An application of Harrison's system theory model to spark a rapid telehealth expansion in the time of COVID‐19

Abstract

Introduction In response to the COVID‐19 pandemic, health systems had to quickly adopt a process for enabling targeted and patient‐centered care delivery. This case study describes the utilization of Harrison's open‐systems model to create an approach for rapid adoption of existing telehealth technologies in a large scale academic medical center. Methods An internal group of organizational developers, was enlisted to enable this effort. Local networks were employed and organized into focus groups to rapidly assess and address barriers to adoption and informal interviews with executive leadership were conducted to align organizational goals. Interventions include rapid deployment of focused and data driven provider, staff and patient support bolstered by effective communication and resource management. Results There was an increase in the number of patient portal activation codes by 75% during the month of March. The number of activation codes generated expectedly decreased in April as many patients now had activated patient portals. The video visit volume as a result of provider self‐scheduling increased went from a baseline of 0 to over 600 clinical visits. Discussion Experienced organizational development programs can facilitate adoption of change. The faculty practice of CUIMC has years of experience with supporting wide scale operational change centered on technology. In this case, providing engaged networks with tailored content that is focused on the process and available technology promoted rapid adoption and optimization. Conclusion In the setting of profound external pressure, experience with the ability to focus on tailoring training and support to the culture of the organization helped to rapidly increase the availability and success of telehealth visits for a large scale academic medical center.

The influence of the learning health system to address the COVID‐19 pandemic: An examination of early literature

“…Touson et al 19 An application of Harrison's system theory model to spark a rapid telehealth expansion in the time of COVID-19…”

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

“…New care processes and workflow changes involving many different stakeholders were needed to successfully transition to telehealth, including changes to scheduling, the additional preparations needed prior to virtual visits (e.g., patient portal enrollment, virtual processes for previsit questionnaires), conversion of in-person processes to the virtual context (e.g., "rooming"), and postvisit follow-up, [47][48][49][50][51][52][53] as well as increased remote disease monitoring and virtual patient education programs. 54 To achieve these changes, HCOs also needed to employ implementation strategies to encourage acceptance among the various stakeholders.…”

“…We found that existing literature was more likely to describe health care professional-facing implementation strategies to encourage acceptance of virtual visits than patient- • New virtual care processes were required for all stages of a visit-previsit such as patient portal enrollment, during such as "rooming," and postvisit follow-up-as well as remote disease monitoring and patient education. [47][48][49][50][51][52][53][54] • The literature describes a wide variety of clinician-facing, sociotechnical implementation strategies, including securing and organizing human resources (e.g., clinician champions); developing guidelines, standard scripts, and best practices; offering trainings and clearly communicating evolving processes and resources; and leveraging technological resources. [47][48][49][50][51][52][53]55 • The patient-facing initiatives reported in the literature are limited to technological training and support, with an emphasis on mitigating the risk of digital health disparities.…”

“…[47][48][49][50][51][52][53][54] • The literature describes a wide variety of clinician-facing, sociotechnical implementation strategies, including securing and organizing human resources (e.g., clinician champions); developing guidelines, standard scripts, and best practices; offering trainings and clearly communicating evolving processes and resources; and leveraging technological resources. [47][48][49][50][51][52][53]55 • The patient-facing initiatives reported in the literature are limited to technological training and support, with an emphasis on mitigating the risk of digital health disparities. [47][48][49][50]52,[55][56][57][58][59][60][61][62] Developing and deploying portal tools to respond to COVID-19…”

“…[47][48][49][50][51][52][53]55 • The patient-facing initiatives reported in the literature are limited to technological training and support, with an emphasis on mitigating the risk of digital health disparities. [47][48][49][50]52,[55][56][57][58][59][60][61][62] Developing and deploying portal tools to respond to COVID-19…”