In this day and age, with many resources and services online, have you considered how to help your patrons access healthcare professionals right from your library? On this show, George Strawley, Library Engagement Specialist for Region 4 with the Network of the National Library of Medicine, and Trish Hull, Library Manager of the Kearns Branch in the Salt Lake County Library System, talk about telehealth 101. They explain the ins and outs of providing important telehealth resources for your patrons in a way that anyone can implement.
Transcript
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Adriane Herrick Juarez:
This is Adriane Herrick Juarez. You’re listening to Library Leadership Podcast, where we talk about libraries and leadership, and speak with guests who share their ideas, innovations, and strategic insights in the profession.
In this day and age, with many resources and services online, have you considered how to help your patrons access health care professionals right from your library? On this show George Strawley, Library Engagement Specialist for Region 4 with the Network of the National Library of Medicine, and Trish Hull, Library Manager of the Kearns Branch in the Salt Lake County Library System talk about Telehealth 101. They explain the ins and outs of providing important telehealth resources for your patrons in a way that anyone can implement. Enjoy the show!
George and Trish, welcome to the show.
George Strawley:
Hello.
Trish Hull:
We’re happy to be here.
Adriane Herrick Juarez:
Question #1: I’m happy to have you both here. Today we are talking about Telehealth 101. Will you start by telling us what is available in this realm for libraries? 01:33
George Strawley:
Some adventurous librarians around the country, and other people in related fields, have an opportunity to serve their patrons in a new way. This is by providing access to medical care over online connections. Patrons can access telehealth medicine appointments in a private space, with library staff there to help them with the technical issues.
This could be a valuable service for patrons in certain situations. Maybe they don’t have internet access at home, or they need help with using digital tools like a computer or a tablet, or they don’t have the privacy at home that they need to discuss sensitive issues. A small, but growing number of librarians are experimenting with ways to promote a privacy-protected space, equipped with a computer connection that patrons can use to have a telehealth appointment right in the library.
I work for the outreach arm of the National Library of Medicine—Bethesda, Maryland. It’s known as the Network of the National Library of Medicine, or NNLM. We are providing a course for library staff and administrators who are interested in knowing more about library telehealth access. It’s called Telehealth 101: What Libraries Need to Know, and it is a free online course. It requires about three hours total, over the course of three weeks. It can help libraries discern whether telehealth is a good fit for them and their communities. You can find out more about it on our website at https://www.nnlm.gov, and we have a section of the class coming up early next year.
Trish Hull:
I just wanted to add to that—we’ve been involved in this. Telehealth is the overarching term. We’ve changed it to a virtual visit room, because we also have something going on here called Community Court. The Utah State Courts have started a program where they come to the community. They bring in the attorneys, and people can come here to the library, and speak with the attorneys. Then the judge Zooms in—in our virtual visit room, because if the judge came to the court, there would be huge security issues, right?
It isn’t just health, it can be used for other things. I think that’s important to let people know that these rooms are not just strictly telehealth, but they’re virtual visits. We also have a gentleman who comes in once a week—once every two weeks and uses it to talk to his probation officer. It could be used to speak to people across the world if they don’t have internet at home and want to speak to a loved one that’s in the military or lives somewhere else.
We found it’s more than just telehealth, we aren’t calling it that, because if you’re in a library and it’s called the telehealth room, and then you walk out the door and happen to see your neighbor, they might go, Oh, what are you doing? So we’re trying to maintain our privacy issue there as well. That’s why we’re calling it the virtual visit room.
Adriane Herrick Juarez:
Question #2: Good to know. Thank you for explaining that. I know telehealth is useful in so many ways for our patrons. Can you talk a little bit about that? 04:50
Trish Hull:
I’ll be honest, we’ve only had one person use it so far. We’re still in the opening stages. We’ve had some tech issues which are not normal. It’s just some weird things on our end. But the U is going to start publicizing it, so we’re hoping that we’ll have people come.
I happen to work in an area that is very high in lack of connectivity. There are a lot of people in our community who do not have the internet in their homes, or like George said they have ten people living in their home and they can’t find a private space.
