Medical Undistancing Through Telemedicine: A Model Enabling Rapid Telemedicine Deployment in an Academic Health Center During the COVID-19 Pandemic

Abstract

Background: The authors draw upon their experience with a successful, enterprise-level, telemedicine program implementation to present a ''How To'' paradigm for other academic health centers that wish to rapidly deploy such a program in the setting of the COVID-19 pandemic. The advent of social distancing as essential for decreasing viral transmission has made it challenging to provide medical care. Telemedicine has the potential to medically undistance health care providers while maintaining the quality of care delivered and fulfilling the goal of social distancing. Methods: Rather than simply reporting enterprise telemedicine successes, the authors detail key telemedicine elements essential for rapid deployment of both an ambulatory and inpatient telemedicine solution. Such a deployment requires a multifaceted strategy: (1) determining the appropriateness of telemedicine use, (2) understanding the interface with the electronic health record, (3) knowing the equipment and resources needed, (4) developing a rapid rollout plan, (5) establishing a command center for post go-live support, (6) creating and disseminating reference materials and educational guides, (7) training clinicians, patients, and clinic schedulers, (8) considering billing and credentialing implications, (9) building a robust communications strategy, and (10) measuring key outcomes. Results: Initial results are reported, showing a telemedicine rate increase to 45.8% (58.6% video and telephone) in just the first week of rollout. Over a 5-month period, the enterprise has since conducted over 119,500 ambulatory telemedicine evaluations (a 1,000-fold rate increase from the pre-COVID-19 time period). Conclusion: This article is designed to offer a ''How To'' potential best practice approach for others wishing to quickly implement a telemedicine program during the COVID-19 pandemic.

Telemedicine Utilization at an Academic Medical Center During COVID-19 Pandemic: Are Some Patients Being Left Behind?

“…15 Of patients with access to the technology who had participated in telemedicine, those who were older and of black race were less likely to be satisfied with the ease of technology, less likely to rate telemedicine as good/ better than face-to-face visits, and less likely to report probable/ definite future use. 11 In deciding between video and telephone visits, geriatric primary care patients were more likely to choose telephone-only visits if they were nonwhite, needed interpreter services, and or received Medicaid. This is despite the fact that video visits were longer, and more diagnoses were discussed between the physician and the patient during video visits.…”

“…10 However, to our knowledge, there are few analyses of telemedicine usage across an entire academic medical center. 4,11 Kaiser Permanente, one of the largest health care systems in the country, expanded their virtual visit system over the past year with COVID-19. By July 12, 2020, their system, which includes 12.4 million members, was performing 880,000 ambulatory encounters per week of which 77% were virtual (38% secure e-mail, 27% scheduled telephone visits, 6% video, 4% e-visits, and 2% COVID-19 online self-assessment).…”

Reflections on a Health System's Telemedicine Marathon

“…Telemedicine offered an optimal path to continue care for patients concerned about potential infection from exposure at health care facilities. At UPHS, similar to other large health systems, 2,3 the volume of telemedicine encounters within weeks increased from <100 per day to >7000 daily encounters (Fig. 1).…”

The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study

“…In response to the COVID-19 pandemic, health care organizations rapidly implemented telemedicine protocols to protect health care workers and patients [1][2][3]. The anticipated surge in patients and shortage in personal protective equipment (PPE) were key drivers for the implementation of virtual visits and medical screening exams in the inpatient settings and emergency departments [4].…”

“…With the COVID-19 pandemic, telemedicine capacity was rapidly implemented in ambulatory settings [1][2][3]. Emergency departments also found multiple use cases for telemedicine including patient triage and expedited care for stable patients, reduced potential provider exposure to COVID-19, decreased use of PPE, reducing patient isolation, and allowing quarantined physicians to continue practicing, among others [4][5][6]12,13].…”