Advocating for our patients is at the heart of everything we do at NewYork-Presbyterian. From my own experience as an ICU nurse for over ten years, then working in digital services and now focusing on improving access to care, what motivates me and my team is our goal to help people get the healthcare they need as easily and seamlessly as possible. In today’s landscape, that means using virtual services to lower barriers and increase access to care among increasingly diverse populations. This requires aligning the strengths and combined potential of three healthcare domains that are too often siloed: operations, technology, and marketing & communications.

How do you bring these three domains together? Firstly, it begins with examining basic operations, such as telephone access or online scheduling, to create a more unified system. By rethinking the fundamentals, healthcare organizations can employ strategies to unify these spheres, establish successful programs, and deliver a better, more convenient experience for the patient.

Collaboration is key to continue to improve the virtual healthcare experience and expand access to quality care.

Operations

Supporting all patient populations begins with understanding the limitations of existing operational structures and removing barriers that interfere with access to care.

For example, phone calls are still a common point of entry into a healthcare organization for many customers. What are the limitations in operational structures that can create barriers over the phone, and how can those be addressed? Is the caller able to quickly get to the person or office they need to fulfill their healthcare needs?

Building virtual platforms with this in mind can help healthcare organizations identify where they may have gaps in coverage and how they can close those gaps. This can include not only developing contact centers capable of direct scheduling for patients or referral follow-ups, but also integrating clinical operations and services, such as virtual nursing, into the phone system to help escalate calls from patients who may have more urgent needs. If a patient tells a call center agent that they need to make an appointment because they are short of breath, the agent can quickly turn the call over to a triage nurse, who can determine the best course of action.

Creating more access points is one step, but that should go hand-in-hand with timelyaccess to care. A 2022 survey shows that in many major american cities, the average time it takes to schedule a new appointment is nearly one month, up 8% from 2017 and 24% from 2004. Healthcare organizations, as they improve access processes, can also look at clinical coverage and scheduling software to optimize their capacity for managing patients.

Central to positioning the organization to best serve the patient at every step of their healthcare journey is a commitment from leadership to invest in the people, processes, and tools to realize these goals.

Technology

Underlying any operational strategy is the technology that will make it work. Organizations should look to bolster and streamline key technologies, including artificial intelligence (AI), to ensure platforms are aligned, integrated, and optimized to support operational capabilities.

Sophisticated call centers can help improve access, but not every customer experience is going to start with a phone call. Online scheduling helps avoid phone calls, which is ultimately more efficient for an organization. But if the person needs additional help, often the suggestion is to call a contact center, creating a barrier for people who are deaf. As live chat and other technologies continue to evolve, this barrier can be lowered, highlighting the importance of using multiple communication channels to accommodate all patients.

Similarly, not every patient experience is going to start with the same language. An organization’s call centers should be able to recognize the various languages common in the community. A recent study found that language barriers can lead to miscommunication, reducing patient satisfaction and the quality of care. Improving access to care requires integrating with multi-language technologies and staff to accommodate all consumers.

The patient experience doesn’t end when the patient leaves the doctor’s office or hospital. Scheduling a follow-up appointment at the time of discharge makes it easier for patients to continue their healthcare journey; and where possible, virtual follow-ups should be considered. Furthermore, healthcare organizations can use remote patient monitoring (RPM) to observe a patient in between follow-up appointments. For example, at NewYork-Presbyterian, we monitor patients who have been treated and discharged after experiencing heart failure. Our clinical teams monitor blood pressure, weight, and other physiologic changes to determine if medication adjustment or treatment changes are required. Organizations that adopt similar technology can lower the need for frequent in-person visits while providing easier access to care.

Marketing & Communications

As the healthcare landscape is highly competitive in the virtual space, a strong and well-funded marketing and communications program is key to virtual growth. External communications platforms should be reevaluated and designed with diverse populations in mind, to support access and quality care for all patients and communities served.

Traditionally, brand advertising such as commercials and digital ads, along with sophisticated search engine optimization (SEO) strategies, have helped healthcare organizations drive consumers to their providers and services. With the increased reliance on telemedicine and virtual care, marketing and communications strategies should make it easy for consumers to connect to virtual care, with simple, straightforward messaging and pathways that prompt consumers to engage with you virtually. Community engagement and outreach offers another avenue to help connect people to virtual services.

A successful virtual services program in today’s fast-paced, highly competitive, and evolving healthcare landscape requires the creation of new, multifaceted capabilities built upon operations, technology, and marketing & communications. Collaboration is key to continue to improve the virtual healthcare experience and expand access to quality care.

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COVID-19 has accelerated the adoption of telemedicine across healthcare enterprises, creating challenges for clinicians trying to manage diverse health conditions while supporting care across both virtual and physical care locations.  

During the pandemic, many specialties found that their care could be delivered virtually, which was one of the positive outcomes of the pandemic. A lot of that got accelerated by the change in the mandate that physical exam was not necessary for evaluation or treatment. The pandemic also induced an aggressive focus on limiting physical interactions and preserving outpatient and hospital capacity for more sick patients.

As the pandemic stabilized, health care facilities began to reopen for more routine care; in-person volume grew slowly while virtual volume fell. Things may change if there is another pandemic, but virtual care continues to be on an average of 18-20% of overall outpatient care across the industry. 

As we see these shifts, clinicians, providers, and practices have a few common questions – What is the best approach to offering virtual care alongside in-person care, and what is the right mix between these approaches? How will we know whether virtual care is succeeding, and in particular, is it reaching patients as safely and equitably as possible?