When we were talking with the University of Utah, they mentioned that 80% of their clients and their patients do not make their follow-up visits. They could be across the valley. For here, the hospital where they might be going is a good forty-five minute drive. They might have to take off work—forty-five minutes one way, forty-five minutes another can take a chunk of time just to go in and say, Hey, how’s everything going? It’s fine. Okay, great. See you later.
Obviously you’re not going to do it for things where they actually need to touch you and do something. But it’s those follow-up visits they say people are not coming back for and that’s dangerous to their health. The university is very excited, the hospitals are excited to have people have an easier way to make those very simple, What’s your temperature? What’s your pulse ox? How much do you weigh? What’s going on? Just those visits where you don’t need that personal visit. This makes it a five-minute visit. They can come in, talk to their doctor and leave. We’re here open ’till nine. They can do it later in the day after work, if their doctor’s available. Those are some very important issues that people don’t think about all the time, especially people—where English is their second language, and they don’t understand insurance, or they don’t understand the importance of going back for a follow-up visit.
George Strawley:
Trish mentions the forty-five minute trip to the hospital. That’s why library telehealth can be especially useful for rural communities where you have that long distance to drive, especially in a community where there might not be certain specialists or there might not be a behavioral health counselor, or psychologist, or someone like that. Those are other ways in which libraries in those communities can help their patrons as well.
I will add that this is also helpful in urban communities that are affected by digital redlining—part of what’s called the digital divide. Telehealth can help address the digital divide, which is that difference between the haves and the have-nots in the digital world. So, it’s very useful for that.
Adriane Herrick Juarez:
Question #3: Absolutely. So what kinds of equipment or resources do libraries need to take part in providing these services? 07:54
Trish Hull:
Obviously that depends on the building you have, but I think that we’ve discovered telehealth can be very, very flexible, and it doesn’t need to be very expensive. Obviously, I know people who get big grants and they can build rooms and do all kinds of really big things. In our case, we had just built a new library. We have several small meeting rooms, and there was one small meeting room that we’ve always kept aside for our use in case we needed to do an interview or call somebody in—maybe we wanted the police to talk to somebody, or for whatever reason we might need. As we started exploring telehealth, we realized this was kind of the perfect room. We weren’t using it a lot, and it’s just a room. All you need is privacy. So we bought a blind to put over the window. There’s a glass wall in one wall, so we bought a blind to cover it that can be raised and lowered. We had a computer that wasn’t heavily used, and so we moved that computer into the room. The light in the room is bright, so we didn’t have a problem with that. We needed to buy just a little camera. We have a PC, so we needed to buy a camera with a microphone, which, you know, they’re pretty inexpensive.
The medical equipment we have in the room was donated by our partner, and we’ll talk about that in a minute. We’ve also started doing blood pressure cuff checkouts. So, we had a blood pressure cuff we could put in the room. That pretty much is all you need— just that ability to Zoom-in. You need the computer. You need the privacy, and then the ability to communicate.
So the tech issues—we are actually, in some of our libraries, because they don’t have that space, they don’t have that available extra room. We have the idea of getting those pods that are almost like little telephone booths. You could do the same thing in one of those as long as they have the privacy, and really the equipment is just small equipment. I think anybody can do it anywhere if they can just find a little, a little bit of space to do it. Like you said, you could do it very expensively. For us, it wasn’t in our budget. So, I couldn’t ask for a lot of money, but I think the most we spent was maybe a couple hundred dollars on the blinds.
George Strawley:
Some really small libraries have put the technology on carts, and the patron can just wheel it into a private space.
Adriane Herrick Juarez:
Question #4: That sounds very doable. Among the libraries that get involved, do they typically work with partners or do this independently? 10:27
George Strawley:
We have seen libraries approach it in both ways. Some want to show no favoritism toward a particular health care provider, so they protect their neutrality by simply providing a space for anyone who might want to come in. Others prefer having the support of a health care system, which can be invaluable in connecting people to the service, and in getting the buy-in of doctors and other professionals, and in promoting the telehealth space. They can still maintain their neutrality by stipulating that the service can be used for any health care provider at all, even though there is a specific system affiliated with the project.
