SSM Health Cardinal Glennon Children’s Hospital is an inpatient and outpatient neonatal health centre based in St. Louis, Missouri. Additionally, Missouri has a significant medical shortage, which means there is a significant psychological health provider shortage. The issue is serious in Missouri, where only 200 of the country’s 1, 000 licensed doctors actually reside there to provide a community of about 6 million. This is especially acute in Missouri, where the need for cognitive health service is high. This deficit began to deepen even before the COVID-19 crisis, and the need hasn’t let up since. The effect was first felt by Cardinal Glennon Children’s Clinics: its emergency departments were becoming overflowing with behavioral health individuals who, at times, were being held for weeks in the ED without proper beds, awaiting medical examination and/or placement. What makes this crisis particularly challenging is its pervasiveness. Behavioral health needs are truly universal, affecting urban, suburban, and rural populations across all socioeconomic backgrounds, unlike many other health conditions that might disproportionately affect some demographics or regions. As a pediatric hospital with an extensive geographic reach, Cardinal Glennon Children’s Hospital serves patients from Missouri, Illinois, Arkansas and beyond. The ED was forcing families to seek crisis care through the waitlists and extended appointment lead times, breaking a cycle that wasn’t working well for neither the behavioral health patients nor the acute care and trauma patients. Cardinal Glennon Children’s Hospital was able to recognize the need to increase its psychiatric capacity through virtual behavioral care as a result of these problems. PROPOSALThe organization quickly realized that telepsychiatry was uniquely suited to its needs when it looked for solutions to its behavioral health access challenges. ” Unlike many other specialties, behavioral health rarely requires physical examination – making it perhaps the purest, most perfect use case for telemedicine services”, said Chris DiGiusto, vice president of ambulatory services at SSM Health Cardinal Glennon. We looked for vendors who could provide dedicated psychiatric care while being aware of the distinct needs of a pediatric hospital with this in mind. Iris Telehealth stood out for two key factors: its consistent track record of fulfilling promises made and its willingness to develop as a true partnership that was relationship-focused rather than transactional. ” The proposal was intentionally designed to scale incrementally. The organization would begin with a one full-time, dedicated psychiatrist who would concentrate solely on Cardinal Glennon’s patients, with the understanding that Iris Telehealth would add additional psychiatric capacity as needed,” DiGiusto explained. This measured approach allowed us to establish and refine our workflows before expanding. The proposal also addressed the stringent requirements of our multi-state service area, making sure Iris Telehealth psychiatrists were permitted to practice in all of Missouri, Illinois, Arkansas, and the surrounding states, a crucial consideration given our hospital’s extensive geographic reach. Meeting the challengers Glennon built its telemedicine program around its current Epic EHR platform, which serves as a single point of truth for patient care. The tele-psychiatrists connect with patients through Epic’s integrated video platform, ensuring a seamless experience for providers and patients “.This integration was crucial, as it allows our Iris Telehealth psychiatrists to work within the same system as our in-house teams, maintaining continuity of care and streamlining documentation,” DiGiusto said “.The success of our program relies heavily on what we call our ‘ wraparound services,’ “he continued”. Our team evaluates patient readiness before each visit, from registration and insurance authorization to patient registration and authorization. We emphasize patient engagement in particular, ensuring they are ready and eager to take part in their care. ” After a psychiatric evaluation, the comprehensive care team – including PhD psychologists, counselors, licensed clinical social workers and nurse navigators – follows through on the psychiatrist’s treatment directives, providing ongoing therapeutic support “.Getting new Iris psychiatrists up and running in our system takes about three months,” DiGiusto noted”. This includes Epic training, hospital privileging, multi-state licensing and payer enrollment. ” While the technical aspects are important, what really makes this work is treating it as an integrated care program rather than just a technology implementation”, he added. ResultsBehavioral health virtual care has produced significant improvements across a number of key metrics.” The psychiatrists become true extensions of our team, fully embedded in our workflows and culture. ” Most notably, we’ve tripled our psychiatric activity volume, dramatically increasing access to care”, DiGiusto reported. We’ve reduced our no-show and same-day cancellation rates from 21 % to just 7 %, ensuring we’re making the most of our psychiatric resources, he continued.” The percentage of new patients scheduled within 14 days has increased from 14 % to more than 60 %, meaning more children are getting the care they need when they need it.” The emergency department, where the organization has cut the average hold time for behavioral health patients awaiting evaluation and placement by 50 %, is perhaps the most notable achievement. This improvement is especially important because, according to DiGiusto, these cases frequently involve crisis situations where timely intervention can save lives.” Many of these patients are now being identified and treated through our outpatient services before their conditions escalate to an emergency status, “he explained. These statistics, which include Missouri’s largest provider of behavioral health care, show real progress in meeting our region’s pressing psychiatric care needs. However, we recognize that more needs must be done. ADVICE FOR OTHERS DiGiusto advises organizations considering telemedicine for behavioral health to approach it as a relationship-building opportunity rather than just a technological implementation or contractual arrangement. Finding vendors that understand one’s specific needs and are willing to advance alongside the healthcare organization, he continued, and who are knowledgeable about how the program will integrate with one’s existing workflows and support services.” Building a successful behavioral health program requires a comprehensive approach,” he said. Focus on developing robust wraparound services that keep patients and providers informed throughout the care process. This approach includes everything from simple registration and scheduling procedures to skilled nursing staff who oversee patient preparation and follow-up. ” While the technology enables service delivery, it’s the human elements – the care coordinators, social workers, psychologists and support staff – that truly make these programs successful”, he concluded. Consider beginning small and gradually increasing as you improve your procedures and increase your program’s confidence.
Email him: bsiwicki@himss .org
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