Long-term lessons from the rapid ramp-up of telehealth Insight Article - September 10, 2020 Electronic Health Records Patient Care Technology HIT Regulations Sign in to save Monica Bolbjerg MD Justin Barnes The 2020 rapid ramp-up of telehealth technology for virtual visits was unprecedented. Never has a technology been so quickly implemented and adopted within the physician community. In fact, within six weeks of the initial COVID-19 outbreak, nearly half of all physicians were treating patients through telemedicine.1 According to Medicare claims data, almost 1.3 million members per week were receiving telehealth visits during the early weeks of the pandemic versus only 11,000 the week of March 1, 2020.2 As telehealth visit volumes grew, so did the best practices associated with them. Medical groups that rapidly implemented and used telehealth in response to the COVID-19 pandemic learned important lessons for optimal practice workflow, practice operations, remote patient monitoring (RPM) and revised technology considerations for the long-term optimization of virtual patient visits. It’s important for practice leaders to understand these best practices, since telehealth is here to stay for most Level 1 and Level 2 visits. From small to large, medical groups go virtual Physician leaders are well accustomed to implementing new technologies and integrating third-party applications into core systems. Likewise, virtual visits were not foreign to most practices before the COVID-19 crisis. However, the chase to conduct virtual patient visits as soon as possible introduced several shortcuts never before imagined: Telehealth applications were implemented in days versus months. The traditional technology evaluation process was completely circumvented. Training was conducted online and within hours. For thousands of practices nationwide, shuttered doors necessitated rapid implementation and use of telehealth technology. In one example, a virtual-visit technology company partnered with one of the industry’s top five EHR systems to deliver rapid-response telehealth capabilities to nearly 3,000 providers and 6 million patients during the first month of the crisis.3 OurHealth, an Indianapolis-based medical group operating 40 onsite and near-site primary care clinics in the Midwest and Southeast, was one of those providers. Up and running in a weekend OurHealth is no stranger to using third-party solutions integrated with its proprietary technology and athenahealth EHR system. But implementing a new application across 40 locations with a one-weekend turnaround to install and go live was unprecedented. Sherry Slick, chief information officer for OurHealth, tapped the ready-made integrations and application programming interfaces (APIs) of athenahealth’s open marketplace. One of the telehealth vendors participating in the marketplace was chosen based on highest ratings, scale and speed to implementation — determining factors during the initial month of COVID-19. OurHealth spoke immediately with the telehealth company and within hours, the group’s EHR vendor flipped APIs so that the vendor’s implementation team could complete the implementation over the weekend. “Training providers first was an important strategy,” Slick explained. “We shared documentation through a common learning management system and then staggered telehealth onboarding for the rest of the wellness staff. By the end of April 2020, telehealth visits accounted for 14% of all appointments across our clinics.” Small practices survive the bind Even the smallest practices had to quickly ramp up telehealth during the initial weeks of the COVID-19 crisis. Again, prebuilt APIs and around-the-clock vendor support were the keys to success. Bright Stars Pediatrics, a small Texas practice, immediately heard horror stories from colleagues about off-the-shelf teleconferencing applications. Instead of struggling with suboptimal consumer products, Karen Pilgrim-King, MD, reached out to her EHR vendor’s marketplace for a highly rated telehealth solution. Once a decision was made, the new telehealth system was installed and running within 36 hours. No assistance was needed from IT resources, and one-third of Bright Stars’ visits were virtual as of April 2020. A text-message campaign was launched to inform parents of the new application and how to download it for use on browsers and mobile devices. “I really do enjoy that I can sit in my office and have a nice, long conversation with the parents. I can even do it during my lunch hour. It certainly removes some of the time constraints,” Pilgrim-King said. Longer-term telehealth requirements emerge: best practices to consider At this point, the move to virtual visits is complete for nearly all physician organizations, including Federally Qualified Health Centers (FQHCs) and clinics. Early 2020 telehealth experiences helped build a solid checklist of technological and operational capabilities necessary to support ongoing and expanded use of virtual visits. Both OneHealth and Bright Stars Pediatrics expect to continue using virtual care and further expand their telehealth services over time including