Patient Needs 

While we look at this from a provider, practice standpoint from a patient perspective, the introduction of virtual care in the mix, which was needed during the pandemic, has created an additional burden on a patient to choose the right channel to start the care, set the right expectations from the interactions and probably many patients are still trying to learn. To improve patient experience and outcomes, virtual and in-person care needs to be balanced and looked at more holistically.

Beyond technology, it’s also important to create a proper support structure to provide timely support for patients, clinicians and clinical teams before and during any visits.

Best Practices and Outlook

Health enterprises and practices have to develop an integrated process/criteria for triaging and scheduling (integrated scheduling) patients for in-person or virtual visits. These criteria can be condition or symptom-based or a combination of visit types across specialties and patient populations. The scheduling criteria should be set up to help determine whether the visit is appropriate for virtual or in-person instead of putting that burden on the patient. For example, a medication follow-up can be done appropriately on a virtual visit compared to an in-person setting. Building a robust scheduling capability and integrating that into the experience helps patients get answers for the right care venue for the condition they are seeking care. This also helps providers to use virtual care in a more integrated way in creating and following a care plan for patients.

Virtual care platforms and technology also needs to be augmented to support these evolving provider and patient needs like the enhancement of EHR to capture both in-person and video visits, the video offered via SMS messages making it easy for patients to join, and low bandwidth video services for patients having internet bandwidth constraints. The platform should also enable collaboration across the care team, which is a must for any virtual care to be integrated well like any in-person office setup. 

Virtual care platforms need to be augmented by integrating capabilities that compliments the visit like ECGs, blood pressure monitors, wearables, etc. These service integrations should be easily available so that the it can be made available to the patient at the time of care. These capabilities have to planned thoughtfully as its not a one size fit all and needs may depend upon the patient population.

Beyond technology, it’s also important to create a proper support structure to provide timely support for patients, clinicians and clinical teams before and during any visits. 

While many practices may have started on this, clinicians will need to offer a mix of in-person and virtual care from the same clinical space (reimagining clinic space) and have to figure out an effective way to balance between virtual and in-person appointments, maintaining the flexibility in provider/clinician schedule and instituting similar processes for patient intake and follow up. It’s important to document these workflows and practice guidelines and train the clinic staff on them. For this to be successful, sustainable providers and clinicians have to be ready to embrace the change and may have to be supported through the process.

This has to be supported by defining key performance indicators (KPIs) which can capture how effectively virtual care is being delivered along with in-person care with a focus on clinical effectiveness, quality and safety of care. Monitoring these KPIs with carefully selected data and insights like lag times between scheduling visit date, visit length, and parity of payments across both modalities can then be used to identify potential gaps or problem areas and make adjustments to the model and approach.

In the coming days, as many practices and health enterprises take ground on balancing care pathways between virtual and in-person care, more capabilities and practices will evolve like AI-driven scheduling platforms that can determine the scheduling needs of a patient across these care venues. The success of these models will be judged by patient experience, clinical quality and how these visits are provided equitably, specially to patients with social determinants that can limit access to care.

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Anne became a nurse even after promising to never follow in her mother’s footsteps. She treated each patient like they were her own son or daughter, easing their pain and discomfort and tending to their needs during their hospital stay. While Anne’s brain and heart were eager to continue, after 30 years and thousands of patients, her body wasn’t able to manage a 12-hour shift. She was on and off FMLA for her back pain and ultimately faced with the decision to retire from the only real career she ever knew. Anne was hired as a virtual nurse and found a new lease on her professional life. 

The virtual nurse program is intentionally simple, by at the same token, dramatically ambitious…optimize nursing activities. COVID-19 brought about many changes to health systems, and the nurses’ occupation was probably single-handedly the most impacted. Burnout, rise in contract labor, shortages, and competing priorities have all placed strains on our caregivers. Virtual nursing attempts to reduce the burden of the bedside nurses, improve outcomes, and enhance patient experience, while tapping into the expertise of experienced nurses.

Lee Health recently launched a virtual nursing pilot program aimed at transitioning the non-tactile activities from the bedside to remote caregivers.

Lee Health recently launched a virtual nursing pilot program aimed at transitioning the non-tactile activities from the bedside to remote caregivers. Each patient bed became equipped with a telemedicine cart/wall unit and a space created for a team of nurses to remotely access. Once the bedside nurse completed their physical intake, they pressed the button and performed a warm handoff to their counterpart virtual nurse. Discharge is handed similarly. In addition, the virtual nurses are increasingly adding on activities to support the unit like chart checks, pain reassessment, documentation completion, education and intentional rounding. 

One of the biggest questions we had as a system was whether to outsource or staff the program from within. We were worried nurses would jump into virtual and we’d lose our bedside nurses. The reality was, we were losing many already due to exhaustion. Additionally, we were able to tap into an entire workforce of nurses like Anne.

I had the opportunity to watch one of the virtual nurse’s chatting with one of their patients, Bob, during intentional rounding. The virtual nurse asked Bob how his dogs managed as there was an impressive thunderstorm the previous evening. Bob admitted that they likely kept his wife awake most of the evening and he was anxious to get back home. The virtual nurse then used the telemedicine cart to conference in Bob’s wife (and dogs) and video chat with them. Bob was so grateful for the opportunity as he admitted he was feeling a little homesick. He really appreciated that the nurse had not only remembered that he had pets, but that they were anxious during storms.  

While it’s a little early in the program to see long-term ROI like burnout, satisfaction, outcomes, etc, it’s not too early to see the soft benefits to nurses and patients.