Trish Hull:
I would agree. We actually approached the University of Utah because we’ve been working with them on some other things after we talked with the telehealth people. I think it helps a lot to have this partnership. They have been invaluable. They helped us with workflow. They’ve helped us with the equipment, and probably the biggest piece—they are one of the three big health providers in our area. It’s the University of Utah Health. Because they are so big, they can reach out to their providers and encourage them and say, Hey, did you know? And especially to the clinics in our area and say, Look, we’ve got this going on. We’d like you to use this. This is available.
They provided the marketing for us. And again, it’s like George said, they are totally onboard knowing that we will invite the other big providers to use it as well. We have contacts with them and can reach out, so it’s never just the U of U. But, they are the ones who, kind of, provide that backbone, and help us work through all of the issues that maybe we hadn’t even thought of. So that was really helpful to us, especially with the workflow, the marketing, the equipment that they’re providing. They gave us the scale, and the thermometer, and the little pulse oximeter, and everything that we need in there to actually have some equipment that a patient can use.
I’ve talked with—I’ve read some of the information that’s come out of the big group of telehealth providers that you can be a part of, and some of them are struggling and a couple have shut down because they don’t have that support. They’re just trying it on their own, and quite frankly, sometimes librarians are not the best promoters of their services— so the word doesn’t get out. This is what they do. As a matter of fact, the first people the U got involved with were their business office. So, between the business office and the marketing, they’re right onboard.
Adriane Herrick Juarez:
Question #5: So it sounds like the partnership has worked well for you. What’s happening in the field in terms of the benefits of telehealth and who generally utilizes these services? 13:14
Trish Hull:
We have had one person come in our testing phase, and he actually did have an appointment, so he used it. This is interesting because many people are work-from-home now. Right? He actually is an employee of the University of Utah Health, but he works from home. He doesn’t work up at the hospital. He was able to just come into the library. He lives not too far away, and he said it worked great. He talked to his provider. It was just one of those appointments. I don’t know what kind, because I’m not going to ask that at all. Right? We’ll get to that, but he said it worked great. It was easy to come into the library.
We mentioned this a little bit—in our area, people usually have one or two jobs, and they can’t just take off. Many people don’t even understand how health care works, so they’re afraid to go to the doctor too much. We have a lot where English is their second language, so they struggle sometimes even finding where the university hospital is. This won’t matter to people outside of the area, but it’s a very, very crowded, complex place with like four hospitals in one very small area. So, they’re very difficult to get to if you’re just going to go up there for a checkup, or for a mental health visit.
I think probably the biggest thing is people love the library. They’re familiar with the library. They’ve been here and it’s a welcoming place. It’s not as scary, in a way, as maybe a medical clinic is. If they have children, that can be kind of—people don’t like that in doctor’s offices very much. So, the kids can go play in the children’s area, or find a book, or something, while they go into the virtual visit room. It’s just that idea of going to a neighborhood friendly place. It’s those people who can’t take time off, or don’t want to bring all their kids, or it’s just that last little visit, or maybe it’s that mental health visit.
For the Community Court it’s the same thing. Courthouses are scary places. The whole idea is a very frightening thing anyhow, having to talk to a judge, but to do it in the comfort of a library and the welcoming environment of a library makes a whole big difference. I know this is about telehealth, but our court people are so excited about the program here that they want to expand it. They’re coming once a month, they want to come more often. I think it’s just that feeling of getting away from the big institutional, frightening area and going to a neighborhood place, and a place that’s affordable because, you know, we don’t charge for anything—parking or anything.
George Strawley:
A lot of these services—if you cut yourself, you want to go to the emergency room as soon as possible. But telehealth will help for other types of appointments that are not focused on having somebody present in the room. A lot of times this can be like a behavioral health situation. If there’s something that you don’t want to share in your family setting, you can go to the library to have an appointment there with a behavioral health specialist, something like that.
