Located in the south eastern section of Pennsylvania, Delaware Valley Community Health (DVCH) is a federally qualified health center, providing quality care to the underserved through a multi-disciplinary patient centered model of care. DVCH incorporates social determinants of health to deliver care in a compassionate and effective manner. For over 45 years DVCH has been the safety net provider for Latino and African American communities. When COVID-19 hit the US shores at the beginning of 2020, few knew the impact it would have, and the enormous way it would alter our healthcare system perhaps forever. Like many healthcare providers across the US and around the world Delaware Valley Community Health would be faced with a surge in health care needs. The question was: how can they quickly adapt to a model that would deliver the best possible care in a safe and effective manner?
Prior to COVID-19, Isaiah Nathaniel, (Chief Information Officer, CIO of DVCH), recognized the value of having an infrastructure that is safe, forward thinking and quickly adaptableto changing healthcare needs. “Everyone deserves high quality care that is kind, considerate and competent, and as CIO I must do all I can to enable this,” states Isaiah. Importantly, Isaiah recognized that barriers to access must be addressed. Whether it is enabling patients’ better access to care or enabling providers better access to tools and their patients, a successful strategic plan must address both. Patients need easier timely access to care. Staff and providers need easier timely access to the Electronic Health Records (EHR) and Electronic Practice Management (EPM) systems. Ultimately, the goal is to provide the best possible care when and where it is needed; and remove unnecessary barriers to access. Isaiah recognized that to deliver quality care he would need to set up the right IT environment. He and his team built a redundant, flexible, safe IT environment. Its visionary design includes a network with a two layer hyperconverged Nutanix backbone, and an overlaying application layer by Citrix which supports, among other things, DVCH’s Practice Management, Clinical, and Population Health Systems by NextGen.
Then COVID-19 hit.
The DVCH team (CEO: A Scott McNeal, DO, CMO: Dr. Julie DeJoseph and CIO: Isaiah Nathaniel, CPHIMS) was faced with COVID-19 and all that it meant to the community they served. How do you provide services to an at-risk community without spreading the virus? How do you keep your providers safe, and still provide the best care? How do you screen and test for COVID? DVCH sees approximately 71,000 unduplicated patients a year for primary care, behavioral health, dental, peds, ophthalmic, MAT (medication assisted treatment) and family care services. How can DVCH continue to service its normal community needs in addition toaddressing the threat of COVID-19 while minimizing exposure for patients, providers and support staff? Additionally, how will services or necessary changes be financed? As an urban community, DVCH didn’t qualify for telehealth reimbursement.
The CEO of DVCH (A. Scott McNeal, DO) and the networks other CEO’s quickly acknowledged that they would need to rapidly implement telehealth and reached out to work with MCOs (managed care organizations) to pay for the service (prior to the government reimbursement changes). The CEO’s were able to work together based on solid relationships established prior to COVID. At the time, when the leadership team asked if he could implement telehealth given their 312 staff members and 50,000 patients, Isaiah having just completed his network migration, said “sure we can do this!” Isaiah explained in a recent interview what happened next, “and so, over the weekend (March 14, 15th) we quickly shifted 80% of our workforce to telework, and within a week we had telehealth as an option for our providers to use.” Since then DVCH has done approximately 33,169 visits using telehealth as of Oct 2020.
DVCH wanted a COVID screening/testing solution that was easy to implement, could be deployed to its 8 sites, or into other community locations, was easy to push and position, and that would give their patients the quality experience they deserve. They implemented their telehealth application on iPads that were mounted on a Tryten Nova Pro Cart. The cart was light weight, easy to position, and had an elegant cable management system. It was available at a great price point; and proved sturdy. “We didn’t have to worry about the wind knocking the carts over, or having problems moving the carts over carpet… you know doctors don’t want a flimsy system that’s tripping over the rugs or has the ability to fall... they want quality”, said Isaiah. Similarly, DVCH wanted a cart that looked elegant to their patients; and represented the quality of care that they deserved.
The patients said, “Wow, oh, this is nice!” which is the reaction that Isaiah goes for. Both the providers and the patients were able to access the telehealth application for screening and testing from the iPad on the Tryten cart. The providers liked being able to use the articulating arm on the Tryten Nova Pro to move the iPad up and down into their preferred position. Practitioners just pull the Tryten cart to their desk side, connect to their patients over video, access the patients EHR, and screen to see if they need to be tested. The patients can connect to the provider using the Tryten tablet-based screening cart at a DVCH facility or using laptops/tablets/iPhone from their home. Once it’s determined that the patient needs to be tested, the practitioner submits an order, and the patient is instructed to proceed to the testing area. DVCH has also taken the Tryten Screening/Testing carts on the road to community-based facilities to deliver service when and where it is needed. DVCH is also using telehealth to support predominantly primary care, with behavioral health to follow.
The foundation of the DVCH’s ability to rapidly pivot to a telehealth environment includes:
- Solid Relationships across the network of care
- A visionary approach to IT which put Eliminating Barriers to Access at the core of its design
- A Flexible IT Infrastructure
- A quality, lightweight, easy to position, affordable, Tryten telehealth cart.
DVCH was able to quickly pivot to telehealth and tele-work to help their community in a time of a global pandemic:
Leadership, IT planning, quality solutions provided:
- Better patient experience
- Better provider experience
- Better outcomes
An elegant, cost effective, easy to implement, and easy to use Tryten Nova Pro telehealth cart helped DVCH provide:
- Rapid Response to COVID-19
- Reassuring care when and where needed
- Efficient screening and testing for COVID-19
- Virtual Primary Care
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Isaiah Nathaniel, CPHIMS
Chief Information Officer at Delaware Community Health, Inc.
Isaiah Nathaniel is CIO at DVCH, a 42-million-dollar nonprofit Federally Qualified Health Center (FQHC) Ambulatory Healthcare Company. Isaiah is responsible for developing and executing the overall information system strategy. He earned a BS in Management Information Systems from Delaware State University where he also was a four-year letterman for the Men’s Basketball team. He graduated from the prestigious DiverseForce OnBoards program offered at the University of Pennsylvania and is an Official Member of the Forbes Technology Council. He is passionate about providing the underserved a first-class healthcare experience.