Rural Hospices Leverage Telemedicine to Augment Care

Telemedicine is becoming increasingly important in hospice care for communities nationwide, but the technology, increasingly called “telehospice,” is making its biggest impact in rural areas where clinicians may have to travel significant distances to reach the patient. 

Telehospice isn’t new, but it is rapidly expanding. The University of Kansas Medical Center piloted the first telehospice service in 1998. That attempt encountered serious challenges due to costs and prevailing attitudes about technology at the time. A second project in 2017 found its footing, which the medical center launched in collaboration with Hospice Services and Palliative Care of Northwest Kansas, Inc..

Between Aug. 2017 and Jan. 2018 Hospice Services engaged in 218 telehospice video encounters involving 917 participants, including staff and patients. The program yielded significant cost savings for the hospice, and participants reported that the program strengthens communication and relationships among staff and patients and family, according to a study on the project published in February.

Rural providers like Hospice Services increasingly rely on telemedicine to stay in touch with patients and families and reduce costs, including those associated with staff transportation. The hospice serves 16 counties in northwest Kansas. About half of those counties are considered frontier, with population density of less than six people per square mile.

“The idea is not to replace visits. The idea is to enhance visits with additional services,” said Sandy Kuhlman, executive director of Hospice Services. “We were able to place several [tablets] in patient homes, each having a data plan. This enables us to do triage and a variety of other activities.”

Triage via telehospice enables staff to prioritize patient visits, taking into account the sometimes considerable distance they must travel to reach the patient.

Many patients in rural areas would be unable to age in place or end their lives in their homes without telemedicine support.

Resolution Care, a Eureka, Calif., palliative care provider operates a virtual hospice program that enables clinicians to support patients and families in real time. Resolutions has about 40 tablets with data plans in circulation in the rural communities they serve in the northern part of their state.

Resolutions’ founder and President, Michael Fratkin, M.D., recalled one patient who was discharged from a rural hospital to pass away at home. The hospital had not provided the patient with discharge instructions, and the family had no idea what they should do for their ailing loved one.

Resolution clinicians, including Fratkin and nursing staff, were able to connect with the family the same day and provide instructions and support for seven hours. They had a virtual meeting with the family at the patients’ bedside, arranged for the patient’s prescriptions and provided education on what the family could expect.

“We take care of people who are at the end of their lives in the places where they lived their lives,” Fratkin told Hospice News. “And around here people want to live up in the hills; they live far away and sometimes off the grid. They have a sense of place that is important to them. So we do all that we can to help them stay in that place as long as possible through home visits and through the very thoughtful use of technologies. There are huge efficiencies, decreased stress and they help ensure patients get a proper response ”

Hospices can leverage the technology in a variety of ways. They allow patients and families improved access to clinicians and enable staff to consult specialists or physicians while in the patient’s home. Clinicians also use the systems to stay in touch with patients during weather emergencies or when road conditions are slowing or impeding travel.

Hospice Services uses the same system to conduct staff meetings rather than covering travel expenses for team members spread across the 16 county area they serve, saving the hospice an estimated $2,500 per month. The technology has allowed some patients to sit in on interdisciplinary team meetings.

Patients can also use the systems to communicate with their families who may live far away.

One Hospice Services patient used the tablet the hospice provided to “visit” with her grandchildren every night via videoconference, Kuhlman told Hospice News. Patients’ adult children who live out of state can also be looped into patient visits or physician consults.

Any kind of technology in health care will only be effective if it is implemented effectively and if stakeholders know how to use the systems. Staff training and patient education is vitally important to telemedicine programs.

“We do a lot of hand holding. There is definitely some resistance, so what we do is help them get comfortable and technology enabled. Our care coordinators speak with them and test the platform, trying to keep it light to help avoid stressing people out,” Fratkin said. “Some patients need a few sessions; other times we send a community health work to the home to help them manage the [tablet] and the technology channel and provide additional education.”

Use of telemedicine in hospice will likely continue to expand in coming years, and technology continues to evolve as more organizations adopt remote patient monitoring systems and artificial intelligence applications.

Kuhlman told Hospice News she would like to see the systems used for more face-to-face encounters between patients and physicians and to increase the role of telemedicine in bereavement care for families.

“As a consulting palliative care doctor, most of the time I don’t need to lay my hands on people, what I am doing is relational,” Fratkin said. “These systems allow me incredible efficiency and freedom. It allows me to integrate a team, communicate with a workforce and allows me to deliver equal or superior results and outcomes, especially with the safety net population.”