Amy Hermes is a women’s health nurse practitioner and the Telehealth Director of Wise Health System in Texas. Telehealth services at Wise began with Stroke-Neuro Telemedicine (TeleStroke), in 2012. The success seen in TeleStroke (faster, better care, and better patient outcomes) by 2016 brought Wise Health to expand the services offered, including the need for a director for the program.  It has since expanded to TeleER, TeleNICU, and TeleCCU, including telespecialists, as well as both inpatient and outpatient telebehavioral health.

Since partnering with a telehealth app in December 2018, Hermes has seen greater utilization of telemedicine services. The timing of the launch of the app was perfect because it hit the greater need seen during the winter flu season, had good success, and established the practice well before the tremendous unseen need that came with COVID-19. The initial surge in Spring 2020 for telehealth proved to be so great that it was almost unmeetable on a nationwide scale, but they have experienced consistently better utilization since COVID, and that use has remained higher since consumers now have greater trust and insight, as well as experience with the value of telehealth services.

Hermes suggests that organizations take time to teach the utilization of technology because the patient experience is influenced greatly at their first appointment.  Having an aid in place to help with such issues makes the patient experience a positive one. When establishing a program, it is critical to bring in anyone it will affect early in the development process. This team environment made up of stakeholders provides ideas from all directions and guides decisions.  Various departments should be represented such as legal/compliance, billing/coding, nurses/managers/providers for workflow input, and of course, IT for equipment and connectivity.

The role of a telehealth director is a unique position. It involves reading all you can on regulatory law and compliance. Each state is different and has multiple organizations with which a director must be familiar. Hermes suggests that you shadow a current director or someone in the field. Ask for help. Be a good communicator. This is a rapidly changing field and provides more options when finding the best fit for patient-centered care.

You can find Wise Health System Telemedicine Services here as an example of an early adopter of teleservices and a well-established program that adapted quickly to the COVID-19 crisis.

For more details, please read the written Q&A session with Amy Hermes:

Q: How did you get started with and when did you first intersect with telehealth?

Amy Hermes: In 2015 I worked as an NP in an OB-Gyn office and was studying telehealth in my Executive Nurse Leader’s program while pursuing my master’s degree. In the program, I learned about telehealth and the value and convenience it could offer, especially in rural areas. My preceptor was a SVP and Chief Transformation Officer and invited me to learn more about a DSRIP program that had been implemented on our hospital side in the ICU. The organization also had a TeleStroke program in place. In 2016, a telehealth leadership position was created, which I applied for and received. 

Q: How have you/ Your clients found telehealth to be helpful?

Amy Hermes: The obvious answer is convenience and access. This was true prior to the COVID crisis, but these benefits were magnified with the COVID crisis. Health consumers now EXPECT telehealth, and because we were fairly early adopters, we were able to transition to be much more expansive.

There also is value – meaning having telehealth available provides your patients and community the option of seeing a provider in their network or at least not having to look outside of the network for telehealth. By offering telehealth, we have been able to preserve existing market share and also capture new market share.

Having telehealth has also allowed the ability for patients to be referred downstream. If an on-demand urgent care visit requires referral to an ER or UC facility or even follow-up with a PCP or specialist, we have measures in place to provide them with contact information on how to utilize these services within our own system of providers.

Q: What challenges has your organization faced with telemedicine and what have you done to overcome them?

Amy Hermes: 

1. Buy-in – including patients, leadership, and even providers. It was a 50/50 mixed bag prior to COVID. Because patients felt compelled to use telehealth and providers felt compelled to provide telehealth in the best safety interest of their patients, buy-in has increased closer to 75% approval and 25% unsure. Far fewer are adamantly against telehealth. Using it has proven to patients and providers the value and limitations of telehealth, both in terms of access and affordability and in terms of the quality of care that can be provided via telehealth.
2. Reimbursement - has always been a challenge. Having temporary reimbursement has allowed more freedom to offer services from a provider standpoint, and also more freedom for patients to utilize these services using their own providers. 
3. Regulatory challenges – Texas had very stringent regulatory statutes set by the Texas Medical Board, which has progressively shown more acceptance of telehealth. We have been very cautious to abide by the rules and regulations surrounding telehealth, but again, the COVID crisis allowed many of these to be waived temporarily and we were able to offer services more freely than before. I am very hopeful that the enormous amount of data available as a result of the telehealth utilization surge during the COVID crisis will provide evidence of high-quality care, patient satisfaction, and cost savings.
4. Broadband access – we are very rural and struggle with both Wi-Fi and cell tower connectivity. This isn’t only an issue in our clinics or hospital, but also out in the community when patients are trying to use videoconferencing to connect to our providers. We are doing whatever is within our power – changing our provider equipment for telehealth from Wi-Fi enabled tablets to ethernet-wired desktops or laptops, creating a telehealth video visit pre-check process, and even planning a platform conversion that is not browser-dependent and offers improved connectivity, speed, and video quality and prompt and dependable technical support when needed.

Q: What recommendations do you have for clinicians as they move to embrace telemedicine? 

