Telehealth may not seem a big deal to some, like their just doing FaceTime with their doctor. But it’s taken a lot of work over the last three months to get to this point.
The coronavirus pandemic has not been easy on anyone, including Campbell County Health, but if there’s a silver lining to COVID-19 from a health care perspective, it’s been the addition of virtual visits, or telehealth, to operations.
Remotely visiting with patients had been part of CCH’s strategic plan for a while. The original goal was to begin work on implementing it in June or July, with it being ready for patients by the fall.
But the coronavirus pandemic changed those plans. CCH wanted to limit the number of employees and patients in the hospital to help flatten the virus curve. It also wanted to continue treating patients.
That’s how a project that was planned to take several months was completed in less than two weeks.
“We completed it in a week and a half,” said Michelle Vogt, a clinical analyst in the organization’s IT department.
Vogt and the rest of the department got everything in place, trained other CCH departments and had the telehealth service to go at the start of April.
Staff then went to clinics and trained all levels of employees, from receptionists to the clinical staff to doctors.
Vogt said one of the most common questions she got while training staff was whether the patient would see them.
“We’re like, ‘Yes, it’s almost like the person is in front of you, but they’re on your screen,’” she said.
Now that the door to consult with patients at a distance has been opened, the possibilities for the future of telehealth are exciting, said CCH IT supervisor Tanya Arbach.
“There’s been a lot of talk and different avenues (we could go down),” she said about using the network as a regular option going forward. “This is not going away.”
“I feel like it was very successful,” Vogt said. “With everyone involved, we just all came together, and it was just amazing when we went up April 1.”
Behavioral Health Services was the first to implement telehealth during the pandemic, and now nearly all of CCH’s clinics have the capability. The two that don’t are anticoagulation and audiology.
“It’s hard to fit someone for hearing aids” over video, Arbach said.
The virtual visits are set up through CCH’s patient portal. People can sign in and select the provider they’d like to have a virtual visit with, and a receptionist will then call to schedule a specific time for the appointment.
The visits require a smartphone, computer or tablet with a working webcam, speakers and microphone. Some providers may request patients have a flashlight, thermometer, bathroom scale or a blood pressure monitoring device available during the visit.
Arbach said it’s very similar to FaceTime or Skype, and the system is secure and HIPAA compliant.
When the visit begins, patients will find themselves in a virtual waiting room until their doctor is ready to see them.
“It ran really well, like a well-oiled machine, and I just think it’s amazing what we have accomplished in a short amount of time,” Vogt said.
Tanya Allee, patient experience manager for Campbell County Health, said feedback so far has been appreciative, and 97% of telehealth patients have said their experience was either good or very good.
Holly Hink, a provider at the Kid Clinic, said she’s not a fan of using things like FaceTime, so she’s had to adjust quite a bit.
“It’s been a huge learning curve for all of us, in addition to the families,” she said. “But everybody has helped each other out.”
Lexie Honey, a behavioral health counselor at the Kid Clinic, said she’s heard from parents who are appreciative they don’t have to take time off work to drive their kids to appointments. Instead, their children can see Honey from the comfort of their homes.
“They’re very excited to give short tours, show me their bedroom or favorite stuffed animal,” Honey said.
There also have been some challenges.
“From a medical standpoint, I feel like it’s been a little bit of a struggle,” Hink said. “When a child has an earache or sore throat, I can’t see that over the computer.”
On the behavioral side, although Honey can see some of her patients’ body language, she can’t observe everything.
“We’re seeing their face, but we can’t tell if their foot’s jiggling with anxiety,” Honey said.
While most patients have adjusted well to telehealth, everyone is different.
“For some kids, it works great and it’s wonderful. Other kids definitely need that in-person (experience),” Honey said.
A lot of the work Honey does with her clients is based on play. With that aspect unavailable, it makes things “a little more difficult,” she said.
For example, with some of her younger patients, Honey will play Candyland with them to help them work on their emotions. That can’t be done with a virtual visit, so instead she’s created an “emotional scavenger hunt,” where kids have to find an item of a certain color in their room that they associate with a feeling.
“We’ve had to be a lot more creative, which is fun at times and challenging at others,” Honey said. “I’m ready to have my kids back in my office so we can have the rest of the interaction.”
