Dartmouth-Hitchcock Medical Center

Matthew J Maughan

Matthew Maughan’s current scope of responsibility includes working with the pharmacy leaders in the Dartmouth-Hitchcock system to organize and implement system pharmacy projects, as well as showcasing clinical pharmacy practice to nurse and physician colleagues. He is always excited to build dynamic health care teams that can rapidly and effectively treat any patient and has held positions as the Director of Pharmacy at Sidra Medical & Research Center in Doha, Qatar, Manager of the Children’s Hospital Pharmacy at the Medical University of South Carolina Medical Center, Adjunct Assistant Professor with the South Carolina College of Pharmacy and Northeast Ohio Medical University.

In an interview with Healthcare Tech Outlook, Matthew J Maughan sheds light on the upcoming changes in the telehealth space and how the pandemic has propelled augmentation in the healthcare sector. 

What are the general challenges or trends in the industry based on your experience in the industry?

Dartmouth has been in existence for 5-6 years and has always taken the initiative to expand roots in the telehealth space. When we started off, people were very skeptical about the whole idea of telemedicine and telehealth. However, the pandemic has played a significant role in propelling healthcare’s fastest-growing sector- telehealth. 

We have been passionate about expanding telehealth services rapidly and helping providers get access to the tools and processes that would ensure efficiency in their work. Initially, we faced many challenges deciding on which providers would be best suited to deliver services remotely. Providers were also not convinced that their visits could be done over the phone. Finally, we persuaded them to reach a middle ground where at least 10- 20 percent of their visits could be accommodated in remote video or telephone calls. We have seen the results of that bearing out with interesting outcomes in the last year and a half.

"One of the projects we are currently working on is the telepharmacy medication reconciliation as a solution to the nursing crunch we face"

What are the project initiatives you have been working on lately?

I am very hopeful of the telepharmacy space, which has experienced a fair amount of reception even before the pandemic. We were working with 22 hospitals in the Northeast region then and have picked up two in the last year. Many people reciprocated with our initiative and realized how telepharmacy could be used in different ways, like expanding the onsite services or serving as a complimentary service to the onsite one. But the pandemic gave everyone a clearer picture of the extent of its scope.

One of the projects we are currently working on is telepharmacy medication reconciliation as a solution to the nursing crunch we face. It includes reconciling patient’s medications and making sure they are summed up on the medications they are taking. It includes making them understand what they’ve been taking, what they’ve been prescribed, or when they last took those medications. This is really helpful during the admission of a patient, like identifying duplication of therapy or for optimized therapy early on in their admission, which helps the course of their treatment. Remote monitoring is all the more important when patients get discharged from the hospital and their medication therapy changes ever so slightly. It is vital patients understand what the medications are as they go home to avoid bouncing back to the hospital due to a mishap. 

Going by the stats, one in every ten patients has a problem with their high alert medications like insulin, anticoagulants, antibiotics, mental health medications, etc., when it comes to getting it correct. Also, over 50 percent of the patients need changes to their current medication therapy. All of this had been taken into consideration when starting the remote pharmacist medication reconciliation project.

Another project on the pipeline is regarding the augmentation of nurses in our inpatient units. As we have a huge nursing shortage, there is going to be high demand for traveling nurses. So we are working in the direction of taking over the documentation and other tasks from nurses to free them up to take on higher patient loads. Though not a properly fleshed-out project, it reiterates the flexibility of our service and our ability to expand. We position ourselves as a tool that can be used by hospitals for the problems they are facing. We are also working with hospitals to better understand other augmentations that can be done and ways our teleservices could be used to support inpatient services in helping ease the nursing crunch.

How do you envision the next 18-24 months in the telehealth space?

It is really stretching to think what would happen in the next 18 months, considering we could never have envisioned the last 18 months. However, the nursing shortage is not going away anytime soon if we continue with our existing models. So we are researching how to augment nursing staff and the tasks that were traditionally done by onsite inpatient nurses. We are working around how to break down every job role into the list of tasks and see if those tasks are necessary to be done in-person onsite or could be done remotely. This is not to add to the misconception that a 100 percent of the tasks could be done remotely. But even a 10-20 percent remotization of those tasks could take the workload off the nursing staff by a huge margin.

The key factor of telehealth is being able to connect people, living and working, in all sorts of different places and providing services irrespective of the location they are in. For instance, we have pharmacists that work from seven states currently across the United States. Consequently, we are able to leverage the workforce of seven states to work in New England. If there is a way of getting work done remotely, that will lessen our reliance on having to recruit bodies for specific areas, and that is the direction we are heading at.

What would be your advice for the upcoming professionals or peers in the space?

We are looking at a challenging but rewarding work environment. We are at the turning point that can change the very nature of this industry. The challenge is to remake healthcare so that it works for the 21st century. I believe the fundamental reshaping of healthcare is going to be determined in the next five to 10 years, which makes it an exciting time for professionals entering and working in this space.