Adriane Herrick Juarez:
Question #6: That’s great. Now one thing I do want to address, librarians are not health care providers. Are there any concerns about that, or about HIPAA privacy when it comes to implementing telehealth resources in our libraries? 16:32
Trish Hull:
Obviously HIPAA is a problem, but as a librarian working there, you get health questions all the time anyhow, right? This is no different than a health reference question. We are not present in the room when the actual interaction between the patient and the doctor is happening, so there is no information being given to us. When they come to reserve the room we don’t need to know why they’re coming to see the doctor. They just have an appointment and they want to schedule the room, and that’s all we have to do.
We take them into the room, we get the computer turned on, have them log in to their doctor’s office, and then we leave the room. We show them where everything is if they need to do it, but we’re not taking blood pressure. We’re not using the equipment. We are not doing anything other than making the room available, and then we leave the room. So there’s no HIPAA involved because we’re not doing anything that would let us know anything that’s going on with their health at all.
I think that’s important to know what the library role is. It was interesting. I know that George talks about digital navigators and so did telehealth—I can’t remember their name. George. I’ll have to help me out…
George Strawley:
…the National Consortium of Telehealth Resource Centers.
Trish Hull:
Yeah. We have a person there that helps us. They talk about digital navigators, and I didn’t know what they were exactly talking about. I asked her to define that. She defined it as someone who can help a patient get on a computer or anything, help them with banking, help them get jobs, and understand how to use computers. I said, That’s what we do every day. That’s our job. So librarians really are digital navigators. There are a few more things that they teach digital navigators, but for the most part, we understand that role and we do it all the time. We have rooms that we book for people all the time. So these are just our normal everyday library things. We’re just showing them one of the rooms we have, turning on the computer, helping them do some basic getting into the computer, and then we leave the room. But George might have some different concerns.
George Strawley:
No, no, what I was going to say was, that there are typically some concerns from the libraries, but what they find out is that, as Trish said, HIPAA does not name libraries as an entity covered under that law. Because libraries are not a named entity in HIPAA, they’re not subject to the restrictions that a healthcare provider would have as far as privacy, so legally there is safe ground.
The other thing is sometimes providers have concerns about the need to protect privacy. But what we tell them is that libraries have a strong ethic in the area of privacy already. It’s already something that affects things like circulation records and booking meeting rooms and things like that. As long as libraries take the same kinds of precautions that they take with their circulation records and their room bookings and things like that, then they should be okay.
Adriane Herrick Juarez:
Question #7: Those are good points. For interested libraries, what steps should they take to get involved? 20:00
George Strawley:
First, they can sign up for our class that I mentioned at nnlm.gov/training. We will be offering a new section of the class sometime in the first few months of 2024. They can also attend one of the NNLM’s telehealth webinars. Those are currently being held on a quarterly basis. The next one is scheduled for December 5th. You can also find information about it on the website. Another one after that is scheduled for April 3rd. Those are the steps that NNLM offers, however libraries should also check with their state library to find out if there’s an organized telehealth effort in their state, or if there are any other libraries in the state that have a telehealth project.
Another thing they can do is research possible sources of funding for things like renovations, or technology, or staff training. NNLM may be able to help with some of these things, depending on your regional office policies. Policies can vary from region to region, however libraries can also check into things like the availability of federal broadband money. Much of this money is intended to go toward addressing the digital divide, and a telehealth project could be a good fit for funding there. I’ll also mention again, the National Consortium of Telehealth Resource Centers. These are a group of regional organizations that assist providers and others with telehealth questions, and training, and things like that.
Adriane Herrick Juarez:
Question #8: Is there anything else you’d like to share? 21:41
Trish Hull:
I just think it’s a really awesome opportunity. I’ve been surprised at the uses that it’ll get and the people who are interested, and especially how interested the healthcare community is. I would really reach out to their local health care, whether it’s a hospital or a group of clinics, or whatever, because they are concerned about health and about the ways—this did come out of Covid. We all did virtual visits during Covid, and I think people discovered it was a good way to do things. It’s just that access and again, libraries are providing that access that started with the access to books and information, and now technology, and now maybe access to your doctors.
