virtual care

Health centers can integrate new technology to improve their patients’ experiences before they even reach the front door. In this episode, we follow Altura Centers for Health throughout the COVID-19 pandemic in their campaign to enhance their digital check-in process. By working with two technology partners to develop an API – a software interface that allows different computer programs to communicate with each other – Altura Centers not only made their patient intake experience more efficient, but modeled how the health care safety net can leverage successful partnerships with technology vendors. Listen and subscribe to the CCI Health Pilots podcast on Apple Podcasts, Spotify, and elsewhere. Below is a transcript of the episode, edited for readability.

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EPISODE TEASER | Arnie Reynoso (guest): ...Initially in our testing, we found that our patients were reluctant to click on links that were coming from an unknown source, and so that put a pause on the initial rollout. We were able to talk to both partners and seeing if there was a way to integrate some of this technology so that the message would come from a well-known or at least accustomed platform that our patients [would know they\ were receiving messages from our clinic... Jessica Ortiz (CCI, Host): Hello. I'm Jessica Ortiz with the Center for Care Innovations. And today, we're talking about one of the exciting projects that Altura Centers for Health has been working on for the past year. Our hope is that by sharing the highs and lows of this particular digital health solution, safety net organizations can apply the lessons learned to their own challenges. I'm here with Arnie Reynoso, member of our Tech Hub Learning Network, which is comprised of 14 tech-forward, California-based community health centers, clinic coalitions and primary care departments in county health systems that are working to accelerate the adoption of innovative technology. We partner with our Tech Hub members to vet, pilot, evaluate and spread innovative digital health solutions, targeting Medicaid markets and historically under-invested communities. We are excited to bring you this story today. Arnie, could you tell our listeners a bit about who you are in your organization? Arnie Reynoso (guest): Yes. Hello, Jessica. My name is Arnie Reynoso. I am the Chief Information Officer here at Altura Centers for Health. Our clinics are located in the Central Valley in California. We are a federally qualified health center (FQHC). So what that means is we basically serve our underrepresented community when it comes to here and making sure that their experience in our clinic is as top quality as any other location or medical facilities that they were to visit. Jessica Ortiz: And we're happy to have you. So tell us more about your project. Arnie Reynoso: Well, the project initiated over about a year and a half ago. We were looking for a solution to allow our patients to be able to digitally check in before they arrive in a clinic, and this primarily stemmed due to COVID and the effects that it had on being able to check themselves in or actually reduce exposure to other patients in the clinic. So we were hoping to find a solution that would help expedite that prior to them arriving at the clinic. Jessica Ortiz: And thinking about your solution, could you share with us what digital solution you chose and how that works? Arnie Reynoso: Yes. We already partnered with OTech for our patient intake, so we had kiosks that were part of our clinic, but because they were high touch devices, we decided that we needed to explore another way to accomplish the same thing. And they do offer an additional product that would allow us to send our patients a link to be able to check themselves in, to do all the pre-check-in information that they would need prior to them checking themselves in. And so that's where the project started off. Jessica Ortiz: What was the vetting process like? At CCI, we suggest this framework of making sure there's a mission fit, an operational fit, and also sustainability. How did this play into your decision-making? Arnie Reynoso: Well, it was a pretty easy decision when it comes to that. The partner that we had, given the fact that we were using their technology, it was just moving that technology to a different platform. So that basically fit in exactly to what we were looking for and what we do know that our patients seem to be very open to messaging platforms that would allow them to do as much as not just check themselves in, but prior to that, being able to schedule themselves or actually even send appointment reminders through that platform. So we know it was a platform that our patients were accustomed to, the way we wanted to approach this, so we figured it'd be an easy transition for them to adopt. Jessica Ortiz: And could you share with the listeners your top highlight of your project so far? Arnie Reynoso: So the highlight of this project was the fact that our patients are really engaged in using messaging platform, which allows them to have less time spent here before arrival and knowing very well that once they arrive, they'll quickly be checked in and their waiting time would be significantly reduced from previous visits prior to COVID. Jessica Ortiz: