Rapidly scaling video visits during COVID-19: The ethos of virtual care at Yale Medicine

Abstract

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.

Synchronous Home-Based Telemedicine for Primary Care: A Review

“…The second study took place in a U.S-based Veterans Affairs facility and found that 82% of patients who received a tablet for telemedicine visits used their devices for at least one telemedicine consultation while 30% used it more than 5 times (Zulman et al, 2019). Among the studies that demonstrated rapid uptake of synchronous telemedicine during the COVID-19 pandemic, there was little consistency in which type of visit was most common (i.e., telephone, video or both; Esper et al, 2020; Hoffman et al, 2020; Joy et al, 2020; Lau et al, 2020; Olayiwola et al, 2020; Reed et al, 2020; Spelman et al, 2020). Two studies cited telephone encounters as the most common visit type (Lau et al, 2020; Spelman et al, 2020) with three studies finding video to be the most common (Esper et al, 2020; Hoffman et al, 2020; Olayiwola et al, 2020) and one noting equal rates of video and telephone visits (Reed et al, 2020).…”

“…Eight articles identified patient or provider training for synchronous telemedicine as a major factor determining successful implementation (Hawley et al, 2020; Hoffman et al, 2020; Khan, 2013; Lau et al, 2020; Olayiwola et al, 2020; Spelman et al, 2020; Srinivasan et al, 2020; Zulman et al, 2019). Three studies noted that integrating appointment systems and EHR systems was critical in enabling providers to stay present during conversations rather than be pre-occupied with notetaking and record keeping (Donaghy et al, 2019; Esper et al, 2020; Hoffman et al, 2020). One study that addressed nursing telehealth competencies cited coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude as critical for successful implementation (van Houwelingen et al, 2016).…”

“…Notably, five studies that evaluated U.S.-based telemedicine programs during the COVID-19 pandemic cited continued reimbursement of synchronous telemedicine consultations as key to the adoption of synchronous telemedicine within primary care practice and as important to ensure further use and increased adoption of synchronous telemedicine post-pandemic (Hoffman et al, 2020; Lau et al, 2020; Olayiwola et al, 2020; Spelman et al, 2020).…”

“…One study that addressed nursing telehealth competencies cited coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude as critical for successful implementation (van Houwelingen et al, 2016). Notably, five studies that evaluated U.S.-based telemedicine programs during the COVID-19 pandemic cited continued reimbursement of synchronous telemedicine consultations as key to the adoption of synchronous telemedicine within primary care practice and as important to ensure further use and increased adoption of synchronous telemedicine post-pandemic (Hoffman et al, 2020;Lau et al, 2020;Olayiwola et al, 2020;Spelman et al, 2020).…”

Feasibility of Group-Based Implementation Facilitation for Video Telemental Health

“…Video telehealth has experienced rapid growth throughout the COVID-19 pandemic, including for mental health (Connolly et al, 2021 ; Hoffman et al, 2020 ; Lau et al, 2020 ; Robinson et al, 2020 ; Rosen et al, 2021 ). The Veterans Health Administration (VHA) has been at the forefront of video telemental health (VTH) directly to patients’ homes, allowing clinicians and patients to engage through a video interface (Lindsay et al, 2017 ).…”