Amy Hermes: Learn from others! Reach out and inquire, watch webinars, listen to podcasts, and spend plenty of time researching all aspects of telehealth. When entertaining vendors or platforms, do your homework and ask them to provide you with references so you can get an unbiased review of the pros and cons of the platform. Look for vendors who provide what YOU as an organization are looking for, and do not become enamored in all the bells and whistles they may offer (but you may not need).

Be certain that your strategy for telehealth is complementary to your organization’s overall strategy, not an independent, siloed project.

Invite participation, feedback, and assistance in decision-making as you are developing your initial strategy and launch from your key stakeholders – leaders in the IT department, Coding/Billing department, Credentialing department, Marketing department, and of course your C-Suite. Most importantly, be certain you have a Provider Champion to drive the program.   

Develop a multi-disciplinary Telehealth Team to include persons from all areas who are designated to assist with your launch and continued oversight. This should include IT, Coding/Billing, Credentialing, Contracting, Business Intelligence, Marketing, and your Provider Champion. 

Absolutely involve your legal, compliance, and IT departments in all aspects from the first step and consult them frequently as your program evolves or regulations change. It is vital to have someone on your team to ensure you are compliant with all security, privacy, and regulatory requirements in a dynamically changing landscape.

Q: What is one thing that is unique/ incredible about your field?

Amy Hermes: The ability to offer care from a distance is amazing. Seeing patients receive timely care from specialists at a distance that drastically improves their care and outcomes versus waiting on a transfer to another facility to see the specialist (such as in stroke care). 

Also seeing minor care problems cared for by telehealth and experiencing it firsthand and knowing the patient received care equivalent to an in-person visit without mom or dad taking off work, without unnecessary exposure of the medically at-risk during an in-person visit, and without delaying care until the condition worsens while waiting for a clinic to open, and all at an affordable cost.

The dynamic growth and creative changes taking place in telehealth are breathtaking. Looking at concepts to provide care at a distance that will result in better care and outcomes, such as RPM for chronic care patients and SNF patients to reduce readmissions and ER visits because providers are alerted of abnormal values or symptoms before the patient may even feel the effects is humbling and just makes you feel like we are headed in the right direction as we are in a constantly changing healthcare system and one that in many ways falls behind other nations in terms of healthcare spending and outcomes. And the new evolving concept of Hospitals Without Walls, which also utilizes telehealth shows endless possibilities to allow patients to receive higher quality and more complex care at home instead of the hospital. Wouldn’t we all rather be at home, whether a visit for allergies on an app or when suffering a chronic condition requiring frequent provider evaluations?

Q: What are some challenges that you have faced/conquered as a female industry leader?

Amy Hermes: I was raised by a single mother who showed me that women could do anything! She did not tell me it was easy, but instead showed me that hard work pays off and I never saw anything other than the hard work she put in and the sacrifices she made to provide for her four children. We never did without anything, but we also learned that “things” come at a price that we should not take for granted. It was her strong work ethic and her ability to survive being left with four children to raise alone and no past job history that has always driven me to work hard and aim high. 

I also have spent my entire career working in women’s health. First, I was a Labor & Delivery Nurse for 10 years, then became a Women’s Health Nurse Practitioner, and have continued to practice in this role for the past 14 years. I was surrounded by plenty of female nurses and providers who were just like me. And also a few men, but they were far outnumbered in my field. In all fairness, they also showed me the utmost respect.

In my organization, I actually feel that I’ve been blessed by having leaders and peers who have fostered my growth as a leader, and never have I felt challenged by being female. I feel my opportunity to serve as a leader in telehealth is an opportunity to smother the idea that women can’t or shouldn’t serve in those roles. I believe each leader has traits to complement other leaders and to lead effectively, regardless of gender.

Q: What are one or two things that you have been doing to stay healthy/ focused during the COVID crisis?

Amy Hermes: The COVID crisis took precedence over almost anything for several weeks. My team consisted of myself and one assistant, plus the available time of some amazing employees from closed departments who were kind enough to help during the rapid changes and new launches. Lots of overtime hours, up to 75 a week. 

I had to address my mental health. We cope and we do what we have to do for a time, but then eventually, you have to practice self-care. For me that started with setting aside time for my family. My kids are 20 and 16, and though almost grown, I truly missed seeing them, talking to them, and just knowing what was going on in their lives and in my husband’s. This scheduled time, even if brief, made a world of difference. 

I also leaned on co-workers in my OB-Gyn office who checked on me frequently and gave me encouragement. I had to learn to drop my guard from the “I can do it all and I will do anything required to get it done” person I had always been and let a peer in the office know I was struggling. That was difficult for me, as I don’t like being vulnerable, but allowing myself to do so made a world of difference and let me know I had all the support I needed. I expanded our EAP plan to allow telehealth EAP, and I would encourage others to take advantage of that, too. 

And I also had to take care of my physical health. I love to run, and in the storm of the COVID crisis, there was just no way to keep up my normal routine. Scheduled to run the Boston Marathon in April that I was looking so forward to, I had to cut my mileage significantly and at times had a hard time getting any miles in at all due to my work hours. This affected my emotional and physical health and cut my ties with my running group temporarily. Scheduling some running, even if not my normal amount, helped me regain mental and physical strength, and also made me hungry enough to remember to eat.

As women, I think we are tempted to always put others’ work needs ahead of our own (as in our families), but it is really important to make sure we take whatever measures necessary to practice self-care.