Sun River Well being, dependent in Peekskill, New York, is a not-for-financial gain system of federally competent wellbeing facilities. It offers culturally delicate and linguistically correct major, preventive, behavioral and oral healthcare, and a total assortment of enabling and aid solutions. It serves predominately minimal-income and extremely vulnerable sufferers residing all through a sixteen-county region of southeastern New York, encompassing the Hudson Valley, New York Metropolis and Prolonged Island.

Sun River’s sixty four wellbeing centre web sites (which include equally directly operated FQHCs and sub-recipient web sites) provide extra than 245,000 sufferers on a yearly basis in equally city and rural medically underserved communities. Sun River Well being was amongst the to start with companies to obtain funding beneath the Federal Communications Fee COVID-19 Telehealth System.

THE Issue

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Prior to employing the telemedicine technologies supported by the FCC plan money, Sun River Well being experienced comparatively restricted and targeted capability to aid distant visits. Mostly, Sun River Health’s telemedicine solutions achieved the desires of the HIV, Medically Assisted Remedy sufferers.

“The use of this modality presented the medical ailments of the sufferers was the most helpful technique to clinician/affected person co-management,” reported James Sinkoff, deputy govt officer and CFO at Sun River Well being. “The wellbeing centre predominantly utilised online video-dependent telemedicine technologies to aid site-to-site visits within just the Sun River network, or to offer obtain to contracted specialty solutions these kinds of as dermatology.”

This variety of programming was targeted on overcoming boundaries to care for Sun River sufferers, notably for specialty solutions not usually accessible to sufferers in underserved communities exactly where Sun River web sites are found. In quite a few situations, time-restricted grant funding was the only money aid for this variety of telemedicine programming.

“Good quality assurance get the job done was equally targeted on this comparatively targeted scope of support in purchase to ensure a stage of affected person fulfillment and HIPAA compliance comparable to that offered by facial area-to-facial area visits,” Sinkoff reported. “The site-to-site programing rode on Sun River’s fiber network and utilised Cisco Telepresence SX10s and Cisco Jabber on Dell laptops with the service provider controlling the digital camera on the affected person side.”

Although this get the job done permitted the wellbeing centre flexibility on sourcing service provider time concerning Sun River web sites, and with contracted vendors, it still needed equally sufferers to be physically housed in a medical location.

“Our legacy telemedicine plan also was restricted to a specific degree simply because of limits on reimbursement for solutions, notably reduced charges for off-site telemedicine compensated by New York Point out Medicaid funding,” he discussed. “As a final result, Sun River’s plan did not usually use systems that operated on non-wellbeing centre network infrastructure and faced ongoing challenges in sustaining telemedicine programming.”

“Coupled with seamless EHR integration and clarity on reimbursement methodology, our new telemedicine infrastructure will drive Sun River to thoughtfully take into consideration affected person knowledge in the progress of a resilient however flexible design of care.”

James Sinkoff, Sun River Well being

The technologies mirrored the reimbursement environment and the bodily network of wellbeing centre places and was restricted to distinct service provider kinds somewhat than supplying capability to accommodate a bigger quantity of Sun River visits, he added.

The arrival of COVID-19 radically disrupted the paradigm in which Sun River Well being was running. Located in the epicenter of the worst initial outbreak in the United States, sufferers faced lockdowns, work reduction and anxiety from a badly recognized viral threat.

“At one place in April, the sixteen counties that make up Sun River’s support spot accounted for somewhere around 97{312eb768b2a7ccb699e02fa64aff7eccd2b9f51f6a579147b7ed58dbcded82a2} of all confirmed COVID-19 cases in all of New York,” Sinkoff recalled. “A lot of sufferers, notably these with serious ailments, have been at a reduction to balance community wellbeing tips to isolate at dwelling with plan professional medical appointments.”

Sun River Well being consequently desired to speedily scale telemedicine capability to offer big quantities of sufferers with obtain to vendors all through its network as opposed to targeted obtain aimed at overcoming distinct boundaries to specialty solutions.


Sun River quickly identified the limitation of the present on-premise option within just the context of the COVID-19 pandemic simply because it evidently did not conform to community wellbeing techniques targeted on decreasing crowding and maximizing interpersonal space.

A rest in reimbursement criteria that bundled telemedicine visits originating from places outdoors bodily wellbeing centre space incentivized the adoption of a new option and promoted immediate adaptation to possible support shipping and delivery modification.

“Even so, building capability to accommodate a considerable raise in telemedicine visits originating from non-medical places offered a significant problem to Sun River’s legacy operational design,” Sinkoff discussed.

“Furthermore, the lack of easily accessible distant diagnostic products restricted the breadth of what Sun River vendors could provide within just the context of a telemedicine go to, notably amongst a subset of sufferers with fundamental ailments most at chance for issues arising from COVID-19 an infection.”

To deal with these problems, Sun River’s proposal sought to purchase new audio-visual abilities that could be carried out outdoors of wellbeing centre amenities. This needed a change from applying technologies dependent on inside networks to a telemedicine option capable of running from assorted distant places.

“We also identified that building distant monitoring systems would be a significant future phase in managing ongoing affected person care remotely and sought out connectable diagnostics that would aid distant monitoring concerning Sun River web sites and outside of,” Sinkoff reported.

