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Prior to the pandemic, Norman Regional had one provider conducting virtual visits and 14 specialty care providers whose practices were on deck to launch virtually, according to Molly McCool-Hare, telehealth coordinator at the nonprofit healthcare system in Norman, Okla. Then, between March 17 and 19 as the pandemic was picking up momentum in the United States, Norman Regional transitioned most of its primary and specialty care practices into virtual care practices.
"We stopped everything we were doing and totally changed focus to respond to that," McCool-Hare said during a webinar hosted by HIMSS. "Now, we have almost 200 providers actively doing virtual visits."
Norman Regional was not alone in its rapid transition to virtual care. Healthcare organizations across the nation faced the same challenge of how to keep patients and providers at home while continuing to deliver services. Now, as they reopen their doors, healthcare systems are sharing some lessons learned in ramping up a virtual care practice and thoughts on how to sustain the momentum.
Building out virtual care practices during COVID-19
McCool-Hare became telehealth coordinator in 2019, operating as a department of one for Norman Regional, a multicampus healthcare system serving regional communities in south-central Oklahoma that employs more than 350 physicians.
When the pandemic started, McCool-Hare faced the monumental task of bringing nearly all of the healthcare system's providers onto telehealth vendor Amwell's platform rather than the 14 she was initially working with. Norman Regional first launched a direct-to-consumer urgent care platform through Amwell in 2018.
"On March 17, our clinic leadership said, 'We've got to get all of our providers on virtual care for scheduled visits; the state is shutting down,'" she said.
To quickly accomplish onboarding physicians onto the telehealth platform, McCool-Hare said she took a "train the trainer method." Normally, she would spend one-on-one time training staff members on how to enroll in and conduct virtual visits. But to speed up the process, McCool-Hare trained clinic directors and managers, who then passed on the training to staff, providers and supervisors in the clinic.
McCool-Hare also helped create shared user guides, cheat sheets and provider scripts. User guides provided information on billing and coding specific to the organization's eClinicalWorks EHR, helping staff maneuver between the different insurer policies for virtual visits related to COVID-19. She also created a shared log of issues that came up.
"If a specific clinic was having connectivity issues, then we knew we needed to contact IT to make sure there was enough bandwidth to support virtual visits," she said. "It enabled us to say, 'Hey, we keep seeing the same issue. We need to share this information with everybody because the fix is the same for everyone.' That was extremely effective."
In Pennsylvania, Christopher LaCoe, vice president of operations at the Penn State Health Milton S. Hershey Medical Center, was also focused on building out a virtual care practice in response to the pandemic.
The medical center was about five years into its telehealth strategy, supporting about 100 of its more than 1,100 providers. With the onset of the pandemic, LaCoe faced a similar challenge as McCool-Hare: He had only a small telehealth team responsible for adding scores of providers onto a telehealth platform, which included virtual services for urgent care. In total, Penn State Health added 4,600 providers and staff to the platform and saw a 2,200% increase in virtual visits, he said.
"We were literally turning out accounts overnight, onboarding staff, providers and patients," he said during the webinar. "We rapidly deployed our own providers onto the urgent care, 24/7 on-demand platform."
LaCoe said that because virtual care had to be deployed across the organization so quickly, the value of virtual care is being realized through its ability to connect providers to patients quickly and efficiently.
Maintaining virtual visits post-COVID-19
It's a value Penn State Health considers a necessary component of its care strategy moving forward.
"We're very focused on continuing in the virtual space," he said. "Not for the sake of just doing virtual visits, but in appropriate use cases."
The gradual return to normal will afford the healthcare system an opportunity to figure out what has worked and what hasn't. LaCoe said the organization will use patient satisfaction data and work with the IT department to mitigate issues such as internet connectivity, a challenge the healthcare system faced particularly with patients in more rural locations.
LaCoe's small support team has been expanded to provide on-hand support to providers, which he believes will help with the organization's optimization efforts.
Christopher LaCoeVice president of operations, Penn State Health Milton S. Hershey Medical Center
"We are going to be, as an organization, more focused on this across the enterprise," he said. "We see it as the way forward."
At Norman Regional, McCool-Hare said she also now has an expanded telehealth team.
"Our goal as the telehealth team is to really integrate telehealth into every touchpoint of our health system, the entire continuum of care," she said. "I don't want to see it as in-person or virtual care, it's all healthcare, we just have different ways to deliver it. So, what is the most effective way to deliver care for this patient for what they need?"