Channel management in virtual care

Desruisseaux, Matt; Stamenova, Vess; Bhatia, R Sacha; Bhattacharyya, Onil

doi:10.1038/s41746-020-0252-4

Cited by 12 publications

(6 citation statements)

References 10 publications

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“…For example, while 84% of all provider survey respondents agreed or strongly agreed that the technology they used to conduct video visits was easy to use, this contrasted with providers’ shared perspectives that they had ongoing challenges with technology, adapting virtual care into their clinical workflows, and the overall effort required. This might be because the technology itself was not difficult to use, but rather its integration within established clinical workflows was contingent on other individual, organizational, and policy-level factors to enable optimal efficiency [ 41 , 42 ]. Collective consideration of the tool (technology), the team (providers and clinical staff), and the routine (clinical workflows) may enhance positive experiences [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context

Fujioka¹,

Chu²,

Baranek³

et al. 2021

JMIR Form Res

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Background Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods This study took place at Women’s College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required.

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Section: Discussionmentioning

confidence: 99%

Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context

Fujioka¹,

Chu²,

Baranek³

et al. 2021

JMIR Form Res

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“…Conceptually, clinicians and patients can interact within telemedicine through many different channels. 29 Desruisseaux et al 29 proposed that each channel of interaction has 2 relevant outcomes: savings, defined as the financial difference in money and time between traditional care models and each channel, and resolution, defined as an encounter that meets the standard of care and gives the patient a good experience. Maximizing these outcomes requires efficiently and precisely funneling each interaction into the appropriate channel.…”

Section: Future Opportunitiesmentioning

confidence: 99%

“…Health systems are only now beginning to grasp the importance of this process. 29 If such implementation is successful, improvements in financial and care-related performance could be significant. 30,31 As we advance teleneurology, we must be mindful of the effect of telehealth on the physician-patient relationship and the potential for widening health disparities.…”

Section: Future Opportunitiesmentioning

confidence: 99%

Rapid implementation of virtual neurology in response to the COVID-19 pandemic

et al. 2020

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The COVID-19 pandemic is causing world-wide social dislocation, operational and economic dysfunction, and high rates of morbidity and mortality. Medical practices are responding by developing, disseminating, and implementing unprecedented changes in health care delivery. Telemedicine has rapidly moved to the frontline of clinical practice due to the need for prevention and mitigation strategies; these have been encouraged, facilitated, and enabled by changes in government rules and regulations and payer-driven reimbursement policies. We describe our neurology department's situational transformation from in-person outpatient visits to a largely virtual neurology practice in response to the COVID-19 pandemic. Two key factors enabled our rapid deployment of virtual encounters in neurology and its subspecialties. The first was a well-established robust information technology infrastructure supporting virtual urgent care services at our institution; this connected physicians directly to patients using both the physician's and the patient's own mobile devices. The second is the concept of one patient, one chart, facilitated by a suite of interconnected electronic medical record (EMR) applications on several different device types. We present our experience with conducting general teleneurology encounters using secure synchronous audio and video connections integrated with an EMR. This report also details how we perform virtual neurologic examinations that are clinically meaningful and how we document, code, and bill for these virtual services. Many of these processes can be used by other neurology providers, regardless of their specific practice model. We then discuss potential roles for teleneurology after the COVID-19 global pandemic has been contained.

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“…Most of these alternative channels were groundbreaking just a few years ago but are now commonplace. Channel management techniques can be applied to neuro-ophthalmology (60). Existing channels include traditional in-office visits, synchronous audio/video visits, and asynchronous communication with patients through the electronic health record.…”

Section: Future Considerationsmentioning

confidence: 99%

Tele–Neuro-Ophthalmology: Vision for 20/20 and Beyond

Busis

2020

Journal of Neuro-Ophthalmology

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Background: Telehealth provides health care to a patient from a provider at a distant location. Before the COVID-19 pandemic, adoption of telehealth modalities was increasing slowly but steadily. During the public health emergency, rapid widespread telehealth implementation has been encouraged to promote patient and provider safety and preserve access to health care. Evidence Acquisition: Evidence was acquired from English language Internet searches of the medical and business literature and following breaking news on the COVID-19 pandemic and responses from health care stakeholders, including policymakers, payers, physicians, health care organizations, and patients. We also had extensive discussions with colleagues who are developing telehealth techniques relevant to neuro-ophthalmology. Results: Regulatory, legal, reimbursement, and cultural barriers impeded the widespread adoption of telehealth before the COVID-19 pandemic. With the increased use of telehealth in response to the public health emergency, we are rapidly accumulating experience and an evidence base identifying opportunities and challenges related to the widespread adoption of tele-neuro-ophthalmology. One of the major challenges is the current inability to adequately perform funduscopy remotely. Conclusions: Telehealth is an increasingly recognized means of health care delivery. Tele-Neuro-Ophthalmology adoption is necessary for the sake of our patients, the survival of our subspecialty, and the education of our trainees and students. Telehealth does not supplant but supplements and complements in-person neuro-ophthalmologic care. Innovations in digital optical fundus photography, mobile vision testing applications, artificial intelligence, and principles of channel management will facilitate further adoption of tele-neuro-ophthalmology and bring the specialty to the leading edge of health care delivery.

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Channel management in virtual care

Cited by 12 publications

References 10 publications

Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context

Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context

Rapid implementation of virtual neurology in response to the COVID-19 pandemic

Tele–Neuro-Ophthalmology: Vision for 20/20 and Beyond

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