When there have been issues with the virtual visits, it’s been because of network connectivity problems on the patient’s end, but those have been rare, Hink said.
“As we’ve all witnessed, it’s been chaotic for all of the people in the community,” she said. “The most awesome thing is we’ve still been able to work and provide services, even though there was quite a bit of chaos for a period of time.”
Those in the health care industry are excited about the possibilities of telehealth moving forward.
“I think there’s a place for virtual visits going forward, for lots of things,” said CCH spokeswoman Karen Clarke. “Now that the door’s been opened, I don’t think it’s going to go away.”
It’s going to be more convenient for people to see their doctor.
“Sometimes you have people, it’s hard for them to get out of the house when they just need a checkup or their medication refilled,” Arbach said.
“With a lot of people who work in the oil fields or drive trucks, this is a great way for them to have that conversation with their doctor instead of sitting in a waiting room,” Vogt said.
During a hospital board of trustees meeting last month, IT director Matt Sabus said his department was working on the second phase of telehealth implementation, which includes increasing the capabilities of the system through the patient portal.
Soon, people will be able to do their co-pays and bills online, and all the paperwork they have to fill out about their allergies and past medical history also will be available through the portal.
“How can we start increasing our patient adoption?” Sabus asked. “We’ll continue to brainstorm ideas on that, how we target our marketing and services to patients. We are not done.”
“You’re always going to have people who are resistant,” Arbach added. “But it won’t be forced on anybody. It’s just another tool.”
Vogt said it will be important to keep up with changes in technology to keep telehealth services up to date.
“We’ve advanced so much over the years with technology,” Vogt said. “To give (patients) more options to stay connected with their provider, that service that they want, this is a great tool and it will just keep growing and evolving.”
A federal report shows annual U.S. energy consumption from renewable sources ahead of coal for the first time since before 1885.
Nearly as significant is what’s expected to come next year.
Rob Godby, a University of Wyoming energy industry economist, said the devil is in the details of the U.S. Energy Information Administration report released Thursday that says Americans consumed more energy from renewable sources combined than coal in 2019.
The report includes all types of consumption, like the ethanol biofuel additive in gasoline and green technologies used in batteries, he said. Consumption from coal energy, on the other hand, is strictly from electricity generation.
“The report is really kind of a strange one,” Godby said. “Nobody has coal-fired cars or things like that that, so the way this report came out is sort of a curiosity and it’s interesting.
“But when people realize it includes the ethanol that’s in every gallon of gasoline and the renewable energy that’s all around us, it’s not just solar panels and our wind farms.”
The more telling report could come next year, Godby said. That’s when the EIA is predicting that the United States will produce more electricity through renewables than through coal.
Natural gas passed coal as the dominant source of fuel for power plans in 2015, and now the mineral is close to dropping to No. 3 on the list of the fuels for electricity generation.
Coal’s market share has been shrinking for some time, which makes this week’s report and the EIA’s projections for next year nothing new, Godby said.
“Coal has not been No. 1 for quite awhile now,” he said. “Gas surpassed coal awhile ago, and no nuclear and renewables are close.”
Although not an apples-to-apples comparison, this week’s report about energy consumption from renewable sources is still noteworthy, he said.
“These are basically first-time happenings,” Godby said. “It was only a few years ago that natural gas surpassed coal, now it’s renewables.”
He also said that renewables passing coal for producing electricity this year is being pushed by the coronavirus pandemic.
“For the first time ever, that is now expected to happen this year, and a lot of that is due to COVID-19 and the reduced power associated there.”
Compared to 2018, last year’s consumption of coal in the U.S. was down nearly 15%, the EIA reports. At the same time, total consumption from renewable sources grew by 1%.
Last year, coal accounted for 11.3 quadrillion British thermal units of power consumption (quads) while renewables combined for 11.5 quads, according to the report. Renewables include solar, wind, geothermal, biofuels, waste, wood and hydro.
“Historically, wood was the main source of U.S. energy until the mid-1800s and was the only commercial-scale renewable source of energy in the United States until the first hydropower plants began producing electricity in the 1880s,” the report says. “Coal was used in the 1800s as a fuel for steam-powered boats and trains and making steel, and it was later used to generate electricity in the 1880s.”
