Skilled nursing, rehabilitation, and long-term care provider American Medical Facilities Management (AMFM) was researching telehealth options months before the coronavirus crisis and was at a crossroads for which would benefit their patients the most.
"A lot of the telehealth companies we were looking at didn't offer a way to do auscultation (examining a patient using a stethoscope to hear) of heart, lung, and bowel sounds," explained Practice Administrator Vickie Powell. "We didn't feel that just an audio-visual call with a patient would be enough to do a good assessment."
As leaders were reviewing options, COVID-19 became more prevalent in a few short months. Like all healthcare providers in 2020, AMFM found themselves with a new urgent goal: limiting both patient and employee exposure to the virus while continuing to provide high quality patient care.
"We looked at telehealth again and found Eko as a way to do that auscultation. With relaxed guidelines on telehealth from Medicare, we started using video plus the CORE Digital Stethoscope, which made the picture of the patient complete. The healthcare provider could hear the lung sounds, which is very important to diagnose respiratory issues in the COVID setting. That is what sold us," Powell said.
Implementation reduced referral costs associated with routine visits. It also allowed nurse practitioners to work from home instead of billing the company for travel between those distant locations, and it reduced IT support by 20% by limiting the need for visiting clinical staff to use their own systems within AMFM buildings.
AMFM is a leading, award-winning provider in West Virginia caring for more than 1,300 patients. Now, all of AMFM's 18 long-term care and rehabilitation centers are equipped with two Eko CORE stethoscopes —1 that stays in isolation pods (for COVID-19 positive patients), and 1 used for exams on non-COVID patients. They use Eko Telehealth to live stream high quality sounds from their Eko stethoscopes. Immediately, providers and patients realized the value of being able to auscultate remotely.
"Early on, one of our physicians was telling me that he picked up on a case of atrial fibrillation and was able to treat in-house. Just by having that auscultation tool, he knew the patient was in AFib. He was able to avoid putting the patient through a trip to the hospital and achieved a good outcome," said Powell.
A trip to the hospital comes with several risks for the vulnerable population AMFM serves.
"A lot of people think the hospital is the safest place to go for healthcare," Powell continued. "If you have a patient in a skilled nursing facility and that patient is stable and you have caught an infection early, then you can give them antibiotics and fluids at the facility. There is no need to increase the risk on that patient by sending them to the hospital. The risk of infection is not only from COVID, but other hospital acquired infections. Or, if you have a patient with dementia, taking them to the hospital skews their whole world. It makes them so agitated; it's a form of suffering. Oftentimes they come back to us weaker than when they went."
Some frail patients suffering from chronic diseases refuse to see a specialist, such as a cardiologist or pulmonologist, when that expert opinion would be a great benefit. With the new telehealth option, AMFM can bring specialists to patients who ordinarily might not be able or refuse to go. The early success of telehealth services is building confidence in diagnosing conditions remotely. Before adopting the Eko solution, clinicians had to rely on what the on-site nurse heard and relayed.
"There are very good nurses out there, but as a provider it's still helpful to know what you're listening to firsthand. That is why having Eko is very important to us," Powell said.
Transitioning to a new technology amid a health crisis
The idea of asking nurses and healthcare providers to learn a new device and platform amid a pandemic presented challenges. AMFM leaders realized the transition could be asking a lot, and it was a decision not made lightly.
"This is a very valuable tool that providers can add to their toolbox to help them deliver quality care. Also, when we're trying to protect our patients, whether it's the COVID crisis or the next flu epidemic, this is an excellent way to protect our patients from infectious disease, and protect our employees who might be exposed," Powell stressed.
It turns out the learning curve was short-lived. The platform was easy to deploy, and Eko's onboarding team helped AMFM through the process.
"The Eko team was very willing to find out what our practice was, what was needed, and together we figured it out and implemented. That was very exciting to me as an administrator," Powell said. "Oftentimes you hear 'we can't do that' from companies, or products are geared toward just an office setting, and not long-term care. The way Eko approached it was very helpful."
Eko brings together advanced stethoscopes and patient and provider software that help providers with advanced tools in all types of healthcare settings.
"The AMFM team brought a clear idea of how they wanted to use Eko's products allowing for a very quick implementation. Their informed and committed approach made our jobs so much easier during a hectic time when many were developing their telehealth programs and COVID response on the fly," said Steve Avila, Director of Solutions Consulting for Eko.
As for employees, Powell said, "Once we got past the initial mindset, it really wasn't that hard."
While Eko recommends the use of headphones, many remote clinicians are not using the earbuds Powell sent everyone during the rollout. For those clinicians, the Eko CORE's amplification, active noise cancellation and high-quality live streaming are enough without headphones or earbuds.
"Most of them said they could hear just fine by using the speaker on their computer or phone," she said.
In the coming weeks, AMFM will begin using the video feature of the Eko Telehealth platform, instead of relying on FaceTime or Zoom. Powell expects the move to come with even more increased efficiency and patient care.
Taking stock, looking to the future
As America's COVID-19 infections surge higher, AMFM has clocked 1,200 telehealth visits and counting. Using the Eko CORE as a diagnostic tool, they have been able to significantly cut trips to hospitals and specialists, offering care remotely instead. They have been able to reduce exposure risk for patients, nurses and providers. This scenario is another advantage to the "new normal" as described by Powell.
"West Virginia is a very rural state and sometimes providers are few and far between. By having this telehealth tool, timely care can be provided, and we can be proactive. With this system we can take care of things sooner rather than later, and that helps us cut down on avoidable hospitalizations and ER visits," said Powell.
Wyoming Nursing & Rehabilitation Center (N&RC) is located about 30 minutes from the nearest hospital. The advantages the Eko telehealth solution provides is a perfect fit for the long-term care center with close to 60 patients.
"The Eko device has enabled our facility to continue providing quality care to our patients during these difficult times," said Wyoming N&RC Director of Nursing Meghan Waldron. "Our attending physician visits hospitals and other facilities, which increases his risk of exposure to COVID-19. How could he cover our center and not run the risk of exposing our patients and employees?
"With the Eko device and other technologies we have been able to ensure our patients receive those essential medical services with their current physician."
Powell is in a unique position to assess the success of AMFM's telehealth solution. She has implemented new programs across several fields, including hospice, palliative care, ICU, and now, long-term care.
"I like creating new things and seeing how it works to the benefit of our patients," she said.
It's a sentiment that aligns perfectly with AMFM's mission "to exemplify excellence in quality care by providing an environment that enhances personal growth, individuality, dignity and respect."
"AMFM blows me away in how everyone at our company is committed to quality care. I've been around for a long time and AMFM has really made that commitment and we follow through on it. It's refreshing," Powell said.
Eko is also running the chain's video-conferencing platform now, and the services were expanded to a 19th location added this summer. Overall, AMFM has made 2,000 virtual visits on behalf of its patients since launching its telehealth program.