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Virtual care is the intersection of telemedicine, remote patient monitoring (RPM), and analytics that drives necessary care for patients. The potential impact of virtual care is immense that not only impact the overall health of a patient or community but also have financial, quality, and accessibility impact. The current, rapid evolution of healthcare will change the experience of healthcare for generations to follow. When done effectively, virtual care will create a lasting, scalable impact on healthcare that will improve health for patients all around the world. However, it is important to focus on both the challenges and opportunities to create meaningful and sustainable change. While these changes are developing rapidly, many might be resistant to the speed or direction of these technological progressions. Change management can be very detrimental to any industry when poorly managed. As a sector, virtual care is still immature, so it is critical that reflection drives maturity.

Consistency of technology quality and reliability is fundamental in leveraging the power of virtual care.

User Experience

Prioritizing user experience is essential when any new technology or service is delivered. When done well, virtual care can be beneficial to drive engagement and provide timely care. However, the industry has seen so many different innovations that it can be difficult to create a seamless experience while integrating all these new technologies. With various tools available for patients, it can often be confusing to choose the right tool or even understand how to use each different tool. Training and support is required to help patients navigate technology and given the vast discrepancy in technological literacy, there are varying levels of training and support required. 

The same can be said for the clinical care team and providers. Because these individuals are focused on clinical care, new and unknown technologies can often be a barrier to care, especially if the onboarding is done poorly. Therefore, it is essential that the care team get adequate training prior to implementing new technology and are consistently supported. These steps will help ensure the technology creates the intended experience. 

For virtual care to drive healthcare forward, it is critical that the technology be easy and efficient to use for all, the provider and patient. A poor experience will be a barrier to positive health outcomes and a burden for the users.

Quality and Reliability

Virtual care combines various forms of technology to enhance the delivery of care to patients; however, at times, the technology can lack quality, consistency and reliability. Any technology should be routinely monitored and maintained by technology specialists to verify it is working properly and ensure that this burden does not fall on the patient or care team. The patient and care team should use virtual care to augment their ability to deliver care, but the clinician’s focus should always be on healthcare, not technology. Technology should not be invasive to the ability to focus on health treatment. Instead, it should be seen as a tool to improve care. The intersection of data and medical technology allows for the use of artificial intelligence (AI) and data science in ways not historically utilized to create efficiency and personalized healthcare.

The overwhelming amount of new technology in healthcare has also allowed the use of devices that do not meet medical quality or reliability, driving poor experience. It is essential that devices used for virtual care meet or exceed the quality level of those used in direct care. This includes the quality of video and sound, as well as the consistency of monitoring devices. The use of AI is extremely powerful. However, if the data feeding the algorithms are not accurate, the outcome will be compromised. Inaccurate data will lead to inferior quality care and poor reliability for technology, negating the enormous potential to improve healthcare. 

Consistency of technology quality and reliability is fundamental in leveraging the power of virtual care. Healthcare organizations should focus on using medical-grade technology that can operate reliably in order to drive innovation. 

Interoperability & Timely Meaningful Data

Interoperability of different tools is an imperative part of utilizing virtual care to deliver an enhanced experience for patients and providers. As it stands now, many technologies do not create an interoperable experience, leading to friction. This friction limits the ability to use technology effectively as it delays timely and valuable insights. As a result, data loses its value when there is not enough data or when there is so much data that it becomes incomprehensible.

For the patient, data overload can lead to confusion or feeling overwhelmed, making the technology not beneficial. The opposite, a lack of data availability, can lead to mistrust in the system and drive disengagement for patients. There are similar parallels for the care team; an overload of data can lead to care inefficiency, while the lack of available data can lead to poor care. Interoperability of systems is vital to ensure that all the data can be used in combination and that the data and insights are structured in a way that can be quickly and easily understood for effective, timely care.

In summary, to drive virtual care forward and improve the efficiency and quality of healthcare, there must be a focus on both the opportunities and barriers that currently exist. Technology should complement technological and human counterparts with reliability and high quality. When used this way, it will create a positive user experience and allow for patients, care teams, and providers to be empowered by technology and virtual care. 

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As was true for most persons in the U.S. in March 2020, essentially, the only way to have a visit with a provider at Sparrow Health System was in-person. You would either need to call the office to make an appointment or drive to one of our urgent care/walk-in clinics. This laborious process would require you to change out of your pajamas, have reliable transportation, drive around looking for parking, wait in the waiting room, be placed in a gown, and wait to be seen in a too-often cold exam room. One month later, in April 2020, Sparrow conducted 3,132 video visits and 22,514 telephone visits. What changed? COVID-19! 

We assembled our virtual health strategy in October 2019 with a target date to begin on-demand virtual urgent care visits in the third quarter of 2020. Not long ago, standing up a single virtual health offering in one year was considered agile. Our strategy began by aligning virtual health as a “tool” to improve access and positively impact the Quadruple Aim (reducing costs; improving population health, patient experience and caregiver well-being), although great change is not without significant resistance. Providers were skeptical, with questions and comments that ranged from, “How can you diagnose and treat a patient without a physical examination?”, “Virtual health is not real medicine,” “Patients will never go for this; they want to be seen in person.” and “Insurers won’t pay for this kind of care.” The COVID-19 pandemic changed everything, including policy changes, reimbursement and immediate acceptance of virtual health by providers and patients. During this time, we proved that health systems could be nimble and act quickly – making technology available in days rather than months or years. Once providers and patients became comfortable with the “tool,” they began seeing its value.

Our goal in 2022 is to reduce medical advice requests by 50% by converting many of these into E-Visits. The response by patients has been positive.