“The integration of these systems provides on ongoing problem as our telemedicine plan moves towards sustainability and has relied on advertisement hoc workarounds leveraging present informatics capability in purchase to supply solutions in response to the instant calls for resulting from the COVID-19 pandemic.”

A change in New York Point out and Medicare reimbursement, together with receipt of the $753,367 FCC grant, infused functioning funds on major of Sun River Health’s expense in telemedicine.

“Within just 3 months, the wellbeing center’s telemedicine network protected our full support spot, was thoroughly operational and was providing affected person care remotely,” he reported. “Notably, our persistently mentally sick and chronically sick sufferers have been the to start with to advantage from this support enlargement. Some operational kinks desired to be worked out, nevertheless, but our ability to join sufferers to their major care vendors quickly reduced panic and anxiety involved with the pandemic.”


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Assembly THE Challenge

Once Sun River identified the significant require for a extra commonly scalable telemedicine option, an inside staff speedily evaluated its eClinicalWorks EHR’s abilities, but eClinicalWorks faced constraints broadly employing its inside option.

“This prompted us to subsequently consider telemedicine seller and speedily pilot it with a handful of vendors,” Sinkoff mentioned. “This comparatively easy and uncomplicated option offered Sun River a platform available from phones, tablets and laptops. As a standalone, HIPAA-compliant telemedicine platform, permitted two-way online video visits to be scheduled speedily and devoid of undue calls for on sufferers.”

A digital ready home simplified the hold out occasions for sufferers have been vendors to operate late. Right after it was vetted, Sun River speedily rolled out 245 licenses to professional medical and behavioral wellbeing vendors. Within just a several months, Sun River Well being was able to make distant telemedicine visits available to almost all of its major care and behavioral wellbeing sufferers.

“Sun River also sought to align the use of with its present EHR abilities,” Sinkoff discussed. “ does involve an software programming interface that lets Sun River to extract some utilization info. This ability lets us to align that information with service provider go to volume, and affected person scheduling. The ease of use and scheduling flexibility made service provider and affected person adoption easy and well timed.”


Two metrics display the efficacy of Sun River’s FCC-supported telemedicine initiatives, Sinkoff reported.

“The to start with compares pre-COVID-19 and write-up-COVID-19 telemedicine utilization,” he reported. “For the week ending February 28, 2020, Sun River experienced conducted somewhere around 30 visits remotely applying its present telemedicine option. For the week ending May well 29, 2020, Sun River Well being experienced conducted 2,792 visits utilizing telemedicine with online video (9,815 applying all telemedicine modalities).”

This evaluate reflects the raw numerical raise in the use of telemedicine within just one month of employing the expanded telemedicine plan, he added.

“The second metric looks at Sun River’s capability to supply solutions remotely,” he reported. “For the week ending May well 29, 2020, the wellbeing centre furnished somewhere around 67{312eb768b2a7ccb699e02fa64aff7eccd2b9f51f6a579147b7ed58dbcded82a2} of its visits by way of telemedicine. This metric speaks to the scalability our telemedicine plan attained. This metric is notably salient presented the fact that specific support lines – COVID-19 testing, for instance – simply have been difficult to supply just about.”

Sun River Health’s share of visits furnished by way of telemedicine compares to an normal of 53{312eb768b2a7ccb699e02fa64aff7eccd2b9f51f6a579147b7ed58dbcded82a2} amongst other New York Point out FQHCs all through the very same time body, as reported by survey info collected by the Well being Resources and Companies Administration. Sun River’s changeover to this stage of capability, for medical and aid staff members, was accomplished in big portion due to the FCC plan, Sinkoff mentioned.

Working with FCC AWARD Cash

“Aside from the implementation of, Sun River utilised FCC funding to ensure that vendors and aid staff members experienced connectable products capable of securely accessing the wellbeing centre EHR from distant places,” Sinkoff reported. “This accommodated telemedicine visits from affected person residences to vendors functioning in assorted options.”

This was notably essential presented the wellbeing center’s dedication to COVID-19 testing in community places exactly where WiFi connectivity was required to build and document affected person results.

“We have deployed telemedicine to boost a broadly scaled and easily available solution for the greater part of wellbeing centre sufferers in the occasion of pandemic resurgence, purely natural catastrophe or other events that may possibly disrupt bodily obtain to Sun River Health’s medical places,” he discussed.

“Furthermore, we foresee that this infrastructure will inform ongoing excellent assurance and advancement functions in a way that meaningfully interprets and aligns legacy medical, administrative and money benchmarks with the knowledge and results involved with digital visits.”

Sun River’s plan also supported its initiatives to greatly enhance distant monitoring systems.

“These systems will allow for goal diagnostic information to dietary supplement online video and telephonic consultations,” Sinkoff reported. “Although the guarantee of these systems is vast, they also hasten constructive disruptions to the operational types FHQCs have typically deployed to deal with social determinants of wellbeing and other boundaries evidenced in our affected person populations.”

Additionally, Sun River’s accountable care group initiatives and other worth-dependent care types will advantage as the group foresees significant reductions in emergency home utilization, increases in digital in-dwelling visits, and improved charges of engagement in transitions of care and care management programming.

“Coupled with seamless EHR integration and clarity on reimbursement methodology, our new telemedicine infrastructure will drive Sun River to thoughtfully take into consideration affected person knowledge in the progress of a resilient however flexible design of care,” he concluded.