integration of remote patient monitoring (RPM) devices. To accommodate this growth, these checklist items can help ensure optimal long-term success: An EHR with API capabilities is the foundation. Many practices began their EHR journey with a low-cost system simply to get started. However, COVID-19 pushed the limits of most basic EHRs. Look for vendors with many prebuilt API-based integrations. This ensures the practice can easily interoperate and scale quickly with essential innovations such as device integration and RPM. Check for all necessary modules and services. The video call between patient and physician is only one step for effective virtual visits. Other clinical and financial capabilities must be present across four specific categories: Payment and reimbursement: This includes ability to handle federal programs and state-based initiatives, including payer-specific value-based care contracts. Vendor contracting requirements: Key contract criteria include desired consulting services, patient-provider communication tools embedded in the platform and integration with RPM devices. Technical considerations: As you reconfigure practice networks to boost bandwidth in support of quality video and audio streaming, one technology must-have is app- or web-based access/call capabilities from any device. Consumer considerations: Remember when you start implementing virtual visits, you are no longer just delivering technology to doctors, you are delivering technology to consumers — and it is completely different. Ensure it is easy to get started, intuitive, works on all devices and integrated with your EHR(s). Look for flexible training options. Rapid telehealth implementations rewrote the book on physician and staff training. Vendors should already have best practices for rapid deployment including the ability to support online training and implementation for dozens of providers and staff, if necessary. Look for a vendor’s ability to conduct multiple training sessions per day. Ensure proactive customer support. Vendors should have established daily customer support rapid response teams by segment (enterprise groups, FQHCs, standard MD practice, etc.) as that proved invaluable during the COVID-19 crisis. These teams gave customers instant access to support. In addition, the rapid response teams continuously monitored support lines to manage rapid rollout of functionality. Ask for patient-facing support. Telehealth and integrated platform leaders should offer product and platform support for patients, including RPM and virtual care devices. Patients may need help navigating the technology, and most physician teams lack sufficient time and expertise to teach patients how to access essential telehealth and healthcare applications on myriad consumer devices. This is where the vendor’s support team is also extremely helpful. Keep an eye on future patient needs. Always look ahead when evaluating telehealth platforms. Forward-thinking technology should already accommodate or be prepared to develop functionality for: RPM devices with no-cost integration Touchless virtual check-in, self-scheduling and copay collections Remote care management Care collaboration Patient engagement Patient empowerment. Know where you want to go. Patient visits have shifted to telehealth and remote care management. But care transitions won’t stop there. Dozens of other essential virtual care applications and modules will be needed in the future to enable more remote care delivery options. For example, be ready to monitor and manage quality, KPIs and outcomes in the virtual model. Finally, as telehealth and RPM reimbursement rules, codes and revenue streams evolve, ensure systems can accommodate, and vendors can provide training and consultative support for billing adjustments. Telehealth lessons learned Begin with a solid EHR foundation Choose a solution with prebuilt APIs to your EHR to improve speed and scalability Train providers first and then stagger telehealth onboarding for other staff Seek all-in-one virtual care platforms that integrate telehealth Ensure your patients receive the essential support they need. Conclusion From serving remote populations to building blended office schedules, telehealth improves the healthcare experience. Consumers appreciate more choices, and physicians appreciate greater flexibility. However, standing up all the various interfaces with telehealth, RPM and more isn’t a realistic expectation for most physician groups. It’s time to ensure your EHR platform is ready for the next wave in virtual healthcare delivery. EHR limitations now may result in your inability to innovate with telehealth technology tomorrow. Notes: Merritt Hawkins. “Survey: Physician Practice Patterns Changing As A Result Of COVID-19.” April 22, 2020. Available from: bit.ly/30b1xbK. Pifer R. “Medicare members using telehealth grew 120 times in early weeks of COVID-19 as regulations eased.” Healthcare Dive. May 27, 2020. Available from: bit.ly/2DEd1wF. Carrasco T. “Qure4u Partners with Healthcare Providers to Deliver Rapid Response Telehealth During COVID-19.” April 20, 2020. Available from: bit.ly/2CCGxCI.