Caring For Covid: Our Strategy For Home-Based Connected Care
Froedtert & Medical College of Wisconsin adopted digital to help over 9000 people to date recover safely at home
While 2020 was certainly not the year we were all expecting and hoping for, necessity has spurred innovation and change. Though virtual visits have been front of mind during the pandemic, other forms of digital health care have been making meaningful impacts on our patients.
As we approach the end of 2020, we are administering our first doses of the mRNA vaccines which help our bodies engineer antibodies to SARS-CoV-2, the virus that causes COVID-19. It’s a triumph of science, built upon decades of research and experience. The technology was there … it was just about putting the pieces together to face the challenge.
While really nothing compares with the efforts of the scientists who worked tirelessly over the last year to create, evaluate, manufacture, and disseminate the vaccines — if you’ll permit me — I’d like to also extend appreciation and recognition to our clinicians who rapidly adopted and adapted to care for people in unprecedented times… our Fastcare clinicians, our virtual care team, and our primary care physicians and specialist clinicians who flexed to meet the challenge. They worked tirelessly as well to help treat and manage patients, and reduce the strain on our very busy colleagues in the emergency departments and hospitals.
In putting together our COVID-19 digital strategy, we also discovered that we could care for people using technology we had invested in and develop new models of care.
During a fortnight of some very long days, our team worked with our internal and external partners to lay out a plan that would leverage our digital care assets and help as many as possible find answers, access testing, manage COVID-19 cases at home, and stay connected to clinicians for longitudinal care.
We also had to make sure that we helped keep as many people as possible out of the hospital, and out of emergency departments, as long as it was safe to do so. We needed to support our colleagues and make sure that we helped people find the right level of care.
Our digital pipeline has evolved over the course of the pandemic. What’s really cool to see how is that we have been able to deploy a new form of health care along the way.
What’s really cool to see how is that we have been able to deploy a new form of health care along the way.
The Building Blocks
From the time someone is searching their symptoms to the time that they recover (either at home or following their hospitalization), patients have the option to be digitally connected with our care teams.
We have leveraged several of our capabilities for COVID
- Our mobile application, which integrates the electronic health record and all of the following components into a single interface.
- Virtual Triage — find out what symptoms mean, and get the latest CDC guidance thanks to our symptom checking tool, powered by Buoy Health.
- Asynchronous Care — Use our “e-visit” to report symptoms and have them be reviewed by a clinician. If testing is warranted, appointments, or the option to self-schedule an appointment is provided. In this way, we provide care for people with a two-hour turnaround time… and usually much less than that.
- Synchronous Virtual Visits — Using both our on-demand capabilities for virtual urgent care as well as scheduled video visits with patients’ primary care and specialty clinicians.
- Remote Monitoring — Since late March, we have been providing patients with a pulse oximeter and remote monitoring that leverages our centralized Froedtert & MCW Virtual Care Team and our technology partner GetWellNetwork. (More Described Below)
- Hospital Virtual Care and Presence — we have leveraged our virtual ICU capabilities to more broadly support COVID-19 related care while also supporting virtual hospital visits when appropriate and family visitation when needed.
- Mental Health Support for people managing anxiety and stress while recovering
The experience of care is perhaps more than the sum of these components… it is also how well they are organized, how personable and person-centered the care is, and how efficient and seamless it is as well.
Asynchronous E-Visits for Assessment and Testing
In many cases, we now start with an asynchronous ‘e-visit’ where people will provide their symptoms and some accompanying information about their onset and any other pertinent details. If they may qualify for advanced therapies, including bamlanivumab, we will ask some additional questions to make sure our chart is up to date with any qualifying criteria.
Those who have undergone testing will have their results immediately pushed to them through our Froedtert & MCW mobile app and/or receive a MyChart notification. In our quality assurance reviews, we find that over 99% of patients tested have followed through to view and manage their results.
For those who are positive, we direct to the latest information about managing COVID-19. We also provided instructions to pick up a COVID Care Kit that includes a pulse oximeter and instructions to use our remote monitoring program. As of December, we have begun shipping pulse oximeters to patients with positive results while also providing ways for patients or their family/friends to pick up a pulse ox if one is needed sooner.
If we are notified of results from external sources, including those done by the State of Wisconsin, our electronic systems will process these results and also enroll patients in the services.
We enrolled patients within 24 hours of positive results into the remote monitoring service. They received a link to manage their account and either continue on the web or download a mobile application. The service allows for daily symptom check-ins and provides important reminders, self-care resources, and tips to navigate recovery. The remote monitoring period lasts 16 days but can be extended for another 16 days if warranted.
- Over 18,000 have been invited to participate in remote monitoring
- Over 9,000 have engaged with us through the program
- Patients have had over 305,000 check-ins with our teams
- We have monitored over 2,200 alerts within the program
Patients have access to a 24/7 connection to our virtual care team for bidirectional and multimodal communication and support. Our virtual care team is comprised of highly trained nurses, many with intensive care unit backgrounds, who are well-versed in digital care. The team supports on-demand and proactive assessment, triage, intervention, and escalation. Our nurses also can recognize other issues, such as anxiety that can accompany COVID-19 and can refer to programs as needed.
For patients who are leaving the hospital after a COVID-19 diagnosis, they are discharged with a 7-day remote monitoring loop that allows for the same level of services and care.
Patients have access to a 24/7 connection to our virtual care team for bidirectional and multimodal communication and support.
When I met with many of my own patients within the past few months, the “what if” question of COVID-19 would frequently come up. It was reassuring to them (and me too!) that we had a set of supports to help monitor and manage people through COVID-19. Our goal was to safely help people recover at home while being able to escalate care to the hospital early based on a person’s trajectory with the illness and their patient-reported outcomes and pulse oximetry data.
What I find inspirational about this process is that, for many patients, this is a new experience of healthcare. One that doesn’t involve waiting on hold to be scheduled into a far off appointment. One that doesn’t have waiting rooms. One that doesn’t have an arbitrary “see you in 3 months to see how you are doing.” It’s one that guides people through, supports them end to end, and provides proactive care for those who need it when they need it.
Certainly, we look to see how we can rearrange several of these building blocks to create better care experiences. We have learned so much this year. Digital care is so much more than just synchronous telemedicine. We do have the potential to rightsize care, have it be delivered in the home setting as much as desired, and to reduce the costs for patients.