Ambulatory Telehealth Efforts During a Pandemic

"…Whether prior to or amid the COVID-19 pandemic, the ambulatory telehealth journey has varied among healthcare organizations. However, the goals and themes have been consistent to delivering quality care in patients across the nation. Regarding my organization, the Medical University of South Carolina (MUSC) started their telehealth ambulatory efforts in 2010. A few years later, the state legislature requested collaboration of organizations to further expand telehealth offerings. MUSC is a state funded entity and was charged with internal and external expansion alongside identified state partners, including but not limited to Prisma Health, Department of Mental Health, McLeod Health, Beaufort Memorial, Care South, and Spartanburg Regional. As a result, the South Carolina Telehealth Alliance (SCTA) was born. State funding allowed MUSC and the SCTA to build their own telehealth programs. In addition, the state funded a new MUSC department called the Center for Telehealth to assist with mandate telehealth development. Through years of improving access to care across the state, the Center was designated by HRSA as a National Telehealth Center of Excellence in 2017. Investment from the state legislature allowed MUSC to create a telehealth infrastructure prior to the pandemic, but analogous to other national healthcare facilities, we were not prepared for the impact and sheer volume of converting thousands of in-person appointments to virtual visits…

…At the beginning of the pandemic, we could not scale up to meet the demands asked of us due to accessibility difficulties for both the patients and providers. We quickly realized that standardized workflows were crucial as clinic staff members were asked to take on new roles of connecting patients and providers virtually. In addition, clinicians needed a way to communicate as staff could no longer discuss cases face to face in an academic setting. Through self-learning and liberation of technologies, providers organically pivoted from our current EHR video model to a simpler web-based platform that broadened access and mimicked in-person clinic features— virtual waiting rooms, multi-party calling, and chat functionality. During the visit, providers instinctively relied on family members’ assistance and home monitoring devices for their individual assessments and plans of care. While most clinicians in the institution were new to telehealth, designated provider superusers from various departments created videos to share with staff, and trainer the trainer concept was encouraged and expected. Further education material was housed on public websites for both patients and clinicians. In addition, for real time clinic support, my colleagues set up a help desk to assist in the virtual transition. Whereas every attempt was made at standardization and clinic support across the working departments, clinicians created efficient and not so efficient workflows. As a result, establishing the ideal virtual clinic continues to be an uphill battle.

In spite of this barrier, MUSC reached the targeted goal of 80% virtual ambulatory visits within two months of the pandemic (Fig 3). With temporary policy changes, the SCTA partners also exponentially increased access to care across the state totaling 1,301,901 outpatient video visits from January to June 2020. These telehealth services offer financial sustainability with full reimbursements. MUSC and SCTA continue to lobby for permanent coverages as providers question how to structure their clinics with the looming unknowns—will all healthcare professionals continue to be provisioned in tele; will CMS revert to designated geographical locations and originating sites; and most importantly, will CMS and private insurers permanently allow for full reimbursement of tele visits into the home…

…Despite challenges, Dr. Patrick Cawley, CEO of the MUSC enterprise, describes this new era of healthcare as a period of digital transformation. He states, “technology is changing the constraints that we have operated under for years.” He explains this change in culture by pivoting to the needs and satisfactions of our patients. Currently trending, patients prefer more frequent, shorter visits, which can be best accomplished via ambulatory telehealth. To further enhance the patient and provider experience, MUSC leadership is exploring a new structure for every service line that encompasses telehealth and clinical support…

…Nationally and internationally, media, law, and literature indicate a positive support to continue this new paradigm of healthcare innovation with telehealth. Future research is needed to support the impact on the quality of care delivered, and the emergence of published best practices will offer new discoveries in healthcare. The ongoing COVID-19 pandemic has allowed breakthroughs in telehealth that have advanced how the world deliveries and accesses care."

Fig 3— Illustrates MUSC’s weekly outpatient volumes from mid-March to mid-May. Telehealth efforts allowed us to reach our first enterprise goal of 80% visit volume via tele. MUSC Source: Dr. Jillian Harvey, Dr. Jimmy McElligott, Kyle Williford MBA