Telehealth: Wiring Changes To Improve Patient Care and Convenience

Imagine being able to receive medical care without ever leaving your home or place of work, truly integrating health care into *your* life. This is now a reality thanks to the growing adoption of telehealth in healthcare systems across the country, and our academic health system is no exception. But we will realize this future only if we continue to offer more and more services for patients through virtual means. In the wake of downward usage of telemedicine (at least from pandemic surges), here’s a status update of virtual care in our organization.

A Compelling Story of Telehealth Success

Let’s start with a win. Recently, one of our colleagues was routed a patient call from the spouse of an older person who was feeling unwell, with respiratory symptoms. Was it Covid, flu, something else?

Instead of scheduling an in-person visit, the colleague suggested a video visit instead. The scheduling team quickly added in a virtual visit, the patient and spouse checked in digitally, and then both parties were live and on camera. During the virtual appointment, the colleague was able to make a diagnostic and treatment plan without the patient needing to travel to the hospital for an evaluation. This was a win-win for everyone involved, as the patient was able to receive care more quickly and conveniently, while also reducing the burden on the healthcare system. How can this be our norm?

Current Telehealth Adoption and Future Goals

Our academic health system has fluctuated in terms of its adoption of virtual visits and care. In the past 12 months, we’ve averaged a 10% virtual care rate, but our goal is to reach 14%. This includes video-based care, scheduled telephone visits, asynchronous e-visits through the portal, and usage of digital therapeutics. The general trend has been downward, coming off of pandemic waves. But why? Our hypothesis is that it’s not because telehealth is not valuable, it’s that we have fallen back into our usual patterns.

Is telehealth inferior to an in-person visit? Yes, probably. I admit that. The richness of a human interaction face-to-face with the ability to do a full physical exam, if needed, is hard to beat. But I would argue that the face-to-face is expensive for everyone, especially the patient who (aside from visit costs, which may be similar) must take time away from other obligations. If we are serious about meeting needs in the lowest cost setting that adequately delivers good care, we will increase our usage of telehealth.

To drive home these points, plus add tools for clinics to set and track golas for virtual adoption, create pathways, and incorporate learners, we created a playbook for departments and clinics to use, thanks to the leadership of Chris Decker, Madison Crowe, and many others.

Learnings

We have focused on how to use telehealth to improve the quality and accessibility of our care. It’s clear that it needs to be easy to use — which has been our primary focus. We recently published a survey of our clinicians who adopted telehealth in the last 2 years. We have applied the learnings to (1) make it easier and (2) hardwire it more through support and education.

Making Telehealth Easier to Access

We understand that one of the barriers to telehealth adoption is the ease of access. That’s why we’ve made it a priority to ensure that our telehealth solution is durable, able to withstand network blips and low bandwidth. We adopted Zoom as our in-app experience for most cases, as it provides a better experience than video through web browsers, which is important for a 15-minute visit with your clinician where you don’t have time to repeat yourself or troubleshoot.

We have integrated Zoom into our Froedtert & MCW mobile app, which means patients can now launch the video visit within the app with just one tap. This provides superior audio and video quality, and we’re seeing this reflected in our after-visit surveys where in-app (Zoom embedded) performs the best for patients technically. We still do offer the ability to launch Zoom in a web browser for some patients, only if they are not able to download our app or the Zoom client on a desktop. As a result of these efforts, video visits performed through the app.

For visits performed through our app, we have recently achieved top decile in patient satisfaction through our Press-Ganey surveys. We also have our lowest video visit failure rate to date.

Improving Access and Convenience for Patients

Our digital operations leaders are also working to further hardwire the ability to more rapidly get patients the answers they need through telehealth. For example, our general medicine team (specialty clinics internal medicine) is creating virtual access slots to be used, while taking complicated MyChart messages and turning them into same-day or next-day video visits. This is also being piloted in our community primary care as well. This is all a win-win, for patients have needs met, more quickly (access strategy), without needing to come to medical clinic taking time away from other responsibilities (convenience), and add flexibility to clinicians (work-life balance) in how they see patients.

Encouraging Telehealth Adoption for Care Pathways

We encourage our medical practice and departments to begin to hardwire some care pathways to use telehealth. For example, follow-up hypertension appointments could be addressed with a $30 home blood pressure cuff and a virtual visit. Medication monitoring, six month diabetes follow-up visits, follow-up orthopedic care, and cancer second opinions are just a few examples of the many ways telehealth can improve patient care while also increasing convenience and access. We are ready to work with our medical practice and departments to identify and implement telehealth opportunities in their areas of specialty.

Collaboration for Continued Telehealth Adoption

We’re excited to be joining an AAMC collaborative with other academic systems to explore ways to further telehealth adoption and improve patient care. By working together, we can continue to find new and innovative ways to use telehealth to improve access to care and convenience for patients, while also providing flexibility for clinicians.