Patients Get Essential Support for Telehealth through Student-Driven Program

In the early months of the pandemic, Jefferson Health received funding to provide iPads and remote patient monitoring devices to patients across the enterprise. The funds came from the Federal Communications Commission (FCC), as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and were issued to help healthcare centers expand their telehealth-related services during the pandemic. “The funds only supported the purchase of the devices themselves,” explains emergency medicine physician and clinical researcher Kristin Rising, MD MS, who led the application of these funds.  Dr. Rising, whose research focuses on improving the quality and capacity of acute care, knew that simply providing the devices would not be enough. “People vary significantly in their degree of ‘digital readiness’ for using technology,” she says. “It didn’t feel right to provide patients with these devices without offering support to help them learn to use the devices to engage with telehealth services.”

To address this need, Dr. Rising turned to Rosie Frasso, PhD, program director of public health at the Jefferson College of Population Health and a long-time collaborator on other public health initiatives. Together, they launched the Digital Onboarding Taskforce (DOT) in September, 2020.

Having decided to focus efforts primarily on Jefferson’s northern division, Drs. Rising and Frasso worked closely with Steven Spencer, MD, MPH and Lori Merkel, RN, PhD to organize initial DOT tasks. Drs. Spencer and Merkel designed algorithms for patient selection and workflows to ensure equitable and efficient deployment that fully integrated the DOT’s services with the staff at each practice. “Our practices were inundated with managing increased volume and rapidly-changing care guidelines in addition to being short-staffed at times. The student DOT made this patient-focused initiative come to fruition,” says Dr. Spencer.

“Public health professionals have to be nimble and ready to fill in gaps, meet new challenges, educate communities, create connections and make things happen,” explains Dr. Frasso. “This is where our students came in. MPH students are required to do a clerkship where they apply what they’ve learned in the classroom to real-world health challenges. This project was just that!”

Over 30 medical and public health students made up the inaugural members of the taskforce. Amanda Guth, an MPH student, has been serving as the student lead of this project. She was responsible for setting up protocols for patient outreach and training students to serve as DOT ambassadors.

“A lot of us are aspiring clinicians and researchers,” says Amanda. “This has been a great way to get hands-on experience, but more importantly it has been a way to do some good during the pandemic and help patients in need.”

The taskforce first conducted screenings to identify patients who would most benefit from receiving the devices and who were most willing to use a new technology. So far, hundreds of patients have received outreach. “Not all patients require the same amount of training,” explains Dr. Rising. “Some may not be familiar with the patient portal or what an app is, or how to connect to the Wi-Fi network. These are things a lot of us take for granted. For others, they may be comfortable with doing the set up themselves, but may simply need help with resetting their passwords.”

“Under normal circumstances, we would have been able to do in-person training, but we had to navigate all of this over the phone and with limited patient contact,” explains Amanda. “So we had to make the trainings really visual – ‘press the green button’ or ‘tap on the app with the blue square’. While it can initially be frustrating for the patient, in the end we’re empowering them by taking them through each step.”

Students have been on the phone with patients for long periods of time, sometimes up to 5 hours. In a time of isolation and social-distancing, in addition to technology support, it has provided a rare opportunity for some much needed social interaction.

“We end up having little side conversations here and there, talking about random things,” says Amanda. “Many of these patients are older and live by themselves or maybe see a caregiver once a day. I think they appreciate the human connection, and so do we.” The trainings required to be a taskforce member also provide students a way to connect with each other.

Dr. Rising says the work of the taskforce has helped highlight barriers to telemedicine, including trust, and there are still important questions to be answered in future work to ensure equitable access to telehealth. What impacts patients’ willingness to engage with technology? How do healthcare providers improve trust of telehealth, particularly amongst vulnerable populations? The project has underscored that it is critical for healthcare providers to be proactive and purposeful in educating and empowering patients to step into the virtual healthcare world.

“I think digital care can be instrumental in addressing health inequities,” she explains. “I’ve seen patients over JeffConnect, our on demand healthcare service, who couldn’t afford to go see a doctor or who are in an insurance gap, and need to get a refill urgently for chronic conditions. In these cases, telehealth truly fills a care gap. I think the work of the taskforce goes a long way in helping patients explore what telemedicine has to offer.”

“Our healthcare system is due for some disruptive structural changes to improve the equitable access to high-quality care,” says Geoffrey Hayden, MD, an emergency physician at Jefferson and a current Health Equity Scholar with the Cambridge Health Alliance who recently joined the DOT team to facilitate the students’ patient outreach efforts. “Health technology definitely has the potential to level a playing field that has long been uneven and frankly unfair to some patients.” 

The project has prepared patients for telemedicine and students for this new era in health care. “It has been a really valuable experience getting to know all the logistics involved, and the small steps that we as future clinicians can take to ensure our patients feel comfortable using virtual care,” says Amanda.

“These students are all working as volunteers, on top of coursework and other research projects or jobs, and they deserve great recognition. It has been challenging for sure, many calls go unanswered, but when students do connect with a patient, they make a world of difference,” says Dr. Frasso. “Amanda has been an amazing leader in this effort, her organizational skills, enthusiasm and professionalism really carried the team.”

Ultimately, Dr. Rising, Dr. Frasso and the team hope to integrate such a taskforce across the Jefferson Health enterprise, providing a long-term tool for expanding access to telehealth services. “We’ve gathered data on what patient needs are, and where we can refine our process,” says Dr. Rising. “Our ultimate goal is to build this patient support system for telehealth into standard clinical operations, with a focus on improving overall digital readiness of patients – not just during the pandemic and for COVID-related concerns –  but for their overall well-being.”