Evo Terra (Host): This is Checkup Chat with EvergreenHealth. I'm Evo Terra. And I'm joined today by a team from EvergreenHealth. Brianne Burnett is the Director of EvergreenHealth's Behavioral Health Department; Cathy Roberts serves as EvergreenHealth's Executive Director of Primary Care; and Kai Neander, the Director of Innovation and Digital Health at EvergreenHealth. Thanks to you all for being here today.

Cathy Roberts: Thanks for having us.

Brianne Burnett: Thanks for having us.

Kai Neander: Thank you.

Host: Let's start with the basics. What is telehealth? And how do providers in your department use it? Kai, I'll ask that one of you.

Kai Neander: Yeah. Telehealth is the provision of medical care through technology. So, phone visits, SMS communication for care and, most commonly, video visits, telemedicine, video chats with your provider or your care team. And we view telemedicine and telehealth generally as a foundational part of care delivery here at Evergreen.

Host: And Cathy, what kind of appointments are appropriate for telehealth versus what should really be done in-person?

Cathy Roberts: Yeah, great question. Telehealth really works best for visits that are more conversation-based. Ones that include followup visits, managing chronic conditions that patients have, diabetes, hypertension, medication adjustments, behavioral health, anxiety, depression, as well as reviewing test results.

So, really, those telehealth visits are once you already tend to have a relationship with a provider and they know you, they're following up on something and/or they're addressing an adjustment of your care. Those in-person visits are still incredibly important for things that require a physical exam.

Obviously, whenever you need to have your hands laid on you, we need to see you in-person. Obviously, that would include any of our new patient visits as we get to know and establish care with our patient. Anything, again, requiring a physical exam, procedures, vaccinations, anything really that is going to require some additional hands-on, EKG, anything like that in the clinic.

Often telehealth helps us decide whether an in-person visit is needed or not in some of the acute areas. So oftentimes, it's how we plan more efficiently for the patient to be seen. And it's really about matching the visit that the patient needs where the patient needs it. So again, sometimes it could be an in-person or a telehealth visit, but the person's at work and it's much more convenient for them to be able to drop off, take their break, and see their provider. So again, they can occur for different reasons, but patient preference or meeting the patients where they are is a big part of that.

Host: Yeah. If you can find a way to do vaccinations through telehealth, you let me know as soon as that is an option. Brianne, I want to go to you now. I've heard that these telehealth appointments have shorter wait times than the in-person ones. Is that true also in your practice?

Brianne Burnett: In our practice in behavioral health, that is especially true. If somebody's looking for a appointment and they're willing to do telehealth, we can usually get them in that week or the week after, which is really great for those folks who are feeling like they just need to see their provider ASAP. It's much easier to do some of those ad hoc visits and squeeze them in via telehealth, especially if folks are traveling in other parts of Washington. They don't necessarily have to be super close to the clinic and we can get them in. So, we encourage people as much as possible.

We know a lot of folks like to come in-person and have that one-on-one interaction with their provider. We tell a lot of them, you know what, if you do every other visit with your provider in-person and then on the other weeks, do them virtually because it does open up a lot of slots for people who are wanting to be seen as soon as possible.

Host: Cathy, a moment ago you were talking about these things that they really can't do, right? Like vaccinations or examinations of someone in a telehealth visit. But I'm thinking about followup care. How do we handle followup care after a telehealth appointment? And that could be for, labs, scans, referrals, whatever.

Cathy Roberts: Right. And actually, the followup care after a telehealth visit is the same as an in-person appointment. So, providers can order labs, imaging, or referrals electronically. They can do prescriptions the same way. It is totally common for us to see a patient, maybe they have a UTI, URI, they need to have a lab done. That telehealth provider can order that lab. The patient can go either into the clinic to have it drawn or go to the lab and get those results in a quick, timely manner, again using myChart.

So, we have myChart. It's an all Epic shop here at Evergreen. So, it is wonderful because every type of visit that is held within Evergreen is accessible there. And again, we are able to follow up with those patients, whether it is through messaging, through myChart. And oftentimes we will also use ticket scheduling, which is where we can actually send a patient a ticket to them to say, "Hey, we want to see you for this type of visit for this long." And we can give even the mode to say let's do it virtually, or let's do it in-person.

And so again, meeting the patients where they are, as well as making sure that, again, all those patients, nobody falls through the crack with the telehealth visit. It's the same type of followup you'd get as if you were seen in-person.

Host: So now, I'm thinking, Cathy, and I'll let you start this bit. And others are probably able to chime in as well. So, what happens if a patient sees a provider via telehealth that's not their regular doctor? How does that get communicated through the process to the entire care team to ensure that continuity of care, which I know you care very much about?

Cathy Roberts: Yeah, definitely. So within primary care, you know, we do our very best to schedule patients with their PCP. However, that is not always possible. We do definitely work as a group and as a care team. so even if you see a different provider through telehealth, continuity of care is still the priority.

