MHealth and video conferencing lead to better care in rural North Carolina

As the CEO of Uplift Comprehensive Services (Greenville, N.C), I have seen to it that our organization fully embraces the notion of “mhealth.” By incorporating mobile high definition video conferencing, our doctors and clinicians can support even the most geographically remote patients, while also being able to access electronic health records and collaborate with other employees. The result not only has been improved service, but improved productivity, reduced travel and office expenses, and a better quality of life for our employees.

Using video conferencing technology and a “bring your own device” (BYOD) strategy for mobile appliances, Uplift is saving at least $500 on each physician trip, or thousands of dollars each year. We are now using that savings for grant-funding opportunities, which leads to better patient care.

Implementing video conferencing in an mhealth strategy is not nearly as daunting as some organizations may fear. Below, I’ll outline how Uplift has employed mobile video conferencing, benefits that we’ve experienced, and advice for organizations considering a similar approach.

Geography and service

Uplift Comprehensive Services provides community-based assistance for children, adolescents and adults, including substance abuse prevention and mental health treatment. The agency is small-to-mid-sized (25-30 total staff, including two doctors and a handful of licensed therapists). The organization supports 15 counties across North Carolina. We've been in business for 12 years, beginning as the trend in mental health treatment started shifting from facilities-based treatment measures to community-based.

We offer a range of treatment options including multi-systemic therapy, outpatient therapy, and medication management, among others. The organization is committed to helping children and adults overcome social and economic hurdles.

Among our biggest challenges in providing this service was coordinating with clinicians in the field. Our patients live in some of the most remote regions of the state – areas in eastern North Carolina we call “little Australia,” where there may only be a land bridge or ferry connecting rural pockets. If a bridge washes out or a ferry is inoperative, we're in trouble. Even on a good day, sending a doctor to catch a ferry to visit a patient could take as much as four hours. We determined that it cost $500 per trip to send a physician to each person’s home for in-person care.

We had to figure out a more cost-effective and less time-consuming way to provide psychiatric and counseling services, while also being able to manage data, documents, coordinating with clinicians, and communicating with staff in the field. The first step was in realizing that we could better control costs if we sent a nurse practitioner to the patient’s home and connected with the doctor remotely. That way, the patient could receive the benefits of individualized, in-person care while still working directly with their physician.

Video conferencing seemed to be the most appropriate solution. Some of our clinicians had used free video conferencing services previously, which worked to a limited degree. The difficulty with these free solutions, however, is that they are not HIPAA compliant. We also knew we needed access to all of our data in a secure environment. For that, we felt we needed an enterprise-class video conferencing solution, yet one that even a smaller organization like Uplift can afford.

Bring your own device

When we began offering mobile video conferencing in treatment, we provided mobile devices and tablets for employees. That changed very quickly because employees and clinicians did not want to have to carry two mobile devices – their own and the one they used for Uplift.

To accommodate the needs of the users, we now implement MDM (mobile device management) technology, which allows us to install software, provide updates, and set security protocols from our end. This ensures that if someone were to leave Uplift, all of our data and related information easily can be wiped from the device.

Transitioning from providing devices to having clinicians bring their own actually created a substantial cost savings for Uplift. Instead of having to pay $500 for a tablet, all we have to do is make sure that the content is protected and can be managed from our headquarters. This has been a useful strategy for our employees as well. They can use the platform of their choosing, and the one that they are most comfortable with, rather than being made to use whichever platform the organization as a whole would otherwise have selected for them.

Some people are concerned that a BYOD strategy could be a huge drain on the IT resources of a small organization. However, that’s not true. Much of this technology is actually being implemented without the involvement of an IT department at all.

Security, connectivity and mobility

Video conferencing solution providers typically offer some cloud-based solutions. That’s important for Uplift, because if we have an issue with our servers, or the power goes out, or there is some type of catastrophe on our end, we always have the failsafeof having our information residing in a secure cloud.

In terms of access, even high-speed cellular wireless networks have sufficient throughput to accommodate high definition video conferencing connections. 4G networks are more than robust enough to carry the two-way high definition video conferencing traffic that Uplift requires. As these networks continue to expand, the portability and usability of mobile devices for high definition video conferencing can only continue to improve dramatically.

Mobility is, obviously, a critical part of Uplift’s strategy for providing health services. With mobile devices, Uplift has extended its coverage to the point that we do not have to worry about establishing an office in a rural area, or having a clinician check in with that office. All documentation can be done on the device, electronic health records can be accessed online, and clinicians and patients can communicate with anyone else in the organization, including doctors, using these mobile remote devices.

This approach has been so beneficial that we were actually able to reduce our need for office space. All of our clinicians are in the field, and they're turning in documents electronically. That led me to question why we were spending so much money for office space. So we downsized, and our clinicians have not missed a beat.

As far as the funding for this technology, some of the costis billable through Medicaid and other insurance companies. For the portion that cannot be billed, Uplift considers it as an operational cost. 

Another key economic benefit came in reduced travel. As I mentioned before, there were days when our clinicians would have to travel for hours to do a one-hour appointment, then check into the offices, drive to wherever the patient they may be, and return and fill out documentation. It would not be impossible for them to spend four hours on the road. That’s not only time consuming, it actually led to a loss in overall productivity. With their own mobile devices, staffers can do their work in the field, and collaborate remotely. The technology even inter-relates with our exchange servers, so it is been a real boon in work productivity.

Advice for other agencies

When adopting a mobile strategy and incorporating video conferencing in your mhealth treatment approach, there are several simple but important aspects to keep in mind:

• Make sure you secure your devices. Use a good mobile device management solution. And don't be afraid of the expense; there are many robust free solutions available. We are able to monitor all of our devices, install apps and update apps remotely with a free MDM tool. This can result a huge savings in time, energy and expense.
• Consider the security aspects of the solution you select.There are a million different ways to do video conferencing, both free and paid. Look for the solution that is the most reasonable for your effort, enabling a layer of HIPAA compliance, providing the greatest flexibility in collaboration and offering the ability to add and drop calls easily.
• Stay current with technology.Remote devices change almost every day, so you have to be comfortable with as many as possible, and their capabilities. Embrace the technology, don't run away from it.

By attending home visits using mobile HD video conferencing, Uplift’s doctors are able to provide the comprehensive treatment patients expect from the comfort of the patient’s own home. The clinician in the field is able to provide the much-needed human element, and collaborates with the doctors as needed.

Best of all productivity has increased throughout the practice. Instead of spending hours on unnecessary travel, Uplift doctors and clinicians are able to visit more patients, to focus on what’s most important: the well-being of our patients.

Garrett Taylor is CEO of Uplift Comprehensive Services, an agency that offers substance abuse treatment, multi-systemic therapy, medication management, outpatient therapy, and intensive in-home. He can be reached at gtaylor@upliftnc.org.