During the third week in March 2020, not only did we set up scheduled video visits, but we made on-demand video visits available 12 hours a day, seven days a week, staffed by our urgent care/walk-in clinic providers. It wasn’t long before our Emergency Departments had the capacity for more patients and were looking for ways to keep their core staff busy. We added five of our Emergency Departments to the on-demand platform and expanded access to 24/7 care. At that time, we had anywhere from 8-15 Sparrow providers available for walk-in or virtual visits at any given time – and patients loved it! The video visits were initiated through our EMR and conducted by Sparrow providers who had access to the patient’s medical record, and documentation occurred within the EMR. Our completion rate was over 80%, the average wait time was under 15 minutes, and everything was great – until the third wave of COVID in fall 2021. This wave was much different than the previous two in that businesses were open; people were not social distancing, schools were back in-person, and subsequently, in-person patient volume was ramping back up. Because of this, wait times for our on-demand virtual platform began increasing, and completion rates plummeted. We once again found ourselves with a new challenge in balancing high in-person volume and managing our on-demand virtual platform. We quickly dedicated two providers to the on-demand platform to cover Monday through Saturday from 8 a.m. to 8 p.m. The Sparrow Hospital Emergency Department added resources and continued to provide after-hour coverage Monday through Saturday, 8 p.m. to 8 a.m. and all day Sunday. The remaining urgent care/ walk-in clinic providers continued to provide backup support. We added completed on-demand video visits to the urgent care/walk-in clinic providers’ quality goals, which proved to be one of the most effective tactics in virtual patients being seen quickly. Full-time providers must conduct 132 video visits annually to obtain full credit for this quality goal.

After launching provider-to-provider virtual consults, patient-to-provider inpatient video visits, virtual behavioral health and virtual connection between our Community Hospitals with Sparrow Hospital, we recently initiated E-Visits. E-Visits are an asynchronous portal exchange between a provider and their patient. We rolled this out in summer 2021, starting with primary care providers for nine minor acute conditions, and expanded it to our specialists in the following months. The vision for E-Visits was more than access; it was to provide compensation for the work many providers were already doing by responding to medical advice requests that required significant medical decision-making. In fact, over 6,000 medical advice requests escalated to providers each month. Our goal in 2022 is to reduce medical advice requests by 50% by converting many of these into E-Visits. The response by patients has been positive. Because patients complete eCheck-in and answer a prescribed questionnaire, it feels like a visit, but the patient can submit it when and where they want to, rather than needing an appointment or waiting in line. E-Visits have been a great addition to Sparrow’s virtual health ‘’toolbox.’’ 

Today, two years after the start of the pandemic, in addition to in-person visits, Sparrow providers and patients can utilize on-demand and scheduled video visits, telephone visits, and E-Visits at their convenience. During a recent snowstorm that closed clinics at 2:00 p.m., hundreds of in-person visits were quickly converted to video visits, ensuring that patients received care without driving in treacherous weather conditions. Beyond COVID, these resources will continue to provide value in the future.

COVID will forever change our lives, and at least some of it will include additional convenient options for safe, effective health care.

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The pandemic has catalyzed the care delivery innovations for the healthcare industry. As many healthcare organizations move towards value-based care, the focus has shifted to patient-centered care. One of the ways we are looking at new ways to provide care is to utilize the virtual platform to provide the proper care at the right time and at the right place. We are increasingly recognizing that the right place can often be the patient’s home, where we can remove barriers such as transportation needs, taking time off from work, caregiver presence, etc. Therefore, virtual care is no longer synonymous with ambulatory settings as it can be in the setting of acute care such as tele- ICU, hospital at home, ED settings as well as e-Consult which is an asynchronous interaction between providers to optimize the care of the patient while avoiding fragmentation of care which means moving away from multiple visits with multiple new providers. Concerns that have surfaced include questions such as whether telehealth can continue to remain an option post-pandemic or that only younger patients in the urban location are the ones who prefer the virtual care option. We will have to continue to observe the trends with time and be flexible to pivot by redefining the scope of virtual care. Our data from west Michigan which includes rural settings currently point to positive patient receptiveness to virtual care. Pre-pandemic, our tertiary care healthcare system based in West Michigan conducted 19,053 virtual yearly visits. We saw an increase during the pandemic with 84,883 virtual yearly visits and these have remained stable. Our data also shows that we impacted 329 more zip codes from 2020 onwards than our pre-pandemic geographical footprint in the virtual care arena.

Value-based care requires primary care redesign to allow patients to get most of their healthcare needs fulfilled by the provider who knows them the best.

Our pre-pandemic top five diagnoses for virtual visits were:

• Acute bronchitis, unspecified (ICD-10-CM: J20.9)
• Acute upper respiratory infection, unspecified (ICD-10-CM: J06.9)
• Acute sinusitis, unspecified (ICD-10-CM: J01.90)
• Rash and other nonspecific skin eruption (ICD-10-CM: R21)
• Cough (ICD-10-CM: R05)

And during the pandemic, the top five diagnoses for seeking virtual care are:

• Anxiety disorder, unspecified (ICD-10-CM: F41.9)
• Major depressive disorder, recurrent, moderate (ICD-10-CM: F33.1)
• Essential (primary) hypertension (ICD-10-CM: I10)
• Major depressive disorder, single episode, unspecified (ICD-10-CM: F32.9)
• Acute upper respiratory infection, unspecified (ICD-10-CM: J06.9)

As noted above, mental health disorders have been an area of focus for us. Based on our data, there has been patient receptiveness to accept the telehealth platform for seeking care for behavioral health needs. The need for easy access to common ailments pre-pandemic points to the need to have various options for patients that can meet their needs to get care quickly.

