For Ryan Health, telehealth seeds planted during pandemic have flourished

Ryan Health is a federally qualified health center located in Manhattan that has been providing comprehensive and affordable primary and specialty care to New York’s diverse and underserved communities since 1967.

Ryan Health has seven primary care centers, seven school-based health centers, two community outreach centers at transitional housing sites, and one mobile health center located throughout Manhattan. As FQHC, 75% of patients are enrolled in Medicaid or Medicare; Another 7% are uninsured.

Problem

Prior to 2020 and the COVID-19 pandemic, there were federal and state policies that discouraged FQHCs like Ryan Health from adopting telehealth services due to payment restrictions.

“For this reason, Ryan Health had very limited telehealth services in behavioral health and care management prior to April 2020,” said Farooq Ajmal, CIO of Ryan Health. “With the onset of COVID-19, not only the CDC and state health officials, but our chief medical officer as well as the infection control officer suggested limiting patients physically coming to our centers.

“At that time, there were discussions at the federal and state level to amend the regulations on a temporary basis to allow healthcare providers, including FQHCs, to act as a remote site for Medicare and Medicaid beneficiaries, thus Providers were allowed to be reimbursed. Telehealth services from the health facility as well as from home,” he continued.

Based on Ryan Health’s efforts to provide care as safely as possible and changes in telehealth reimbursement, the organization’s IT department began to explore available telehealth platforms.

“Our first choice was to have a secure integrated solution with our EHR,” Ajmal said. “Ryan Health did not immediately have the infrastructure to accommodate telehealth services from centers or providers’ homes. In addition to telehealth platforms, we lacked webcams and laptops for providers.

“Ryan Health started procuring those devices, but due to supply chain issues emerging, there was a shortage of devices in the market,” he recalled. “Ryan Health was making these investments out of our own capital budget, however later in the year Ryan Health received several grants that covered those costs and allowed for new investments on infrastructure.”

Prior to March 2020, only a few providers or employees were connecting remotely. For that reason, Ryan Health’s firewall and VPN technologies were not able to support 400–600 simultaneous remote connections.

“I strongly recommend that it is always better to choose an integrated solution than to choose individual best-in-class solutions.”

Farooq Ajmal, Ryan Health

Ryan Health invested much of its own capital and later gave grant money to strengthen the infrastructure to meet the increased needs. This also brought other challenges, such as cyber security concerns, which were also addressed.

“Ryan Health utilizes the Healo telehealth system from eClinicalWorks as well as the technology from Doximity as part of our telehealth solutions,” Ajmal explained. “These solutions not only addressed concerns with COVID-19, but allowed expanded access to patient populations. Telehealth has become an integral tool in healthcare delivery since the start of the pandemic – with many patients relying on it because it overcomes some of the barriers to care, such as finding childcare, taking time off from work, and transportation.

Proposal

In the early days of the COVID-19 pandemic, there was panic among Ryan Health’s patient population. People wanted to see their doctor to find out if they were infected and what they should do. Patients wanted to hear from a provider they trust.

Ryan Health had to come up with a solution to allow patients to continue taking care of them without risking their health and spreading COVID-19.

Ajmal explained, “As a CIO, my main concern was that the solution should integrate with our existing technology system, be scalable and be easily adopted by our providers.” “Ryan Health uses eClinical Works as our EHR. We contacted eCW and began to explore their integrated telehealth solution. Their solution was readily available, cost-effective and could be deployed immediately.

“Ryan Health has begun testing that solution and has prepared training documents for deployment,” he continued. “Very early in the process, we found some limitations with the eCW solution, including requirements that the patient must have an eCW patient portal enabled and the eCW Healo app installed on their smartphone.”

Given the patient population, those requirements were limiting factors serving the entire patient population. The system also did not work well for behavioral health providers because they often provided group therapy. Telehealth systems were limited in capacity to no more than 2–4 participants.

“Ryan Health deploys Microsoft Teams and LifeSize as telehealth solutions for behavioral health group therapy,” he added. “We are still using these platforms on a limited basis but have expanded the Doximity and eCW Healo platforms for more participants.

“We started to explore a number of other solutions commonly used in the market,” he said. “Since so many providers were part of the Doximity network, Doximity released a telehealth solution that was agnostic to the mobile device the patient was using. The provider could connect with the patient via video call or audio directly from their desktop or phone. Is.

It also allowed anonymization of the original phone number so the patient could be sure the call was coming from Ryan Health and to protect provider confidentiality. The Doximity platform met the organization’s needs, was available at no cost and was HIPAA-compliant. It also allowed non-providers to use the platform to help the provider with pre- and post-arrival preparations.

