look at all the different employers in Beaufort County and point them to that clinic not only for their new hire drug screening, but also for workers comp.

As part of our population health plan, we're going to have software that looks at each one of those populations and puts together care plans. For someone that comes in at medium risk for diabetes, we'll have a care plan for anybody within certain parameters and we will follow up to make sure they are doing what they need to do to not get to a higher risk of diabetes.

Peds Telepsych is on the road map. Let's say a fourteen-year-old gets pregnant and they need to talk to a psychiatrist. A Peds Telepsych is not available in the Beaufort area so we look for one at MUSC that she could see via virtual visit at the Harrison Peeples office and have that private conversation.

Some of the best use cases our vendor has shared with us is lactation support, Peds Telepsych, OB... there are some best practices and strategies for the things we're going to tackle first. Right now, we're just focused on urgent care to figure out our reports. Primary care first, then the next focus is cardiology. The first visit is always in-person. They're going to put monitors on these patients, so that second visit would be at the Harrison Peeples telemedicine center if they're rural and out in that area. We'll have the software connected to those monitors to talk with our cardiologist at BMH.

Also, Amazon is getting into the telemedicine business, and one of the next big things is telepharmacy–-rural areas cannot afford a pharmacist. Though that's not something we plan to get into at this time.

*The Digital Health Innovations group will talk about Telemedicine in Beaufort at the May 11th Fridays @ the Corridor series.*