Value-based care requires primary care redesign to allow patients to get most of their healthcare needs fulfilled by the provider who knows them the best. If we continue to explore new ways to meet patient needs, we can avoid fragmentation of care where patients have to seek care from different providers/specialists for different conditions leading to an increase in the cost of care and poor value for the patients. As we continue to refine our offerings within the virtual care setting, one important new addition worth mentioning is our portable all-in-one medical exam kit that enhances the virtual visit experience. During a virtual visit, the mobile medical exam kit links to a patient’s provider, allowing them to capture high-quality sounds from their heart and lungs and share readings of their heart rate and body temperature or create images and videos that show their inner ears, throat, and skin. Their provider then uses this information to make a diagnosis and offer a treatment plan. It has mostly been utilized by primary care but gaining interest by specialty providers too. With the Mobile Exam Kit, patients can get a diagnosis and treatment for many common conditions, including stomach aches, allergies, sinus pain, bug bites, ear infections, pink eye, fevers, rashes, cold and congestion. This allows primary care to help patients in an acute setting and allows avoidance of unnecessary ED/Urgent care visits. In addition, patients need not have to pay more for a virtual visit when using their Mobile Exam Kit. A single kit can also be used for multiple family members. Our experience has been that patients and providers enjoy the enhanced virtual visit capabilities that the mobile medical kit provides. Patients express their appreciation for being able to see the numerous assessments in real time (such as inside their child’s ear, for example) while completing video visits via the kit. Through traditional virtual visits alone, this type of exam was not possible. Providers now can perform exams that were once only possible in an actual exam room. This simple tool allows us to provide care to the patients at the right time and in their home setting. This decreases the unnecessary demand on ED utilization, allowing costs to remain low for patients from a co-pay perspective. We have completed approximately 2,200 visits thus far, averaging around 350 visits per month. Though the percentage of the mobile medical kit vs. traditional visits is low (approximately 5%), we see it increase a percentage point each month or two with continued awareness campaigns.

Similarly, electronic consultations (eConsults) are asynchronous provider-to-provider consultations (between a primary care provider and specialist) that occur within an EHR. We are utilizing eConsults to take advantage of the expertise of our specialists without increasing the demand for specialty care by increasing the referral rate, which leads to long wait times for patients. eConsults provide another ramp onto the telehealth superhighway, to enable specialty practices to explore novel ways of coping with the national shortage of specialists coupled with increased demand for access.

The above have been some ways that have allowed us to leverage virtual health platforms to provide care differently. The virtual health space will continue to grow as we think of new ways to provide care to our patients focused on their convenience while maintaining quality. Outside of acute and chronic disease management, virtual care can be an essential pillar for setting up preventative care models as the healthcare system continues to expand in the population health space.

Acknowledgment (non-author contributors at Spectrum Health): Jared Cowan (Operations Director, Virtual Health), Alexia Eaton (Database specialist, Virtual Health), Michelle Rizor (Principal Strategic Partners, Virtual Health), Dr. Rima Shah (Chief of Primary Health).

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Even before the COVID-19 pandemic, healthcare consumers sought convenient, more affordable ways to access healthcare. The pandemic rapidly accelerated this trend, encouraging healthcare organizations to develop and deploy patient-centered telemedicine services that gave consumers what they wanted. Due to its versatility, accessibility and cost-effectiveness, I believe consumer demand for telemedicine will only continue to increase.

After witnessing the need for more telemedicine in the early pandemic, Envision increased its investment in and deployment of virtual services to include teleneurology, maternal-fetal medicine, transitional care, neonatology and direct-to-consumer occupational medicine, among many others.

To effectively deliver virtual care, organizations must collaborate with technology companies to create platforms that are easy for both patients and clinicians to use.

One of the programs we’re proudest of is our ET3 virtual emergency medicine program, which launched in January 2021 with our strategic partner, Global Medical Response (GMR) and other EMS agencies. We are now active with the program in 17 states across the U.S. ET3, or Emergency Triage, Treat and Transport, is a voluntary initiative in partnership with the Centers for Medicare & Medicaid Services (CMS) that incentivizes appropriate utilization of emergency medical services. Coupled with Community Paramedicine (CP), which dispatches a caregiver following non-emergent 911 calls, these programs deliver a patient-centered emergency response by supporting the right care at the right time in the right place.

Our Virtual Health Services team uses two-way, real-time audio/video on mobile devices to bring local emergency medical services (EMS) responders together with Envision’s national network of more than 60 EMS medical directors and 3,500 board-certified emergency medicine clinicians. We serve more than 100 U.S. counties and 20 million patients in the ET3 program.

Challenges transitioning from brick-and-mortar to virtual

With the numerous virtual health technology platforms available, it can be challenging to find the right platform that meets the exact functionality required for a given service while having the right level of configuration to match the needs of Envision’s virtual health programs.  

Using our ET3 care program as an example, Envision’s leading team of clinical and operational experts worked closely with our platform vendor to develop functionality beyond “out-of-the-box” features. The results were new technology features and workflows that allowed for streamlined platform functionality while focusing on the patient-clinician experience. Partnering with a high-quality technology vendor that is willing to collaborate with your organization and take an innovative approach to their platform’s features is critical.

