Children's National Hospital in Washington was in the midst of an enterprise digital-transformation initiative before the COVID-19 pandemic struck in early 2020.

THE PROBLEM

The organization was transitioning telehealth platforms pre-COVID-19, and was using Zoom as an interim solution. Telehealth reimbursement realities at that time constrained a compelling business case for significant capital investment in a new platform. Few insurers were paying for telehealth encounters where the patient's location was in a nonmedical setting.

The financial realities of the COVID-19 environment postponed the organization's implementation of a new long-term enterprise platform, but it rapidly scaled Zoom for ambulatory use cases and vendor InTouch Health for inpatient telehealth activities.

PROPOSAL

"Maintaining flexibility and adaptability while transitioning platforms was a major challenge," said Clarence Williams, director of telemedicine at Children's National Hospital. "Focusing on a long-term strategy while adapting to the operational demands of the COVID-19 pandemic was paramount."

Zoom allowed a rapid implementation free of APIs and integration diligence, he added. The COVID-19 pandemic placed considerable demand on health IT project resources, so scaling the interim solution was a cost-efficient solution to the challenge of rapidly implementing an enterprise telehealth capability, he said.

"We surpassed 100,000 billable telehealth encounters nine months after the COVID-19 ramp-up, and many more non-billable transactions were performed to support wraparound services such as case management, care coordination and social work."

Clarence Williams, Children's National Hospital

"We combined Zoom with other patient-facing IT systems to create a cost-feasible telehealth workflow," he explained. "Fortunately, we completed purchasing diligence requirements before the COVID-19 pandemic, which helped streamline our rapid implementation."

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MEETING THE CHALLENGE

Children's National Hospital chose to forgo creating APIs in transitioning to a more dynamic long-term solution. The workflow included Zoom, InTouch, Phreesia, Martti, eClinical Works and Cerner.

"Each specialty division established a standard operating procedure, given the complexity of the populations we serve," Williams said. "Clinicians throughout the organization rapidly adopted the technology to minimize disruption in patient access managing chronic patients. We centralized our internal stakeholder messaging through a SharePoint site as our communications team helped manage real-time mass communications."

RESULTS

Telehealth utilization peaked when 85% of ambulatory encounters occurred via telehealth.

"We surpassed 100,000 billable telehealth encounters nine months after the COVID-19 ramp-up, and many more non-billable transactions were performed to support wraparound services such as case management, care coordination and social work," Williams related. "Telehealth encounters are 20-35% of current ambulatory volumes."

The organization has seen a decrease in clinic no-shows and cancellations, comparing telehealth visits to face-to-face visits. Less than 1% of telehealth encounters require technical support, and the staff is pleased with the 99%-plus technical success rate. Staff members also are happy with the value that telehealth has driven.

USING FCC AWARD FUNDS

In 2020, the FCC telehealth funding program awarded Children's National Hospital $928,183 for telemedicine carts, tablets and other connected devices, a telehealth platform, and other telehealth equipment to treat seriously ill COVID-19 pediatric patients, as well as patients up to 30 years old, and to continue to provide evaluations, diagnoses and care to patients with acute or chronic health needs via telemedicine.

"The FCC funding supported telehealth operations by enabling the organization to continue scaling telehealth use cases," Williams said. "Some of the use cases include direct-to-patient and clinic-based telehealth. We procured telemedicine carts to support our telehealth workflows requiring telemedicine peripherals such as digital stethoscopes and scopes. These devices expand specialty access in the community and allow our providers to manage chronic patients throughout the region."

Ultimately, the FCC award allows the organization to maintain long-term focus while solving short-term operational challenges related to the COVID-19 pandemic, he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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