The University of Alabama at Birmingham (UAB) has successfully implemented telemedicine and remote patient monitoring programs, revolutionizing healthcare delivery in Alabama. These initiatives have improved access to care, increased the census and case-mix index of rural hospitals, and achieved over 650,000 ambulatory telehealth visits. UAB’s inpatient telehealth services have transformed hospitals financially, while remote patient monitoring has shown significant improvements in blood pressure control. UAB’s experience highlights the importance of starting with a minimum viable product and emphasizes the need for clinical and executive leadership in telehealth implementation.
The University of Alabama at Birmingham (UAB) has leveraged virtual care and remote monitoring programs to bring about significant advancements, particularly in rural hospitals. These initiatives have not only improved access to care but also increased the census and case-mix index, among other accomplishments.
When UAB Health System established its telehealth program, its primary objective was to address the challenge of enhancing care accessibility throughout the state of Alabama.
Alabama has been grappling with some of the poorest healthcare outcomes in the nation. Dr. Eric Wallace, Professor of Medicine, Medical Director of Telehealth, and UAB eMedicine Medical Director, highlighted that telehealth technologies were adopted to eliminate the geographical barriers contributing to these issues.
“We aimed to overcome both ambulatory and inpatient care access issues,” he explained. “Videoconferencing has enabled us to redistribute care across the state. UAB collaborated with the Alabama Department of Public Health to secure funding and acquire videoconferencing equipment for each county health department. We utilized these health departments as a means to deliver subspecialty care statewide.
“Furthermore, we initiated inpatient telehealth services at rural Whitfield Regional Hospital. Initially, we implemented tele-stroke and general neurology programs, which were later expanded to include telenephrology, tele-critical care, and telecardiology.”
The COVID-19 pandemic accelerated the adoption of videoconferencing, extending its reach to patients’ homes. UAB witnessed a significant rise in video visits, from 1,000 in 2019 to 280,000 in 2020. Presently, approximately 15% of the total ambulatory volume is handled through telehealth.
In response to the pandemic, UAB introduced a remote patient monitoring program to better cater to the needs of diabetic and hypertensive patients.
Telehealth was envisioned as a solution to alleviate the access-to-care problem in Alabama.
“While we have an abundance of hospital beds in our state, around 70% of our rural hospitals are operating at a financial loss,” noted Wallace. “This is largely because patients start bypassing rural hospitals when they lack the necessary services to address their illnesses. Urban hospitals have subspecialists with available capacity, but their beds are consistently occupied.
“Telehealth has allowed us to redistribute this care,” he continued. “This was especially evident during COVID-19. There were instances where rural hospitals without telehealth support for critical care and nephrology had to transfer patients via air transportation to other rural hospitals that possessed these subspecialties.
“Once healthcare professionals witness how telehealth can completely transform care delivery when properly organized, they understand its necessity and its potential to reform the healthcare system in a significant way.”
From a financial perspective, UAB’s inpatient telehealth services have brought about transformative changes in hospitals.
“One of our hospitals saw its average inpatient census rise from 20 to 50,” Wallace highlighted. “Their case mix index also increased from 1 to 1.5, as did the case mix index of patients transferred to UAB.
“We have not only witnessed care improvements in rural areas,” he added. “Even within UAB, we have implemented full tele-ICU capabilities in over 250 beds and observed a significant and sustained reduction in ratios of observed to expected mortality rates.”
On the ambulatory side, telehealth has facilitated access to specialists specializing in rare diseases, not just in rural areas but across the entire region and even internationally. Access to all subspecialty services has significantly improved.
“Most importantly, telehealth has provided us with a tool to continue transforming care delivery,” he emphasized.
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Through its telemedicine programs, UAB has achieved several notable successes, including:
– Increased census and case mix index of rural hospitals.
– Increased case mix index of patients transferred to UAB hospitals.
– Over 650,000 ambulatory telehealth visits.
– Average systolic blood pressure drop of 9 mmHg within 45 days through remote patient monitoring.
ADVICE FOR OTHERS
“To develop a telehealth program, it is essential to draw lessons from the software industry,” advised Wallace to his peers. “Healthcare should plan for the minimum viable product. Once that is in place, start with the goal of seeing one patient, then two, then three.
“When implementing technology, there is no time for a randomized controlled trial, as, by the time the trial concludes and is analyzed, the technology has likely evolved,” he continued.
Identify the problem first, then assess whether technology is a viable solution to address it, he added.
“If it is, plan just enough to ensure that one patient can be seen and scale up from there,” he concluded. “Too often, we plan excessively, resulting in inaction. Finally, having a clinical lead paired with an exceptional executive lead has proven effective for UAB.”