In addition to being functionally flexible, virtual health platforms must be easy for providers to use. The technology must work as intended. Otherwise, the platform may create challenges that can lead to underutilization. I often find myself saying that we have to make the virtual “front door” easy for patients to walk through. We have a responsibility to provide them with a positive care experience. Any virtual service must be easy to access and use. Complex registration and login processes or connectivity issues related to audio and video functionality will only create user frustration and, over time, a lack of patient utilization.

Embracing emerging healthcare technologies

To ensure our virtual health platforms like the one used for ET3 provide a positive experience, we routinely ask patients for their feedback. A patient recently explained that they were hesitant to call 911 as they did not want to go to their local emergency department. The EMS team, in partnership with an Envision emergency physician, assessed and treated the patient via a virtual emergency visit. With the patient’s health and safety top of mind, the care team determined the patient’s condition was not high risk and it was not clinically necessary for the patient to go to the ED. The patient told us, “I can’t believe I was able to speak to an ER physician from my living room couch. My family and I are so grateful we didn’t have to go to the emergency room.”

When I think about the positive benefits of emerging virtual health capabilities, I think about the real impact we have on patients’ lives. With the help of technology, we are helping patients access the most appropriate care when and where they need it most.

Naturally, embracing and implementing emerging technologies comes with a learning curve. Telemedicine regulations at the federal and state levels were expanded dramatically during the COVID-19 pandemic. However, the need for permanent legislation still exists for everything from interstate licensure compacts to telemedicine reimbursement dynamics. Public and commercial health insurers must also keep up with the demand from consumers and the need to reimburse clinicians.

While virtual healthcare expands patients’ access to care, improves patient outcomes and drives healthcare costs down, how quickly and to what extent this takes place will be influenced by regulatory and insurer dynamics.

I am confident that virtual care is the future of healthcare delivery. Consumer demand for more convenient, low-cost service models is here to stay and will only increase with time as consumers become more selective in how they access care. To effectively deliver virtual care, organizations must collaborate with technology companies to create platforms that are easy for both patients and clinicians to use.

As the healthcare system continues to evolve, more providers will likely adopt or expand virtual health capabilities. Those providers that are open to embracing innovative changes and virtual services are better suited to meet patients’ unique and ever-changing needs.

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By Debbie Welle-Powell, Chief Population Health Officer, Essentia Health

Digital Care is here to stay. 

The COVID-19 pandemic accelerated change to a new model of care; a virtual (digital) model built to deliver care at the right time, all in the comfort of the patient’s home.

Health care systems, including Essentia Health, were challenged by the pandemic to deliver necessary care differently. Prior to COVID, we offered limited retail E-Visits and remote patient monitoring (RPM) only to high acuity chronic heart failure patients. When the pandemic hit, we took a quantum leap forward, resourced our change management capability and fast-tracked the adoption of digital technology. With the technology platform in place (built), we were able to move quickly to direct-to-consumer services that kept our patients safely in their homes. This technology also kept our providers and staff safe by limiting the number of patients on campus and reducing viral transmission in the community. Today our direct-to-consumer digital programming includes on-demand video visits, retail E-Visits, RPM, and our newly approved CMS Hospital at Home waiver program. 

A shift in mindset is occurring with our clinicians. They are trusting the technology to deliver timely and safe care.

This new model of care is generating higher patient satisfaction scores, showing we are truly improving the patients’ experience.

Essentia Health’s Story and the Impact of Virtual Care

1. The Numbers. Essentia led other health systems in Minnesota with well over 604,000 telehealth visits since the pandemic started. Our expanded RPM Program prevented 102 hospital admissions and prevented 67 emergency department visits. This work generated savings of approximately $2.5 M across Medicare, Medicaid and commercial populations. Essentia holds thirteen total cost of care contract agreements totaling 180,000 at-risk lives. When we appropriately reduce utilization, these earnings are reinvested in chronic care programs, enhanced technology applications and analytical tools. Negotiating value-based, risk contracts has been a key to our success as an integrated health system and Level 3 NCQA Accredited ACO because we are able to measure the impact of closing gaps in care and quantify making health care more affordable.   
   
   
2. Screening Social Determinants of Health (SDOH) and Social Needs. The COVID-19 pandemic placed a great deal of strain on our communities. At the beginning of 2020, we were just piloting a social needs screening program asking our patients about food insecurity, transportation and financial strain. In April 2020, we rapidly scaled up social needs screening to ensure our 75 primary care and pediatric clinics were offering this screening to all of our patients. To date, we’ve offered this screening to more than one million patients, with 46% (420,330) of patients responding. We found that a significant increase in requests for social needs (particularly food) was reported. As a result, more community health workers were hired, and our relationships with community partners were expanded. We’ve been able to successfully connect more than 2,000 patients with the community resources they needed.
   
   
   In April 2021,  building on our work, we launched RESOURCEFUL, a free, online, public resource directory, through a partnership with Aunt Bertha. Its name “RESOURCEFUL,” reflects our desire to bring community assets to our patients. The program makes it easy for patients to identify resources close to them, empowering them to seek needed information to help themselves. We are widely promoting this to our patients and community. The process has truly been collaborative in nature, with our community partner organizations helping us name, brand and promote the site.
   
   
3. Evolving New Care Team. As our care models evolve, so too must the care team. With the successes in implementation and growth of virtual visits and RPM for both COVID and chronic care patients, we recently approved a permanent Essentia 24/7 Telehealth Care Team. It is  essentially backup to primary care services, however, performed remotely with digital technology. Now, on a 24/7 basis, we provide on-demand care to our patients, along with annual wellness visits and advance care planning. A shift in mindset is occurring with our clinicians. They are trusting the technology to deliver timely and safe care. With RPM devices, we are seeing our emergency medicine physicians, cardiologists, and hospitalist coming to us and asking if we can deploy the devices in the patient’s home. RPM is becoming a standard of care for patients with conditions such as diabetes, enabling them to manage their diet and blood sugar levels with wearable push/pull devices.
   