And a follow-up question on that. Were all of the intake forms in production on the kiosk? Arnie Reynoso: There were. There are a handful of those that were on the kiosk, but we also have a platform that allows our front office staff to actually hand patients a tablet to complete some of those more complex forms that require just a little bit more information from them. So they could fill them out in the comfort of either the waiting room, prior to COVID, but in this time, actually being able to fill them out in the comfort of their own home. Jessica Ortiz: And did the forms that you had port over to this new environment or did you have to redevelop forms? Arnie Reynoso: Yeah, no, that was seamlessly. Luckily, since most of it was part of the OTech platform, it was just a matter of enabling it on this additional technology. Jessica Ortiz: And have you incorporated digital signature into the platform for consent and other forms that need signatures? Arnie Reynoso: There are a few consent forms that do have signatures, so yes, we have incorporated some level of signatures on those tablets. Jessica Ortiz: Thanks for sharing that detail. And could you share with listeners the biggest challenge from your project so far? Arnie Reynoso: Well, the biggest challenge really didn't come from the OTech technology. It basically came from when we initially rolled out this technology, was the fact that OTech was the primary carrier for these messages. Just add to the listeners, just for their understanding, we actually have in-house a different technology with a two-way messaging technology that allows us to have appointment schedules, rescheduling and actually get an appointment through our two-way messaging system, which is WELL Health. Arnie Reynoso: And so initially in our testing, we found that our patients were reluctant to click on links that were coming from an unknown source, and so that put a pause on the initial rollout. We were able to talk to both partners and seeing if there was a way to integrate some of this technology so that the message would come from a well-known or at least accustomed platform that our patients were receiving messages from our clinic. Arnie Reynoso: And so what was really nice about this project in addition to the technological advances that we were having with our patients checking themselves in, was the fact that both partners were willing to work with us and each other to create an application interface that would allow both platforms to talk to each other in a seamless manner, which turned out that they both benefited from due to the fact that now they've opened themselves up to creating a very standardized interface that would allow them to integrate other vendors, not just each other. That was the initial take on that. Jessica Ortiz: And how does this new remote platform support surveys like PRAPARE or PHQ? For our listeners, PHQ is "patient health questionnaire." Arnie Reynoso: Well, it does support it in a very seamless manner. Those PHQ-9s and actual PRAPARE forms when sent out are already integrated into our electronic medical records. So when it comes to filling those forms out and actually populating in our medical records system, it's pretty seamless. Jessica Ortiz: And Arnie, I'm curious. Doing all of this during pandemic, how did COVID-19 factor into this project, and more broadly, what has it been like to innovate in the middle of a pandemic? Arnie Reynoso: Well, the pandemic expedited this whole process. Like I mentioned, we were trying to look at a platform that would allow our patients more access and give them more time than having to spend the time at the clinic itself. And so the pandemic actually expedited this, though we haven't necessarily completed what I feel is fully integrated like we would like. Arnie Reynoso: In addition to us integrating with our WELL platform, we also had some integration with our medical records system more to keep front office staff in line to where in the process of these forms that were being filled out at home the patients were, so it would be seamless when they arrived. So those forms that were completed didn't have to be re-completed. Those forms that were left half completed were finished off here with our tablets. So that allowed us to even further integrate this technology to make it more seamless, both for our staff and our patients themselves. Jessica Ortiz: And you mentioned staff. How have human factors played out as a part of this project? Arnie Reynoso: Well, as far as human factors have played out, our staff themselves actually appreciate the integration of it, which seems to have reduced the typical crowds you see in a waiting room where patients are just waiting to either interface with our front office staff to check themselves in or waiting to fill out forms and being handed back to our staff. So this has helped in that sense. Arnie Reynoso: And it feels like patients are more comfortable with the fact that they don't necessarily have to be standing in line, waiting for someone to attend to them. They feel like a lot of that has already happened and it's simply, the only interaction, if all their forms are filled out ahead of time, the only interaction they really have with front office staff and saying, "Hey, I'm here." They just officially check them in without them