Change Agent Dr. Kristi Henderson: Diving in to save lives

Dr. Kristi Henderson has always loved change – and the unexpected.

She’s Seton Healthcare Family’s new Vice President of Virtual Care and Innovation and, though we’ve only recently started working together, I can already tell that I have much to learn from this agent of change.

I was in a meeting with her not so long ago where our technology services team and her team of healthcare leaders were exploring how we can use technology to connect patients to providers in new ways.  She recalled ideas then from her experiences where she and her team investigated new ways to get care to the people living in rural areas of the Mississippi Delta.

“So, we were brainstorming around this idea,” Dr. Henderson said in the meeting, “Who else goes to each person’s house but the United States Postal Service? And, what could we maybe have them do to help patients in these inaccessible areas, to deliver mail and…medicine? Technology!“

I had to learn more about this obvious natural innovator and what drives her to find these ideas.

Was she an out-of-the-box thinker from the time she was a child?

“I wanted to be a marine biologist when I grew up in Central Mississippi,” she explained to me later. “I grew up going to the beach in Florida and loved the ocean so much so that I became a lifeguard every summer as a teen.”

One of the things she loved best about lifeguarding, she told me, was *saving* people (she air quoted the word “saving”).

“I covered the wave pool at a water park,” she recalled. “The only female there. Seeing all the injuries we’d see – head injuries, giving CPR…that hands-on feeling of being able to help stayed with me.”

Later she became an emergency room volunteer. It was there that she fully dove into healthcare.

She enrolled in college, pre-med, and worked as a nurse practitioner, long before it was a more conventional healthcare career choice.

“I found myself drawn to the nursing approach to healthcare. I wanted to combine my nursing skills with the ability to diagnose and make care plans and be really actively involved with each patient,” Dr. Henderson said (she worked her way from nurse practitioner to an advanced PhD degree).  “It was a very fulfilling aspect of my job – blending administrative, clinical and technology into it.”

With each step of Dr. Henderson’s career, she would course correct if she felt she wasn’t making enough of an impact. She would then dive into an even bigger arena, maintaining her passion for patient care.

As a clinician, on rounds in the academic medical center in Jackson, Mississippi, a certain thing distressed her.

Patients in their hospital beds were queued up in the corridors because the hospital’s demand outweighed their capacity to care for them. Hospital rooms were at a premium and in high demand. Meanwhile, she said, across the Delta, the rural community hospitals where these patients actually lived sat empty or worse – were threatening to close.

“The ER is a testament to a broken system. Three fourths of the population is there and a majority are not true emergencies,” Dr. Henderson lamented. “[Those patients are there] because some subset of the healthcare system has failed them. They have no access to preventative care or a specialist. It was a total misalignment, with our community hospitals struggling to stay open and the emergency departments of city hospitals overstretched. Despite programs like ‘Rural Scholars,’ facilities could not attract enough specialized clinical staff to serve these rural hospitals.”

So, instead of just seeing it as an annoyance and being a bystander to the problem, Henderson dove in again – suggesting a solution that could connect patients to specialists without them having to travel. 

“I said ‘We have got to do something different with the system. We’re going to collapse on our own weight,’” she said.

“So, I said why can’t we just use who’s out there? Instead of making people go somewhere where they’re not going to stay? Let’s find out who lives there and who works there and how can we support them. So we went and found out that the ERs were being staffed by all kinds of different people from nurse practitioners to family doctors to urologists to plastic surgeons to people that had never been trained on the approach to emergency medicine. And so I said they have license and skills – why can’t we connect them to the expertise and then we co-manage patients together?”

And so that’s when Henderson turned to technology and what would become the beginning of her telehealth journey.

Connecting the Delta -- From the Catfish Capital to Jackson

In 2003, Dr. Henderson began with three little communities. First: Belzoni in Humphreys County Seat, population 2,663, on the banks of the Yazoo River. (“The ‘catfish capital of the world’ – a very, very rural, underserved and high poverty area,” she said.) Dr. Henderson’s team connected Belzoni’s only hospital to her academic medical center in Jackson. Then Port Gibson, population 1,567, deep in the Delta southwest of Jackson, very poor and underserved, and the neighboring Holmes County Seat of Lexington, Miss., population 2,025.  

Dr. Henderson and her team worked with what they had – a point-to-point T1 fiber optic line that stretched the entire 64 miles between the two hospitals in Belzoni and Jackson, and the 116 miles between Port Gibson and Lexington.   