I think it’s really a very useful way to connect with your communities and help them just get the services they need, especially if you’re in underserved communities. I don’t know, maybe it would be—I think we’re going to try some in our more affluent areas to see if maybe they do it too. I’m always amazed at things I think are better for underserved communities—then those in not underserved, those in well served communities, still like this advantage. I think it can be useful for everyone. I do think it really helps connect the library with your community in providing more resources.
I’m always amazed—there was someone I was talking to and said something about, we’re doing all these things. And they said, You mean you don’t just tell people about books? Isn’t that all you do? So there are still many people out there who don’t really understand the new role of a library as being a community connector, this is just another piece to be that community connector.
Adriane Herrick Juarez:
Question #9: Do you have any favorite management or leadership books or resources and why? 23:27
George Strawley:
Well, it’s been a few years since I read it, but I got a lot out of Getting Things Done, by David Allen. I liked the way it approached time management as something as a tool to declutter your mind, because my mind needs a lot of decluttering. Now that I think about it, I think I want to read it again.
Trish Hull:
I’m a bit of a book leadership junkie. I own a bunch, and I love to read them, and I like to get bits from all of them. I’m going to give you a few because I just think they’re all amazing, but one that I really enjoy is Extreme Ownership by Jocko Willink, and about how we need to own mistakes and not be afraid to say, Yeah, I goofed. I should have made sure you understood this, or I failed in my leadership role to help you. And then those wins—to make sure the team gets the wins, leave our egos at the door.
I love Adam Grant, Michelle Obama, The Light We Carry. I think to be a good leader you have to be emotionally intelligent, and you have to understand yourself, and have a core of compassion and kindness and empathy before you can really be a good leader.
I love just the daily Dan Rockwell Leadership freak, little minutes. I read those daily—today’s was amazing for me. There’s just so much out there and I think everything that you can read—you can pick pieces of. You can either follow somebody’s plan, or you can just read them and say, Oh, this piece is what I need. I really like that. So yeah, sorry, I have a long answer for that.
Adriane Herrick Juarez:
Question #10: Thank you for those. George and Trish, in closing, what do libraries mean to you personally? 25:05
George Strawley:
More than anything else libraries remind me of how much there is to learn and and enjoy. When I walk into a library and see how much material there is, I actually get a little stressed. But it’s a good stress. I can remind myself that I can take one item off the shelf and make progress on learning and enjoying life in full.
Trish Hull:
So, libraries are just my life. I moved around a lot as a kid. Whenever we moved anywhere, the first thing we would do is go get a library card. I’d grab fourteen books and take them home and read. As an adult, I needed a job. I had a bunch of little kids and felt like I needed a little additional income. I thought, I’m always at the library, I might as well work here. So I hired on at the library, and then as I’d been there a few years my manager said, Why aren’t you a librarian? You need to go back to school and get a master’s. So she helped me, and I applied and went back and got my master’s. The best thing I ever did was become a librarian. I’m involved in a lot of other things in my life now, in the government, in my community—I would not be involved in that political role if I hadn’t been a librarian. That’s what led me there. So to me, libraries are just such an integral part of my life and have led me to the best things of my life.
Adriane Herrick Juarez:
Libraries can definitely lead us to good things, and they can help us in ways that sometimes our communities don’t expect, such as telehealth. Being able to go to your local library, find a private space, and have a convenient consultation with a health care provider is an amazing service that libraries can provide. This is a great way that libraries can help those we serve. So, thank you for sharing this with me today.
George Strawley:
Thank you for having us with you.
Trish Hull:
Yeah, thanks for letting us talk about this. Thank you.
Adriane Herrick Juarez:
You’ve been listening to Library Leadership podcast. This is Adriane Herrick Juarez. For more episodes, tune in to Library Leadership Podcast.com, where you can now subscribe to get episodes delivered right to your email inbox. Our producer is Nathan Sinclair Vineyard. Thanks for listening. We’ll see you next time.
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