The market still rules
While the pandemic and social climate against fossil fuels continues to pressure thermal coal, its main obstacle continues to be cheap natural gas, Godby said.
As plants burn gas instead of coal, long with decreased production during the pandemic, the outlook for the rest of 2020 continues to be bleak for Powder River Basin coal, he said.
Last year’s decline was the sixth consecutive for coal as a fuel source to make electricity in the United States. Electricity generation from coal also dropped to its lowest level overall in 42 years.
“Natural gas consumption in the electric power sector has significantly increased in recent years and has displaced much of the electricity generation from retired coal plants,” the EIA report says.
Along with coal’s decline, the growth in U.S. renewable energy is “almost entirely attributable to the use of wind and solar in the power sector,” according to the report.
For the first time in 2019, wind also surpassed hydro and is the now the largest source of renewable electricity.
The Powder River Basin, which makes up much of Campbell County, produces about 40% of the thermal coal used in U.S. power generation, the EIA reports.
However, that statistic doesn’t tell a complete picture. That’s because while the PRB continues to be a significant source of the coal that’s consumed by power plants, overall there has been a big drop in coal consumption.
About a dozen years ago, the PRB accounted for 50% of all electricity produced in the nation. That has dropped to about 19%, according to the EIA.
The PRB produced 266.8 million tons of coal in 2019, about 9% less than the 293.5 million tons produced the year before. And it’s 40% less than the region’s high point in 2008 when 446.5 million tons of coal came out of the basin.
Projections for 2020 before the COVID-19 pandemic were for the basin’s production to be just over 200 million tons.
The coronavirus has had a significant impact on the energy sector with consumption down nearly 20% as people stay home and economies are shut down.
That’s only fueling an already poor outlook for thermal coal, said Benjamin Nelson, lead coal analyst for Moody’s Investors Services.
“Coal-fired power generation has fallen below renewable energy for the first time in more than 130 years — when wood was the primary source of energy in the United States,” he said in a statement reacting to the EIA report. “We expect ongoing secular decline in the demand for coal, accelerated by the economic fallout from the global outbreaks of COVID-19 will persist in the early 2020s.”
The decline in energy prices and impact from the COVID-19 pandemic leaves the city of Gillette with an uncertain future. As a result, the City Council may have to make some tough decisions.
On Tuesday it will host the first of three readings on its annual budget. The budget would go into effect July 1.
In anticipation of the impact of a tough economy, the city proposes spending about $146.4 million in the next budget year, about a 3.6% decrease from its $151.9 million budget this year.
General fund revenues are projected to be $32.2 million, about $14.7 million less than this year. The city also anticipates a 21% drop in sales and use tax revenues from about $21.6 million this fiscal year to $17 million.
The city don’t know yet what the impacts of the COVID-19 pandemic and huge losses in the stock market and energy industries will mean, but it is likely to be significant, City Administrator Pat Davidson said.
Sales use and tax numbers for April are expected to come out in the coming days. About 70% of the city’s revenue comes from its sales and use taxes, he said.
Sales and use tax collections affect a variety of things aside from the general fund. One of those is 1% Optional Sales Tax.
For the 1%, the city is anticipating collecting $22.2 million, but the work needs to follow the top priorities residents gave during a citizens survey like street repairs, drainage projects and water and sewer main work.
The city recommends cutting $6.5 million from it capital improvement projects funded by the 1%. It would include reducing the budgets for water main replacements from $5.70 million to $2.25 million and sewer main replacements from $5.35 million to $2.50 million.
City department heads started meeting to see where they can scale back. While the city does not expect to lay off people, departments are not filling vacant positions, said spokesman Geno Palazzari.
In January and February, things were looking good for the city. It was anticipating having a budget about $12 million higher than 2019-20, $219 million.
The city was “fairly optimistic” as to what the future would look like before the city entered that “perfect storm,” Davidson said.
The storm includes the COVID-19 pandemic, static natural gas market, and declines in coal and oil.
The city has about $14.2 million in reserves and has proposed a budget that would allow the city to adjust one way or another, if needed, he said.
First reading on the budget will take place Tuesday followed by two more on June 9 and June 16.