“It took 90 days to get it installed – to get the fiber in the ground,” she said.  “If a farmer hit the line with his backhoe the whole system went down (and he did and it did).  So we learned a lot.”

But Dr. Henderson and her team made it work. They were connecting the specialists in the larger medical centers to the patients in their rural hometown hospitals at their critical points of care.

They developed a 24-hour program where ER physicians would collaborate and do virtual consults with the rural hospitals for their patients.  They also provided education on the ‘approach to an emergency patient’ to the rural health care providers to further improve their capabilities when the virtual consult was done.

“So I sat down and devised a curriculum that would give them didactic and clinical training that the remote healthcare providers could get on their own timeline but where we knew they had a minimum standard,” she said. “We would connect them through telemedicine so any time they saw a patient they could have video conferencing and telemedicine carts to connect them to us. It took me three years to get it approved through the medical and nursing board to be able to do it.”

All eyes on you

“I vividly remember ‘Ohmigosh! Everyone’s watching. There’s a huge magnifying glass we’re under,” she said. “No one’s really sure if this would work. We didn’t know of anyone really doing [virtual care/telehealth] 24 hour programs in emergency medicine anywhere in the country.”

Their little pilot worked.

Dr. Henderson said they had a 20% increase in admissions to the rural hospitals, thus avoiding 20% of unnecessary medical transfers where patients would have been sitting in the waiting room. In the academic medical center back in Jackson, the right patients were seen and their collection of beds was optimized. The community hospitals that were facing closure now had a revenue stream of the patients who were coming there and were virtually connected. They pushed their consults up from 200 to 8,000 per month – everything from ER to pediatric care to chronic adult care – with teams using telehealth everywhere to connect to remote clinical access points. 

“The biggest impact was we were able to give care to people sooner,” she said. “So instead of them driving to Jackson with some of these conditions that were life threatening, we were saving peoples’ lives (by treating them locally). Everybody won.” she said.  “In Jackson, we had the right people sent to us, so beds were used better. The community hospitals that were threatened with closing now had the revenue stream and they were improving health at the same time in the community.”  

And, their program began to grow. It was the catalyst for every other program in their area, expanding to 35 specialties in 213 sites around the state of Mississippi. 

Dr. Henderson would go on to guide others nationally on implementing telehealth -- testifying before the U.S. Senate and Congress and eventually catching the attention of the Federal Communications Commission whose executives visited her program to make sure bandwidth supported it and brainstormed with her on ways to make an even bigger impact for patients across the country (see postal worker idea above).

But I had to know on a heart-to-heart, personal level. Was there a story of a patient she and her team impacted with telehealth? A story that stayed with her the most?

“Every day I heard stories that blew me away,” she said. “I remember an extreme story: two young brothers in a rural area who had a hunting accident and the younger brother was accidentally shot in the chest when his gun backfired.

“He was saying ‘goodbye’ to his family as they were frantically driving him to the convenience store where an ambulance would then meet them. Luckily, the ambulance was close to the hospital wired with our telehealth program. Their hospital didn’t have an ER specialist or trauma team, but they connected to the ER trauma specialists in their connected hospital virtually. They talked the boy’s care team through it, resuscitated him, saved his life andflew him to the closest hospital to do an immediate surgery. Now he’s fully functioning, he’s finished high school and was able to return to his routine with only a scar to show of the traumatic event . He would have died,” she said. “They would have done the best they could but – without that manpower and specialty – they would not have been able to save the boy’s life.”

I’m looking forward to hearing more stories of impact from Dr. Henderson and her new team at Seton Healthcare Family as they work to carry forward their Humancare focus and I asked her, what makes her most excited about her move to Austin?

“The technology community, the resources, the partnership between public and private entities that are quite profound,” she said. “Within Ascension (Seton Healthcare Family’s parent healthcare organization), because they’re in 23 states and the District of Columbia, they have senior care, they have home health – those are all areas where we could make a difference using technology. So it’s a platform where I can take the work that was done in Mississippi and scale it to a much larger level.

From the role of a nurse practitioner who didn’t just walk by a problem but dove in to make change to the now-executive in charge of new high profile telehealth program, what is she thinking as she enters this turning point in her career to bring compassionate, personalized care for all?

“Every day I cannot believe I’m doing this and how well it works,” Henderson said. “And that’s why I came here because everyone needs to have access to this kind of service in healthcare – because it works.”

Related - A great podcast:  Listen to Dr. Henderson’s podcast with Dr. Jay Sanders, founder and past president of the American Telemedicine Association, on how telecommunications technology is revolutionizing the delivery of healthcare in the U.S.