During the pandemic, out of necessity, the adoption and use of telehealth grew exponentially. Health systems that already had telehealth programs rapidly expanded these offerings, while other health systems sprinted to implement virtual care capabilities. This resulted in a dramatic uptick in providers trying to see patients online through any means possible, whether that be via a Facetime call or connecting through their EMR. But as a "new normal" for healthcare is emerging, it’s becoming increasingly clear that not all video connections are created equal.
Now, as health system leaders reassess their telehealth strategies and look to make virtual care a sustainable part of the care experience, they realize that simple video connections aren’t enough to power seamless and easy care experiences for patients and providers alike.
To understand how health systems are evolving their virtual care strategies and leveraging a telehealth platform to meet the needs of patients and providers beyond the pandemic, Amwell hosted a roundtable featuring five health system leaders during its 2021 Client Forum, which Becker’s Hospital Review attended.
Participants were:
- John Callison, MD, vice president and chief medical information officer, University of Tennessee Medical Center in Knoxville
- Sally Eckford, assistant vice president, virtual health, Wellstar Health System in Marietta, Ga.
- David Kogan, vice president, Indiana University Health (IU Health) in Indianapolis
- Eric Liston, administrator, Intermountain TeleHealth Services, Intermountain Healthcare in Salt Lake City
- Teresa Neely, MBA, BSN, RN, senior vice president, chief ambulatory officer, chief nursing officer, ambulatory, University of Wisconsin Health (UW Health) in Madison
These leaders represent large health systems with multiple hospitals, outpatient clinics, and urgent care centers, all requiring significant digital care coordination.
The pandemic supercharged telehealth
While most health systems had some form of telehealth in place prior to the pandemic, COVID-19 caused them to have to completely rethink their care delivery strategy and expand what was being done virtually. "Prior to the pandemic, Intermountain already had a pretty robust telemedicine program, and the pandemic put it on steroids and made everything go faster," Mr. Liston said. Similarly, UW Health had a robust telehealth program in place pre-COVID, said Ms. Neely. This program offered specialty care consults across UW’s hospitals as well as on-demand care, eICU program and tele-stroke services. When the pandemic began, however, within a four-week period UW scaled its virtual platform across its inpatient and ambulatory system to support 1,700 providers.
Likewise, for Wellstar Health System, the need to scale happened quickly, “As fast as COVID came, we reacted just as rapidly,” Ms. Eckford said. Reacting meant educating providers on a range of things such as how to access Wellstar’s virtual platform and how to conduct virtual “no touch” exams. To keep its physicians and medical staff updated on virtual health platform offerings, Wellstar created a Virtual Health Guidebook, a comprehensive manual with up-to-date information on trainings, and resources that could be accessible from any location.
The situation was a bit different for UT Medical Center where they did not yet have a telehealth program until the pandemic hit. "We had thought about telehealth, but had not taken the first steps to implement it," Dr. Callison said. "COVID created a burning platform. I’m not sure how we would have accomplished what we did without having our providers being essentially forced to seek alternative options to continue managing their patients when in-person visits dropped off... I don’t think telehealth at our institution would have been as successful without that burning platform."
Beyond urgent care: During the pandemic, health systems relied on telehealth for numerous use cases
Throughout the panel, each health system highlighted how COVID-19 caused them to expand the amount of use cases they were using virtual care for. A few examples: In April 2020, IU Health built a “hospital at home” program to serve COVID-19 patients after they were discharged from the hospital. Mr. Kogan said more than 800 patients have been assisted. Similarly, UW Health piloted using virtual care for patients who were discharged from the emergency department.
To Dr. Callison’s surprise, UT Medical Center’s neurology and dementia clinic embraced the use of telehealth during the early days of the pandemic. “For a couple of months, they did no inperson visits; everything they did was via telehealth,” Dr. Callison said. “They were doing dementia assessments, cognitive assessments, all remotely.” He also described a radiation oncology use case where patients, instead of having to travel back to the tertiary hospital, could have images done closer to their home at satellite clinics.
Ms. Neely described an in-hospital digital health use case as well. UW Health decided to have smaller rounding teams go into patients’ rooms and then connect virtually with other team members outside of the room.
All of these use cases underscore how virtual care is now being used to enable much more than urgent care visits and can improve patients’ access to care, enhance the patient experience and increase operational efficiency across many specialties.
