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29
Posted by Darlene Kaskie on March 29th, 2024
Posted in: Blog
Tags: telehealth
My dream of a Telehealth Room at our library began when I read an article on the Pottsboro Area Library’s Telehealth Space in Texas in the May 2021 issue of American Libraries. I greatly admired the concept of telemedicine at a public library. That was during the pandemic, when our library was closed to the public but preparing to re-open at 50% capacity. Our patrons were eager to browse the shelves again. The staff were also tired because we had books everywhere due to a leaking roof that damaged a portion of the nonfiction area. Among all the reshelving, I stared at the Pottsboro Area Library photo and wondered how we could make it happen in Iowa.
Northwest Iowa’s Storm Lake Public Library serves 11,000 residents of a small city surrounded by miles of farmland. Two meatpacking plants are the major employers of an ethnically diverse group of residents who collectively speak over thirty different languages. Our library maintains a collection that has grown to over 48,000 materials since it began 1906. I have been with the library for over twenty years, after starting as the Children’s Librarian until I became the Library Director.
In the summer of 2021, our City Management decided to pursue a state-funded Community Block Development Grant to mitigate COVID and realized the library could play an important role in that effort. Mindful of approaching grant submission deadlines, they hired a grant writer to solicit bids from architectural firms for the project. It took two days in July for the Library Board to compare the bids, and our Board President presented their decision to the City Council. CMBA best served the vision of the Storm Lake Public Library, so our City Council approved it. The CMBA Team met with the Library Board, City Management, Friends of the Library Board, and the grant writer in a Special Sessions Meeting for an on-site visit in early August. As time went by, the Library Staff came to value Angela McCaulley, the architect, for her enthusiasm and knowledge.
In another Special Sessions Meeting, the Library Board prioritized ways to mitigate COVID. They asked what I wanted on the list, and I told them the telehealth room was a one-time opportunity for our community. A small group of elderly women were taking one-hour trips to medical specialists and questioned what would happen if there was no driver to help them five years from now. The pandemic revealed how online telemedicine can make a difference. The Library Board requested an HVAC (heating-ventilation-air conditioning) system overhaul and a dedicated telehealth room.
For these two projects, the architect and structural engineers worked on plans and schedules for the grant proposal. A state-wide competition arose for the grant, and as the City Council approved the project in September, they provided additional matching funds to increase the city’s chances of getting state funding. A week later, the Library Board endorsed the grant application for library improvement.
The architect chose a small staff workroom as ideal for Telehealth. The room was added as a microfilm research area in the 1980s. As the refurbished microfilm readers gradually died, the room was repurposed as a staff room for processing materials. As time allowed, I started to clear out the room in late summer while recruiting people to write recommendation letters for the grant. It’s amazing how much stuff library staff can accumulate. The goal was to empty the Telehealth room for new construction before a bid was awarded. My archival training came in handy as I assessed what remained valuable among the old paperwork and other materials.
The grant application met the October deadline. Around Halloween, a radio station called with hearty congratulations for a Telehealth Room and wanted an interview. The Library Clerk who answered the phone was so excited and all smiles as she told me. I thanked the journalist for his support and enthusiasm but informed him that the grant had not yet been awarded and we were waiting for any news.
The grant was awarded in December. Angela began the first of three design phases during the winter while structural engineers made their site visits. By March 2022, the architect had drafted the required construction documents. In May, she presented blueprints to the Library Trustees and City Management and addressed any further concerns that arose. That summer, the bidding was announced for construction companies. In August, Angela led the formal process of awarding the bid, assisted by the City Clerk who documented the procedure. With a major construction company on board, the dream was progressing.
Due to supply issues for major equipment and materials, the preconstruction meeting with the Construction Project Manager did not occur until November. In attendance were all stakeholders: Library Board, City Management, City Information and Technology, the grant writer, the Friends of the Library Board, the Structural Engineer, and Angela. Everyone met the construction crew for the first time. Due to our usual weather, construction began in February 2023 and continued very slowly until May 2023.
