Innovation

Meet The Oracles of Virtual Care

online doctor
The patients, who had metastatic or advanced cancer, used a web- or telephone-based digital reporting system.  Pixabay / Free-Photos

 

For the better part of the last five years, Courtney Stevens has given her telehealth elevator pitch to physicians and hospital administrators across Detroit.

Like a telehealth evangelist, Ms. Stevens shared her good news about telehealth’s value and benefits. Anyone she could buttonhole heard the word about the number of small but successful telehealth programs that the Henry Ford Health System had up and running. She was a one-woman road show.

“And it was a road show,” said Ms. Stevens, Henry Ford’s director of Virtual Care. “I was out pounding the pavement talking to anybody and everybody I could about virtual care and telehealth and sharing the success that we had.”

She answered questions about telehealth’s best practices and lessons learned. Her expertise and unflagging determination earned the endorsement of some heavy-hitting physician champions. The converts followed.

“Finally, we got to the place where this is around service, access, growth and convenience. Virtual care is a tool that you need in your tool belt,” she said.

Heading into 2020, just 24% of U.S. health care organizations offered telehealth services, according to the analytics firm Forrester.  By April, a Becker’s Hospital Review reported that 76% of American hospitals were remotely seeing patients using audio, video, chat or email.

“Telehealth is having a moment,” Ms. Stevens said.

That moment arrived in March to find many health systems unprepared. Henry Ford, however, quickly adapted because its investment in telehealth began in 2010. In that year, the hospital started a remote monitoring program for patients at high risk for readmission. A few years later, its primary care practices launched e-visits. Over the years, other telehealth options came online.

By 2019 Henry Ford had six telehealth capabilities, or tools spanning 17,000 video, audio and other methods of online visits, a 123% increase over 2018. Ms. Stevens crossed her fingers and set 2020’s goal to be 1.5% of total outpatient visits as virtual.

“At the time [35,000] seemed a stretch,” she said. “But we were confident we could get there. We had gotten people’s attention. [They] were starting to see the value in virtual care.”

With the pandemic’s arrival, Ms. Stevens’ team scrambled to shift priorities so healthcare personnel could see patients via smartphones. The system created other tools, including e-visits and patient texting to support pandemic care, and a coronavirus concern e-visit program to field and answer questions. Training in the hospital system, usually “by-the-elbow,” went online.

But the healthcare workers weren’t the only ones using these new systems. So were patients.

“A lesson learned was that we were not just training the [healthcare provider’s] team but also the patient,” she said. “So we had to be careful about explaining and putting information out there in multiple ways.”

From mid-March through April, the hospital started 120 new programs. It was hectic, but the hospital’s telehealth system absorbed the gut punch with nary a flinch. By the end of July, Henry Ford had processed 266,000 virtual video and audio visits across all of its telehealth platforms.

“I feel like we had a very solid foundation, a very good footing to react when COVID-19 hit,” Ms. Stevens said. “We had a lot of these tools available and deployed in these areas.”

Across the country in Philadelphia, COVID-19 was also stress testing the University of Pennsylvania Health System’s growing telehealth services. Years ahead of most telehealth systems, Penn Medicine began in the 1950s with radiologists reading X-rays remotely. Penn continued developing other forms of telehealth over the last decade, including several pilot telemedicine uses. In 2016, with demand increasing, it began developing the technological infrastructure necessary for a comprehensive system’s approach.

“We began to look at it and say, what does the pipeline look like?” said John Donohue, vice president of Penn’s Information System Enterprise Services. “That’s when, all of a sudden, the bigger picture became clearer to us and that it had a chance to explode and become much larger.”

In 2017, Liz Deleener, RN, was named director of Penn’s Network Telemedicine. Her job was to map out a broader telehealth strategy based on Penn’s medical expertise and local healthcare policies – and to do it in a financially sustainable way. Benchmarks here were reduced readmissions, including increased access to physicians. Like Ms. Stevens, Ms. Deleener had some inside help.

“We had pretty much a cohort of providers within each specialty that were champions,” she said.

Recognizing that Penn Medicine is a large, expanding six-hospital system with ambulatory sites and thousands of healthcare providers, Ms. Deleener and Mr. Donohue worked with clinicians and technologists to build a model that could expand, but not in a haphazard way. Determining the right programs to prioritize would come with input from people, while evaluating existing processes and technology at the same time. Looking back, Mr. Donohue said, they got it right.

“We recognized that we are a big system and that we’re a growing system,” he said. “And we recognized that the demands for these kinds of services are going to be pretty dynamic.”

When the pandemic hit, Penn Medicine’s telemedicine program – video and audio - went from serving a few hundred providers (in early 2020) and 300 to 400 patients a day, to thousands of providers and 7,000 patients a day. Over a weekend, the team ramped up a telemedicine command center to field calls, a multidisciplinary advisory group, and a tech team to sort out problems.

“Troubleshooting a telehealth appointment is not a simple task,” Ms. Deleener said. “When a provider called seeking support, having such a robust group of technology experts to help the clinicians and identify anything that was happening really was great.”

The system proved its mettle through the pandemic, experiencing “rare, if any” downtime, she said. By August, things had quieted down, and Penn Medicine’s daily telehealth visits and calls dropped to a little over 3,000 as the government shutdown subsided. Since then, Ms. Deleener and Mr. Donohue continue working on new ideas to anticipate what the future could bring.  “I think telehealth is here to stay,” Ms. Deleener said. “I think that has been acknowledged.”

This is the second part of a three-part series on telehealth. The third installment: The Future.

Robert Calandra is an award-winning journalist and book author who has written extensively about health and medicine. His work has appeared in People, Parent, AARP the Magazine, The National Institutes of Health, WebMD and The Philadelphia Inquirer. 






 


 




 

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