Looking to the future, health systems are thinking more broadly and strategically about virtual care
Having made it through the pandemic surge, virtual care leaders are now focused on current and future opportunities for their health systems to take greater advantage of digital health. Through virtual care technologies and creative operational design, IU Health is launching integrated behavioral health into all of the system’s primary care offices and other ambulatory clinics across Indiana. “Over 100 clinics will now have a virtual behavioral health consult available to them in an acute setting,” Mr. Kogan said.
Ms. Eckford explained that Wellstar is now focused on designing the future of healthcare by standardizing technology, having the entire health system follow the same workflows, while also looking into a virtual hospital concept. Wellstar is currently defining what a virtual hospital would mean for its system, pursuing tele-sitter and tele-ICU as well as considering a shared services model with many subspecialties. “We are eagerly working to define what hospital at home might mean for us and the best approach for our patients,” she said. This month, Wellstar also introduced Catalyst by Wellstar, a global digital health and innovation center created to disrupt how Wellstar delivers care to create better patient and provider experiences.
Intermountain is focused on both making the experience far better for patients cared for in the hospital, while also “recognizing that more and more care will be delivered in patients’ homes,” Mr. Liston said. To improve the in-hospital experience, Intermountain has partnered with Amwell to make the existing televisions inside of patient rooms be the primary telemedicine communication piece for any interaction. To better serve patients at home, Intermountain has an acute care at-home program that has provided care to thousands of patients in their home utilizing video, as well as remote patient monitoring and devices.
Making the vision of virtual care a reality requires a technology platform that integrates all aspects of telehealth and with traditional workflows
The panelists described how in order to truly make virtual care an integrated and sustainable part of care delivery moving forward, they needed an enterprise-level platform. The most frequently stated requirements for the platform were to be well integrated, including with the EMR and with multiple technologies, systems and devices to make it a part of existing clinical workflows.
Integration is also a key factor in making virtual care seamlessly fit into the care experience, allowing patients to see the same doctor in person or online depending on their needs, even as those needs change over time. This allows for relationship building and consistency whether the care needs are episodic or longitudinal. Health system leaders also expressed a desire for their telehealth platforms to be able to aggregate data and be simple and easy to use, no matter where or how patients are connecting. Mr. Liston described Intermountain’s desire: “To be able to care for patients in their homes or in care centers and combining these pieces together to build an ecosystem that is agnostic to where people are.”
Mr. Kogan expressed a desire for “seamless, agnostic, multifunctional capabilities for patients, providers, and team members to engage.” He continued, “being statewide and having patients who engage with us in a lot of different venues, having a common front end and ease of use is absolutely critical.”
Amwell’s Converge platform delivers what health systems are looking for
There was consistent excitement about Converge as a virtual care platform that could support health systems’ needs. Mr. Liston shared Intermountain’s perspective. “We’re super excited about what Amwell is doing with Converge. The idea of building an ecosystem that feels consistent to our providers, patients and those who do the work — we’re very excited about that.” He also complimented Amwell for being forward-looking and “building ways that we can appropriately bolt on other partners to provide a true broad ecosystem for those that we care for.”
Ms. Neely sees Converge as providing “an opportunity to have an integrated approach for all and making sure that UW Health’s care model supports patient choice.” She sees the Converge platform as an integrated platform that is a way to smooth the patient-provider-team experience. UW Health views the EHR as a “system of record and Amwell as our system for engagement,” she emphasized.
Ensuring virtual care success for the future
When asked about how they will define success for their digital health strategy moving forward, answers varied and included looking at the percentage of visits that happen via telehealth, measuring the patient experience and provider engagement, and looking at return on investment. One area of agreement however was around the value of creating teams and councils who can help hospitals and health systems prioritize the most important digital health opportunities for this postpandemic world.
Even before the pandemic, IU Health created a virtual care council to provide input and feedback about virtual care opportunities. IU Health also created patient and family advisory councils to make sure that community members had a voice in its digital health plans. “We process all that feedback from providers and patients, and we’ve morphed that into significant new models of care and continuous improvement opportunities,” Mr. Kogan said.
Wellstar also previously had a virtual health steering committee. But during the pandemic, digital health became such a high priority that this health system created an executive virtual hospital group that is driving the health system’s most important digital initiatives — now and in the future.
In addition to these executive-level councils to drive digital initiatives, Dr. Callison called out that a longer-term key to success is leveraging supportive physician champions to advocate for telehealth and to communicate its successes.
Mr. Liston summarized the sentiments of Intermountain, and of several other panelists. “Our mission is to help people live the healthiest lives possible, regardless of where they are — if it’s in their home, if it’s in the hospital — and find the least restrictive care patterns and use technology to make their lives better. That’s our commitment.”