   
   Our hospitalists, paramedics, pharmacists, social workers, and nurses are developing clinical competencies to provide care in a different environment with our hospital-at-home program. We can see that the care team of the future is going to be heavily influenced by digital technology and the data it produces. Care team members must have skills on how to integrate technology and data into their care of the patient, and we must expand our definition of the “Team”, as we will see the patient and his/her devices become more of an active member in the plan of care, in this virtual world.

The Challenges of Virtual Care. There are still many challenges and barriers with telehealth to overcome. From parity in reimbursement, and state licensure, to the technological challenge of broadband connectivity and integrity, we must assume the virtual/digital care model will continue to evolve. There is also the need to cut through the noise and distractions, help make the data timely and more meaningful, and provide ongoing education to our clinicians. In addition, there are new, non-traditional stakeholders in the health care ecosystems too, such as regulators, financiers and intermediaries who will shape the future. As is the constant, this too will change.

In Summary

The disruptive nature of the COVID pandemic forced us to re-think the care delivery model and optimize the digital and virtual delivery system. It continues to force us to evolve, to adopt and to expand upon the new care model. Consumers are increasingly willing to share their personal data through “wearable” technology and bluetooth-enabled devices. Additionally, this new virtual model of care is empowering consumers to take control of their well-being in ways that were impossible just a few short months ago. Health systems and clinicians with deep roots in care delivery must ask themselves how to best use this new technology, and its data, to transform what well-being and virtual care delivery means in the future. The future is not as far off as it seems. In fact, it’s at your very finger tips. 

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Few, if any, of our cohorts in healthcare IT could have foreseen the unveiling of a global outbreak in the early days of 2020. And while my health system had dabbled in telemedicine for well over a decade, we were woefully unprepared, as were many, when the first wave slapped our doors shut. By the second month into the public health emergency, our volume had increased by 2000% over pre-COVID days. We had moved the needle by years in a matter of months, even weeks.

Telehealth proved its value during the pandemic out of necessity. And now, we must not let it lose its luster.

The pandemic offered little hope to humanity, save one thing. The hope of innovation, out of necessity and desperation, in the form of a digital paradigm shift in healthcare. Seemingly overnight, all of the fears and skepticism of this emerging care model were swept away, and telehealth was embraced by the masses. Out of the most challenging and heartbreaking year for many of us, our families, friends, and colleagues, I offer these perspectives on what it taught us.

1. The policy was not in line with the times. Prior to the PHE, CMS limited telehealth access to only rural areas – and only at facilities designated under the antiquated provisions of the Social Security Act. Fortunately, Congress acted quickly to temporarily waive the geographic restrictions on telehealth and allow social communication technologies, such as FaceTime, to be used without repercussion. It is yet to be determined whether these waivers will remain in effect long term.
   Despite the uncertainty…
   
   
2. Telehealth became the safer, and sometimes, the only choice. Almost immediately, all routine visits and elective surgeries were canceled to accommodate the surge of COVID cases flooding our EDs and ICUs. Personal protective equipment was at a premium as we struggled to understand the epidemiology of this disease. “Tele-” (aka “distant-”) health provided a natural barrier between the virus and our caregivers, and it allowed our patients to be seen without in-person contact. In just two short months, we had completed over 80,000 such visits.
   Nonetheless…
   
   
3. Adoption was a choice. Even with the high demand for virtual care during the pandemic, there was no guarantee that telehealth would be leveraged to its full potential for various reasons. Lack of familiarity, technology hurdles and frustration, the perception (or reality) of creating more work for the caregiver, etc. Human nature will almost always gravitate toward the easier or more comfortable path if the change is not purposeful.
   And so, we learned…
   
   
4. It must be simple to use and readily available. The core tenets that “everyone knows how to use Zoom” and “everyone has a smartphone” turned out to be fundamentally flawed. In fact, nearly 1 in 3 of our patients were deterred by the so-called “every day” technologies that most of us in healthcare IT take for granted.
   This created its own challenge…
   
   
5. Keeping patients in touch with family was critical. One unintended consequence of restricting all visitation was the isolation that bore down on our patients. Solving this became a crucial use case for telehealth. Staff was using their own social media accounts and personal devices to make sure that patients could see their loved ones – sometimes for the last time. We now have purpose-built tools for patient-family communication and even a virtual companionship program for those who just need someone to talk to. Which supports the notion…
   
   
6. Telehealth aligns with consumer expectations. Perhaps for the first time in modern medicine, our patients want to choose when and how they receive healthcare services. They want convenience, access, value, and an overall positive experience. As such, telehealth aligns with consumerism in the same way that Amazon appeals to online shoppers. Why wait weeks to be seen in person by a specialist when an online consultation is available on-demand, 24×7?
   But this revealed…
   
   
7. Health inequity exists in telehealth, too. Our own data suggests that factors such as age, race, language, and socioeconomic status disproportionately exclude minorities with regard to access and utilization of telehealth.
   Which demonstrates…
   
   
8. The need for video interpreter services is growing. I consider it a requirement for almost any program today. Yet, it presents its own unique challenges in terms of bridging the connection at the right time with the right language interpreter. The promise of NLP translation – the likes of which Google already offers – would be a game-changer in this space.
   And yet…
   
   
9. Telehealth is exciting, but it’s not innately different. Telehealth is just another tool in the proverbial toolbelt. It will continue to evolve rapidly. And hopefully, in the not-so-distant future, it will become an integral part of how we deliver timely, quality care.
   That said…
   
   
10. Telehealth is not for everyone or every situation. We will never replace in-person doctor visits, at least not in my lifetime. Telehealth has its purpose, much like a hammer does with a nail. But thanks to COVID – as odd as that may sound – it has emerged as a practical and promising answer to many of the challenges we face in healthcare today.
    So, in conclusion…
    

Telehealth proved its value during the pandemic out of necessity. And now, we must not let it lose its luster. Telehealth has been a novelty for far too long. Today my organization considers it one of our top strategic priorities. We cannot allow this genie to go back in the bottle.