needing to do any forms or any interaction other than that. Jessica Ortiz: And, Arnie, given the complexity of integrating these platforms, what did you have to consider as you started to negotiate with vendors? Arnie Reynoso: So, we knew upfront that we already had an existing platform that was going to overlap, and we knew that there was a strong possibility that we wanted some integration with this platform as we progressed through this. And so in those negotiation processes, we actually included language in the contract that would allow us and the vendor to work through potential integrations with another vendor and not considered being live until that integration was either completed or it was up to par with what we were expecting the outcomes to be. Jessica Ortiz: How difficult was that, the negotiation process? Arnie Reynoso: Well, the negotiation process, I think, went rather smoothly and I'm not sure if it had to do with the fact that vendors were looking at opportunities during this pandemic to further strengthen those relationships with our existing partners. But none of our negotiations actually hit any stumbling blocks. They were very willing and open to actually put in those clauses into the contract. Though, I'm hoping that this is the beginning of vendors being cognizant of that and being able to work with their partners in doing similar [projects] as they move forward. Jessica Ortiz: Yeah. What is your take on how the vendors are feeling now at this point? Arnie Reynoso: I think the vendors are feeling like there's an upswing when it comes to embracing technology. So they're wanting to bring other vendors on board. From a personal experience, I found that vendors, even new vendors, are willing to, in the contracts, actually allow customers to use their technology free of charge even for a significant period of time before actually embracing them or deciding to using their technology. Jessica Ortiz: Thanks for sharing that. I'm sure that's really useful advice as people are considering negotiating with vendors. As a member of our learning network where we're big believers in collaboration and not reinventing the wheel, how did your peers in this program support and help you to push this project forward? Arnie Reynoso: Well, the Technology Hub in general and the peers were very resourceful, meaning I was able to reach out to a few of our partners through this group and get feedback and take on either existing technology that they may have that was similar to what we were trying to integrate or had similar experience with the technology we were trying to bring on or these features that we actually were trying to bring on. And they did have a lot of feedback into discussing the potential integration issues that we may encounter or actually pushing these vendors to do some of that integration for us as well. Jessica Ortiz: And thinking about this community of learning, we are trying to share with a broader community. So, do you have any advice for listeners that are tuning in when they're thinking about implementing a similar technology? Arnie Reynoso: We did spend a lot of time integrating these two platforms and from my perspective, it just made more sense to push for an application program interface (API) that would not only benefit us in this integration of technologies, but would also benefit other users or other clients to be able to integrate not just these two technologies, but other technologies, and given the fact that we foresee working with these vendors. And as we brought in new technologies that they might not have available, we felt that it was a sort of no brainer to create these interfaces so that we could easily integrate any other vendor as we move forward to allow more capabilities with these platforms. Arnie Reynoso: What I would add is that you have to plan for not just the short term, meaning that it's not just testing it out and rolling it out, but sometimes it's good to put into plan that you might have to reset halfway in between when you're seeing that the technology isn't really suiting your needs, whether it's the needs of you as the clinic and employees and staff or even if it's the technology from the patient's perspective or the consumer to better adopt that technology. Jessica Ortiz: I'm sure that's great advice, Arnie. And we are excited to hear what's next for you. What can we look forward to hearing from you in the future? Arnie Reynoso: Well, what we're hoping to is use this as a starting platform for embracing other technologies within the staff and knowing that vendors are willing to work with you to do that integration themselves as well, in partnership with the clinics themselves. As we move forward, what we are hoping to is use this as a springboard to make our accessibility to our clinics and services more widespread and allow the patients on their own to be able to access those services when needed. Jessica Ortiz: Thanks, Arnie. Thanks for sharing that. Wishing you all the best as you continue this project. Just want to say thank you for being a valuable member of this learning community and for sharing your experience and expertise with us today. Thank you. Arnie Reynoso: Thank you for having me. _____________________________________________________________________ Illustration: Ground Picture/Shutterstock