All of the telehealth visits, as I mentioned, are documented within Epic. So, your primary care provider and care team, even if it's at a different location, can see exactly what was discussed, what was addressed during that telehealth visit, and are able to follow up with that. So, it is not uncommon for a provider to see somebody else's patient. We again access the medical record. We follow each other's care plans. And so, It should not be a dramatically different visit if you are not seeing your PCP. We all follow evidence-based care. And we again communicate and cover for each other. So again, a care plan that is documented would be followed by another provider. They don't change those unless, of course, there's some intervention needed for the patient. And again, they communicate with one another. So if a provider sees a patient that they are concerned about, and they want to message that other PCP, they're able to do that. We have numerous ways to flag the chart, send messages, and send staff messages to our other providers to keep them in the loop of that care team.

Host: Great. Brianne, I want to ask a similar question to you about that question. Your focus is on behavioral health. Any changes between the way the behavioral health team the primary health team deal with telehealth across providers?

Brianne Burnett: No. So, our team is a little bit different than working with our primary care team. When you get set up with a behavioral health provider, you are typically only seeing that one therapist for the duration of your care or that one psychiatric provider. What I will say is that, whether those visits are in-person or telehealth, similar to what Cathy said, all of the team members are checking and reviewing the notes, and keeping up on them so that, like she said, it's seamless across the system. People are all subscribing to the same care plan and making sure that the providers are all on the same page.

I think what's nice about being able to offer telehealth for both primary care and behavioral health is that patients are able to get seen sooner and the documentation is the same across the whole system. So, I think it's just a bigger advantage for our patients who, like I said, might not always be in the city, might not always be at home, might have barriers to coming in, including transportation. A variety of things that can come up with their work schedule, that really gives them the option to maybe not have to leave work and just be able to pop on a call from their car that could be confidential and allow them to get the care that they need when they need it.

Host: As we get ourselves closer to the end of this conversation, I want to ask this question, of all of you. But I'll start with you, Kai. Anything else that people need to know, whether they're current or prospective patients about telehealth?

Kai Neander: Telehealth is a foundational component of care delivery. It is just like the other tools in our toolbox for making healthcare accessible and high quality and efficient in our patients' busy lives. It is a resource just as an in-person visit with your primary care or a visit to the lab. it is another modality for accessing the care that we provide.

Patients should be prepared for a slightly different setting. They can do it from their couch. They can step out of work take a call with their provider a little bit more efficiently. And the questions and conversations that they will have there are slightly different.

Obviously, it's a little different to have a conversation with your doctor from your house than it is in a sterile exam room after waiting in a waiting room with a bunch of other patients. But it is a resource that we want patients to take advantage of because we know patients who have access to telehealth have better outcomes. And patients who have access to telehealth are more engaged in their care because they have a larger suite of resources to access that care and receive the healthcare that we want to provide.

Host: Brianne, I know that lot of telehealth visits for behavioral health has been pretty common. I think probably more so in my world. I've seen more of it than anything. Anything you'd like to know, or like to add that tells patients what they should be thinking about when they had their telehealth visit.

Brianne Burnett: Yeah. I think for me, as a social worker by training, I think a lot about accessibility. And the privilege it is to be able to come to an appointment and to be able to be on time to the appointment, to get there, to battle traffic, and kind of all the barriers there. And that we have a lot of patients that we see with variable accessibility needs, with busy schedules, with just a lot of things that keep them from getting into healthcare.

And I've been delighted to use telehealth and see how many more patients we can reach. I can think of a number of college students who go off to college for the first time and they've had Evergreen their whole life. And they're overwhelmed by going to a college town and thinking, you know, "Where am I going to get all my care?" And having that seamless process where they can still see their therapist, they can still see their primary care provider when something comes up, I think, is really grounded in a sense of safety and security and having that relationship with your provider that I think is really important to us at EvergreenHealth.

So, I think that is something that I really emphasize is that this expands opportunities for more people to access care. And that's always been our goal.

Host: And lastly to you, Cathy, same question. Anything else you want current and prospective clients to know about telehealth? And I'm also curious, what do the providers think about telehealth? But that might be a totally different conversation though. You

Cathy Roberts: I'll

Host: tell me.

Cathy Roberts: I will say my providers love telehealth. They really do see it as a real benefit to access, right? Again, meeting patients where they are. People are so busy. And families, people are taking care of both their parents and their children. Time is precious And so, telehealth really does help a lot of people gain access where they may otherwise have avoided it and then ended up in the ED or urgent cares.

The one other thing I would mention that I think is a benefit of telehealth that hopefully we don't have to use too much in the future, but we do have a measles outbreak here in Washington state. And knowing that it is a highly contagious disease, during a measles outbreak, telehealth can be a very important step for triage, really for any type of contagious thing. Being able to have patients be seen virtually will, again, allow us to address people quicker, right? Get them the care quicker, but also will reduce exposure to our clinics and all of the patients in those clinics. So again, the benefits of telehealth just kind of don't end. And I think in the future there will be more and more benefits of that with remote patient monitoring and more interactive information or even asynchronous information going back and forth between patients and providers to improve their overall care and health.

Host: Wonderful. Brianne, Cathy, Kai, thank you very much for being with me today.

Cathy Roberts: Thank you.

Brianne Burnett: Thank you, Evo.

Kai Neander: Thank you.

Host: That wraps up this episode of Checkup Chat with EvergreenHealth. Head on over to the website at evergreenhealth.com for more information and to get connected with one of our providers. I'm Evo Terra, reminding you to subscribe, rate, and review this podcast and all the other EvergreenHealth Podcasts. For more health tips and updates, follow us on your social channels. Thanks for watching.