“Ryan Health has standardized on Doximity along with eCW Telehealth as two of our approved telehealth solutions,” Ajmal said. “Initial testing and documentation for the eCW telehealth solution was completed in April 2020, and was deployed to all providers. These platforms were quickly adopted by both our providers and patients. Doximity was deployed a few months later in July 2020.

“During the height of the pandemic, 80% of our visits were conducted through telehealth for both medical and behavioral health services,” he continued. “We felt that telehealth services are best suited for follow-up visits where more information sharing or coaching is needed, rather than taking vitals or testing.”

As the pandemic subsided and vaccines became available, Ryan Health began offering face-to-face visits. It gradually returned to pre-pandemic volumes, with 80% being in-person and 20% via telehealth.

“We advocate for telehealth payment parity for FQHCs so that telehealth services are fully reimbursed after a public health emergency,” Ajmal said. “Telehealth provides a great tool especially in the FQHC space because it allows us to serve patients who might otherwise not receive proper healthcare due to social determinants of health such as lack of transportation or time off work. Was doing.”

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meet the challenge

To further enhance telehealth efficiencies, Ryan Health also explored remote patient monitoring systems. Its remote patient monitoring project was unsuccessful because of the infrastructure and staff required to support the patient equipment. It is now exploring working with a vendor that provides integrated remote patient monitoring services.

Ryan Health also expanded its work with vendors that provide chronic care management that feeds clinical data back into the EHR. Ryan Health is currently partnering with Chartspan for these services.

Result

Prior to March 2020, Ryan Health did not have a telehealth system. All visits were individual visits. After the telehealth system was put in place in April and July of 2020, Ryan Health was providing 80% of services through telehealth.

Aside from dental services that were suspended according to the CDC and New York Department of Health, FQHC was providing all other services and maintained its patient volume and visit numbers above 80% of pre-pandemic levels .

Ryan Health also purchased and implemented an online scheduling system by the end of 2020, just in time for COVID-19 vaccines becoming available. Ryan Health exclusively used an online scheduling system to schedule COVID-19 vaccine appointments.

“Due to the tremendous demand for vaccines and short supply, it was not possible to manage that demand through our call centre,” Ajmal said. “Also, like many organisations, we had a shortage of staff due to COVID infections.

“The technology implemented in 2020 and its successful adoption has allowed Ryan Health to continue our mission of providing healthcare for the community while maintaining its financial stability,” he continued. “Due to the great work RyanHealth is doing during the pandemic, we were selected as a preferred provider by the federal and state departments of health for vaccination administration, outreach and population health.”

Ultimately, this sudden paradigm shift in care delivery allowed the organization to re-examine its processes and allowed it to think outside the box.

“The Ryan Health Clinical Informatics Committee has been trying for many years to standardize the workflow,” Ajmal said. “The disruption caused by COVID-19 allowed all Ryan Health employees to be more open to change, allowing us to standardize most workflows.

“One example was that we were using both the thick client as well as the web client to access our EHR,” he continued. “eClinicalWorks stopped growing the fat client and significantly increased the capability of the web client. Regardless, most people were used to the look and feel of the fat client, which is less robust than the web client.”

The transition to remote work and telemedicine forced the workforce to start using web clients to access EHRs.

advice for others

“The healthcare transformation is still in its early stages and a lot remains to be done until we reach a fully integrated healthcare system at the national level,” Ajmal said. “For this reason, each healthcare provider is unique in how it uses its technology and workflow to provide care. Even if two organizations are using 90% of the same technology, their architecture and workflows can be vastly different.

“I strongly recommend that it is always better to choose an integrated solution than to choose individual best-in-class solutions,” he continued. “Most EHRs are still too restrictive and don’t work well with other systems, although there are a number of vendor-agnostic solutions on the market.”

Ajmal feels that part of Ryan Health’s success was a strong governance structure, with the Clinical Informatics Committee at its core.

“The committee has representation from most areas of the organization and was instrumental in providing oversight to select the right solutions and workflows,” he said. “I also think the buy-in and agility of our clinical staff made this a success.

“I’m a firm believer in the famous words of Peter Drucker, ‘If you can’t measure it, you can’t manage it,'” he continued. “We built reports and dashboards around the use of most of the new technology, including the use of various telehealth solutions. This allowed us to identify which solutions are working, which ones need further optimization, and which ones need to be eliminated.”

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