When Debra Philpot was 8 years old, she lost her father to a brain tumor.
“I saw first-hand how a neurological disease, whether it’s a tumor, stroke or traumatic brain injury, changes that person forever and how it impacted our family and how it impacted me,” Debra says. “Tragedy can really forge something in you that makes you rise to the occasion and makes you stronger, and I think that personal experience has been a driving force throughout my career.”
Indeed, Debra, a nurse-turned-administrator who’s risen through the HCA/TriStar ranks, launched a telehealth initiative in 2009 to provide faster care to patients suffering from strokes and other neurological conditions. Since then, under Debra’s leadership as Neuroscience and Telehealth Administrator, TriStar Health expanded its telehealth services to over 30 partnerships in areas like behavioral health, pediatrics and ICU/pulmonology. We sat down with Debra Philpot, April’s FACE of TriStar, to talk about what telehealth really is and the impact it’s having on TriStar Health’s patients across the Southeast.
What is telehealth?
Initially, it meant telephonic only, just being able to get a hold of a provider over the telephone. It could be store and go, where I send an image to a provider on the other end who looks at that information and makes recommendations. But the true telemedicine is really defined as a live, real time, two-way interaction that involves both audio and visual. It’s a little bit like Skype, except a much more robust platform in terms of it being compliant with security and information privacy standards. And also because it does interact with patients, it’s FDA compliant. That’s the definition of it, and essentially we use those types of services where we can extend the reach of our professionals, our providers. Patients may show up in one location, one physical bricks and mortar location, that might not have the necessary specialist available or the specialist may not be available very quickly. So, instead of a patient having to be moved from one location to another, this technology enables the physician to go to the patient, as opposed to the patient having to go to the physician. So you can take a pretty small number of providers and scale them across a large geographic area. There really are no geographic barriers now because the technology enables them to go anywhere, as long as there’s an internet connection.
How does it work in terms of TriStar Health’s stroke care?
In 2009 through 2011, we developed what we call a stroke network, where there wasn’t just one hospital in our health system that was considered the expert in stroke care. We really wanted to make all of our access points primary stroke centers, where a patient could arrive at any of those locations and expect to receive high-quality care the same as if they went to just one center. It was very apparent to us that there were just not enough neurologists to provide rapid access to that expertise. So in 2011, we deployed our first telemedicine robot. They are on wheels, and they are cart-based. We deployed five here in the Nashville market to expand the availability of those stroke neurologists. So if a patient would come in with a sudden onset of the BE FAST acronym (Balanced Eyes, Facial droop, Arm weakness, Speech difficulty, Time to call emergency services — these are the symptoms identified by the American Stroke Association.) or issues with balance or difficulty with eyes, the hospital could rapidly get a hold of a neurologist who could be in person with that patient in about four minutes. So, it really improved the access to care, the timeliness of care and the quality of the care.
Stroke was the gateway, and it has definitely been the one thing that we have continued to grow, not only the depth of the service, but the number of states, the number of locations, the number of providers. And from that we launched into other neurological conditions that may not be a stroke or may look like a stroke but might be something else, like a seizure, a complex migraine headache or some other neurological deficit. We really kind of open ourselves up for anything that’s not normal neurologically, whether it’s an emergency, it could even be routine. We want to make ourselves available to make sure those patients get that level of care.
Were you tapped to develop the stroke network or was this your idea?
Back in 2008, all of our hospitals were kind of working independently of each other, and my colleague Dr. Adrian Jarquin-Valdivia, a neuro-intensivist who had just joined TriStar Centennial Medical Center, set up a meeting with me. I was actually employed at TriStar Skyline at the time, but we sat down together and immediately we had a kindred spirit. We said, “What difference could we make if all of our hospitals could be high functioning stroke centers?” We really developed the concept in a white board type of session and got a mission and vision for what a network could be. I was able to go to my hospital administration and present this idea and really work with the TriStar Skyline administration to get in front of the whole division administration and executive team. We said, “We have this proposal — let’s do a stroke network, let’s have telemedicine’s help enable us.” It’s really pretty rare when you have the Chief Nursing Officer, the Financial Officer and the CEO all say, “This is a great idea.” So, even though I was at a director level at just one of the hospitals, Dr. Valdivia and I had the vision, articulated the vision, got support from the local administrators and then got buy off and engagement from all of our hospitals. That was how it started.
What inspired you to pursue telehealth for stroke care, and why is it so important?
I think about the mission of our company, and above all else, we are committed to the care and improvement of human life. Stroke is the number one cause of disability, not only in our country but across the world. It’s a devastating disease, and one of the things I was passionate about is making a difference. So, I thought if we could assess patients sooner, and if we could provide quick treatment, we could diminish the number of patients who suffer stroke and who have severe disabilities. To give you an example of that story, the very first day we flipped the switch and went live, we had an elderly patient who showed up at TriStar Southern Hills Medical Center. He was paralyzed on the right side of his body, and as you know, most people are right hand-dominant, and when you can’t move that part of your body, it is devastating. Not only that, he could not understand what people were saying to him, nor could he speak at all. So this is what I would call a catastrophic stroke, but they had just had their training. So, they got the neurologist on the robot. They were very quickly able to assess the situation, looking at the images and the labs, and they gave the order for the clot busting medicine that actually stops the stroke. Before the patient was taken to the inpatient bed, the patient reached up with the arm that was paralyzed and squeezed the nurse’s hand with a strong grip and then looked up, and with big tears in his eyes, told her, “Thank you.”
Of course, I felt so much satisfaction just knowing that even if we just helped this one patient, that this gentleman could go back to gardening, he could play with his grandchildren. That just inspired me to say, “We can do more, this is just one situation.” And that’s exactly what we’ve done. This past year, we saw over 8,000 patients between all of our services. We saw 2,200 stroke patients in this past year. Those are lives that are changed, those are disabilities that are decreased, and that really helps me know that I’m using this technology to live out our mission and values about improving human life.
Do you anticipate other telehealth services, or are you all just trying to maintain what you have now?
We do intend to grow, and what we try to do is think about the grassroots needs that come up, and a lot of times it’s on an as needed basis. Perhaps a physician has left a hospital service, and there’s a gap until they can recruit another one. Can we use telemedicine to fill that gap so patients don’t have to be transferred? Most of the care that we’ve done to this point has really been focused on patients who are already in one of our hospitals or a free standing emergency room, which we have several in our market. What we will be focusing on in the future are patients who haven’t come in to a bricks and mortar location. Maybe they’re thinking about going to an urgent care or calling their PCP or going to an emergency room. We want to be able to provide an access point virtually so a patient can request a virtual consult and then determine if treatment can be provided just at that level, or if they need to be recommended to a location to see a provider for further care.
Thank you to Debra Philpot for sharing this amazing technology and how it drives your work. To learn more about all of TriStar Health’s services, click here.