The post Ten Takeaways on Telehealth from the Perspective of a Pandemic appeared first on HealthTech Magazines.

Throughout the pandemic, consumers have changed their expectations for doing business in every aspect of their lives, including banking, shopping, dining, entertainment, worship, and most of all, healthcare. In 2019, prior to the COVID-19 pandemic, Henry Ford Health System providers conducted just over 17,000 virtual encounters, or about 65 per day. Once the COVID-19 pandemic hit Detroit in mid-March 2020, that number skyrocketed to more than 1,500 per day, ending 2020 with over 420,000 virtual encounters. Consumers’ needs and expectations have risen, and our job is to meet them. Within the Henry Ford Health System, this means challenging healthcare delivery norms and focusing on customer experience to create what we have termed “Radical Convenience.”    

This drastic increase in the delivery of virtual care (including Video Visits, E-visits, E-consults, and more) came with its fair share of lessons learned, which Henry Ford has embraced and leveraged to set priorities and our path forward. Here are some of the bigger lessons.

Henry Ford was driving our path forward to enhance our virtual care strategy before the pandemic and recognized the value and benefit that it could bring to our customers with the right technological innovation, integration, and support.

Having an Enterprise Virtual Care Approach is Key

In 2015, Henry Ford’s leadership made the strategic decision to dedicate resources and structure to the organization and standardization of virtual care, then known as telehealth. Six years later, the system-wide Virtual Care Department not only drives the virtual care strategy for the health system, but also aligns and supports every aspect of virtual care integration and enablement. This team acts as project managers and strategic advisors/consultants in the implementation of virtual care capabilities. It maintains standard build and operational models to ensure standardization from hardware/software to EMR integration to training. They also act as subject matter experts in telehealth billing, regulations, and facilitate knowledge sharing throughout the organization. Without all of this in place, we would not have successfully scaled up during the pandemic.

Entree to Virtual Care Needs to be Seamless for the Patient

For patients, the virtual care experience itself begins before they ever see a provider. We strive to attract, engage, and retain customers by providing an exceptional digital experience that allows them to engage with Henry Ford where, when, and how they prefer. An essential driver of virtual care utilization is for the health system to build a frictionless “digital front door,” ensuring that patients and providers can both navigate their way through it, and more importantly, find a connected, accessible, easy-to-navigate experience once on the other side. To make this happen, for example, our care team can send a direct hyperlink to the patient if they are having trouble starting their appointment. In addition, we have added a dynamic patient video visit instruction wizard to our website. After the patient answers a couple of quick questions about the type of device they are on, the decision tree lands them to the quick and easy steps with images that help them get through their virtual connection, as well as description patient instruction videos.

With the use of various voice of the customer tools, such as market insight surveys, Patient and Family Advisory Councils, and patient satisfaction survey comments, we gauge how we are doing and where we need to focus our efforts in our path forward.

Don’t Forget to Collaborate

Virtual care is not a self-contained strategy. It cannot be accomplished without ensuring internal and external collaboration and coordination of care to align the best course for everyone. Critical internal collaboration includes not only the operational and clinical stakeholders, but also information technology/security, market leadership, population health, patient outreach, and corporate support services. In addition to internal collaboration, the importance of external collaboration such as partnering with vendors, other health systems/providers, community organizations, and employers helped to bring our trusted and innovative aligned virtual and “brick and mortar” services to patients and create a collaborative healthcare ecosystem that now expands to anywhere the patient may be.

Ongoing Challenges Are – Always — to Be Expected

This innovation and discovery do not come without challenges. Some of these include maintaining adoption and standardization throughout the organization as the dust settles from the pandemic, continuing pressure to evolve or push innovation in healthcare design and hospital strategy, identifying the appropriate use of telehealth at the service line or specialty level, mounting security and privacy concerns, honoring patient preference, confronting digital inequities (i.e., telehealth literacy, accessibility, compatibility, diversity, equity, inclusion), and reacting to the ever-changing government, licensure, and reimbursement landscape. This list isn’t short. Add to it one final item – “the unknown.” By being ready for change and challenges, and having a foundation and collaborative partners in place, we are prepared to tackle these issues.

There is an old saying that there are decades when nothing happens, and then there are weeks when decades happen. Henry Ford was driving our path forward to enhance our virtual care strategy before the pandemic and recognized the value and benefit that it could bring to our customers with the right technological innovation, integration, and support. But the pandemic proved the value of virtual care to the American healthcare system at large. With this solid foundation, Henry Ford’s application of virtual care during the COVID-19 pandemic provides a working model of steps other organizations can take to maximize their telehealth and telemedicine programs. Virtual care is no longer experimental. It has moved to the mainstay in the healthcare ecosystem, and to succeed, organizations must evolve and embrace it.

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