Lesson 1: The loosening of federal government regulations enabled the rapid scaling of telehealth, as it enabled providers to be reimbursed for video visits at the same rate as in-person services. Lesson 2: While resistance to change was the norm, the COVID-19 crisis motivated improvements to four major internal operational workflows (scheduling, appointment conversions, patient support and Virtual Rooming Assistants) for video visits, which were met with acceptance by both clinical and non-clinical staff. Lesson 3: Leveraging prior intraorganizational relationships and active collaboration between different stakeholders, helped drive rapid operational change. An ongoing centralized communication and support strategy, ensured all stakeholders were informed and engaged during these uncertain times. Lesson 4: Regular electronic health record (EHR) training and educational material increased end-user knowledge of video visits and helped ensure the visit was safe, medically effective and maintained patient-provider relationships. Lesson 5: A clearly defined intake and evaluation process to filter out technologies that do not integrate with the patient portal or the EHR, ensures operational consistency and long-term sustainability. Lesson 6: Personalized support to patients of different levels of technical literacy with using the preferred patient portal and application, was vital to its use, adoption and overall patient experience.

Background COVID-19 accelerated telehealth use to ensure care delivery, but there is limited data on the patient perspective. Objective To examine telehealth visit uptake before and during COVID-19 and correlates of patient satisfaction and interest in future telehealth visits. Design Cross-sectional observational study between October 2019 and April 2020. Participants Patients who completed satisfaction surveys following telehealth visits. Key Results A total of 8,930 patients completed the satisfaction survey using 4-point Likert Scales. Multivariable, hierarchical, cumulative-logit models were constructed to examine correlates of satisfaction with quality of care and interest in future telehealth visits. Most patients were satisfied with the patient portal, video quality, and instructions (92.7-96.8%). Almost half reported saving 1-2 hours (46.9%). Correlates positively associated with quality of care and interest in future telehealth visits were ease of patient portal (OR = 1.43, 95%CI 1.30-1.58; OR = 1.56, 95%CI 1.41-1.73, respectively), video quality (OR = 1.62, 95%CI 1.50-1.75; OR = 1.26, 95%CI 1.16-1.37, respectively), instructions (OR = 5.62, 95%CI 5.05-6.26; OR = 1.80, 95%CI 1.62-2.01, respectively), and time saved (>4 hours: OR = 1.69, 95%CI 1.22-2.34; OR = 3.49, 95%CI 2.47-4.93, respectively). Being seen after the COVID-19 surge in telehealth (OR = 0.76, 95%CI 0.63-0.93) or by providers with higher visit volume (OR = 0.71, 95%CI 0.60-0.85) was associated with lower interest in future telehealth visits. Conclusions Patients expressed relatively high satisfaction levels with telehealth. Better technical quality, quality of instructions, and greater time saved were associated with higher satisfaction ratings. To maintain interest in future telehealth use and improve the patient experience, we must enhance the quality of telehealth delivery platforms and instructions provided to patients. Lay Summary COVID-19 accelerated telehealth use to ensure care delivery, but there is limited data on the patient perspective. Therefore, this study focused on factors impacting patient satisfaction with telehealth. We found that better technical quality, quality of instructions before the visit, and greater time saved by having a telehealth appointment rather than in person were associated with higher satisfaction ratings. Given that telehealth will likely remain an important aspect of healthcare delivery beyond the COVID-19 pandemic, we must enhance the quality of telehealth delivery platforms and instructions provided to patients to maintain interest in future telehealth use and improve the patient experience.

No abstract