The Telehealth Room slowly came around as Angela and the Interior Designer chose a soft grey color for the walls. Angela instructed workers to install noise-absorbing carpet, ceiling tiles, door sweeps, acoustical wall panels, and windows glazed with opaque film. The city’s Information and Technology team installed two computer stations and noise reduction panels which were purchased with the State Library’s Enrich Iowa funds. Their keyboards could be switched from regular to American Disability Act typing. Included were three noise- cancelling machines to be placed outside each of the three doors. The Police Department donated two white tables, and the Friends of the Library provided the chairs.
After the final construction documents were submitted in the summer, I had to learn how to manage a telehealth room. In an email response from the Iowa State Library, I found out there were no other public libraries with a telehealth room and therefore not much of a lead towards policy writing. My next email was to the National Library of Medicine, Region 6, from whom I learned a series of webinars on Telehealth 101 had just closed to registration.
I was already attending the American Library Association Conference in June 2023 for a seminar on Telehealth with the National Library of Medicine, Region 4. I went to the podium to inform the Region 4 panel that they should include Iowa on their telehealth map since we now had a telehealth room. I requested help in drafting library policy writing and patient consent forms.
On my first workday after the conference, I was given access to the Telehealth webinar by the National Library of Medicine Region 6. Three of their weekly sessions were especially valuable. To my pleasant surprise there was very little homework assigned in the class. In the first session, I learned there were other ways to provide telehealth services such as the hotspot program of the State Library of Hawaii. Libraries in Wyoming offer laptops for their patrons’ telehealth visits.
After the second webinar session, I revisited the issues regarding HIPAA (Health Insurance Portability and Accountability Act of 1996) and my classmates’ responses. My Library School courses covered medical reference materials, but my focus at that time was on youth librarianship and fun literacy. I leaned heavily on the resource link to HIPAA provided by the Office of Intellectual Freedom at the American Library Association. This session gave me even more to think about: including HIPAA, privacy issues, this new service required a policy and a consent form. I returned to the webinar recording and found all the resource links I needed.
The third session was a refreshing breeze for me since it was about infrastructure. The Telehealth Room was already finished but I found a golden resource in their webinar notes. The closest Telehealth Resource Center was in Minnesota. I called the Great Plains Telehealth Resource Center (GPTRAC) and found out that our library was the only public library in the Great Plains area to have its own facility. In a few days, there was a Zoom invitation hosted by the Telehealth Resource Center for a discussion with the Delaware State Library since they already provide Telehealth services at several public libraries.
Because of the GPTRAC visit to our site in October, I had a draft consent form to share with them. The Library Board had read their policy draft and was also eager for any additional input from Great Plains. They also provided us with a few table posters regarding patient expectations that could arise during a telehealth session, which we put in standing plastic frames.
A few days later, the County Public Health Nurse came for an on-site visit. She read the consent and policy drafts and recommended that we get the City Attorney’s advice as to how long we should keep completed consent forms in files. She smiled when I asked if we should provide a thermometer and other common medical items for patient use, and she recommended that patients come to Public Health for their vitals before the telehealth visit. Public Health will forward the information immediately to their doctor for evaluation before the telehealth visit begins.
In November, the City Attorney had a very short informational meeting on my proposed consent form with the City Manager, Keri Navratil. The City Attorney pointed out that the Library Board needed to approve the Telehealth Policy at their next meeting. Everyone was excited because we were the first public library in the state to offer Telehealth service.
On January 4, 2024, the Trustees held their Telehealth Open House before the start of the State Legislative session in order to thank state legislators for the state funds. It was well attended, and the Storm Lake Bakery provided sandwiches and super-sized cookies for the event. In only two-and-a-half years, we had a Telehealth Room for our community, and a new chapter of wellness service began.
There will be future addendums to the policy and consent forms. There will be people who are digitally challenged and as digital navigators, our staff must learn something about the new technologies. In the near future, we will also have to find funds to replace the current technology as it becomes outdated.
This narrative account of how we gained a Telehealth Room at the Storm Lake Public Library was intended to clarify the process of acquiring telehealth services at a remote but publicly accessible location. It also celebrated the ways in which small towns throughout America are reliant on the dedication and often volunteer efforts of a wide range of public- spirited individuals.
– Guest post by Elizabeth Huff
Library Director of Storm Lake Public Library
Learn more about telehealth in the upcoming webinar “Implementation of Telehealth Services in Rural Public Libraries“.
ABOUT Darlene Kaskie