El Camino Hospital in Mountain View, California, is located near Silicon Valley, home to self-driving cars and robots that deliver food. So there is an expectation for tech-enabled healthcare.

THE PROBLEM

Deborah Muro, CIO at El Camino Hospital, actually would receive calls from leaders of high-tech companies asking why the hospital had not adopted a tech-enabled care system.

"On the one hand, I love it: It sharpens us and helps us get better," she said. "But it also adds a higher level of intensity to meeting patients' needs in a more immediate way and with the best solutions available."

Before the pandemic hit in March 2020, El Camino had moved in the direction of telehealth, but virtual care was still a tool the hospital did not yet have. In 2019, when the organization launched a selection process for a telehealth vendor, Muro said it was difficult to talk with executives about why the hospital needed a virtual care platform.

"If you were to look at the statistics at that time, just 1% of visits across the nation were performed virtually," she remarked. "But we knew we needed to skate to where the puck was going. We selected Amwell as our telehealth vendor and planned to initiate implementation during the first quarter of 2020."

Then COVID-19 hit. Muro received a call from the CEO: "Could you stand up a COVID-19 virtual visit offering tomorrow?"

"If we hadn't done that prep work and had a relationship with a telehealth vendor in place, it would have been much more challenging," she noted. "Instead, we were able to leverage our relationship to stand up a 24-hour urgent care offering through our virtual provider within days.

"From there, we worked to train our physicians on telehealth so we could offer scheduled virtual visits with physicians in our clinics, an initiative that naturally followed in our progression toward a full virtual visit program," she added.

El Camino found that with the right infrastructure in place, it could stand up virtual care offerings quickly as various needs arise. The platform and the training staff provided gave the hospital the agility to rapidly meet patients' changing needs.

PROPOSAL

Before the implementation, El Camino Hospital's work with Amwell was designed to offer a full-spectrum telehealth system that would support virtual, on-demand physician services across the continuum of care. It's a system that would provide 24/7 support for physicians, patients and business units using the Amwell Medical Group.

"Under the proposed plan, patients would download an app on their smartphone or other digital device and use it to request a virtual visit," Muro explained. "The app would allow them to select a physician or healthcare provider from a menu according to the provider's availability and then connect to that provider. Wait times would vary based on demand.

"Once the visit was ready to take place, patients would be taken to a two-way video screen where they could talk with a provider through a secure, HIPAA-compliant connection," she continued. "Care delivery options included urgent care, primary care, behavioral health services and chronic care management."

El Camino also was seeking a technology that could support what Muro calls high-reliability care.

"The easy solution would have been to pick a platform that leveraged virtual meeting technology, but we wanted more than that," she said. "We wanted a healthcare-specific platform that would integrate well with our EHR so that patients could see their records during the visit and so physicians could kick off their visit in a professional way.

"Additionally, we needed a highly secure platform that did not put us at risk for privacy, security or compliance challenges," she continued.

Further, connectivity was critical. The Amwell platform has the bandwidth to easily connect patients and providers to one another, regardless of where they were located, she said.

MARKETPLACE

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MEETING THE CHALLENGE

Initially, physicians were skeptical of virtual care. They were thinking, "How will this impact clinic appointments? Will it impact my relationship with the patient?" But soon after launching the telehealth platform, El Camino saw greater acceptance of the value of virtual care, especially in the throes of the COVID-19 pandemic.

"For instance, we actually had several physicians who were quarantined and unable to conduct in-person clinic visits," Muro recalled. "With our virtual care platform, they could work from home, continuing to see patients if they were able to do so.

"That's an option that did not exist before the pandemic," she continued. "In addition, the beauty of virtual care is that it eliminates geographic and location-specific requirements. We could have on-demand visits performed by physicians who were not in our geographic area but were licensed to provide that care."

This not only strengthened the hospital's ability to meet patients' needs as opportunities for in-person encounters narrowed, but also ensured the right specialists were paired with the right patients for high-quality care.

At El Camino, the ability to provide a highly reliable virtual care experience is key, Muro stated.

"Our platform provides the data we need to ensure we are meeting patients' expectations and following evidence-based protocols of care," she said. "We're noticing, for example, that we're experiencing a higher number of readmissions, and we're peeling back the onion, thinking about what we can do better.

"Just as retail providers check in with consumers and offer rewards for trying their products, we need to leverage virtual care to connect with patients between episodes of care, whether we're using technologies such as chatbots, remote monitoring or telehealth," she continued. "These tools ensure patients are on a good path and that they trust us as their healthcare guide, mentor and provider."

They help El Camino meet patients where they are so they receive the care they need, when and where they need it, she added.

RESULTS

Muro said El Camino does not yet have final telehealth metrics to report, but that the hospital is making investments in predictive analytics to not only care for patients when they are ill, but also put them on a good path for care by anticipating their needs.

"Predictive analytics also helps us staff appropriately – including on the virtual care side – so we can provide the optimal patient experience," she said. "We also look at reliability and operate on a 'zero-defects' model that prioritizes functionality and consistency."

ADVICE FOR OTHERS

"A couple of years ago, I heard a futurist say that the home would soon be the place that monitors your health, and I don't think we're far away from that state," Muro observed. "It's important to make investments in virtual care that not only help manage chronic conditions and health recovery, but also help people stay well.

"These investments also will strengthen performance under value-based contracts as these payment models become more widely adopted," she added.

El Camino Hospital's virtual care journey was not what it had envisioned before the pandemic emerged, but it addresses pain points in the patient experience in ways that the organization would not have anticipated.

"For instance, we deliver a lot of babies at El Camino Hospital," Muro said. "When a new mother needs a lactation consultant, it's likely she will need assistance at all hours of the day and night. We leverage virtual lactation services to meet the unique needs of these mothers.

"When a stroke patient comes into the ED, our team can connect with a neurologist who is not on site and diagnose the patient quickly at a time when minutes count," she continued. "My advice is to think about all the opportunities where virtual care could address gaps in expertise or in resources. This will give you the flexibility to meet your community's needs as they arise."

It's also important to consider whether patients have the right devices and the right connectivity to be successful, she added.

"This is an area we are still working through, and we are anticipating some exciting new features such as the ability to provide language translation using closed captioning during virtual visits," she concluded. "Ultimately, our work in this area not only will meet the needs of consumers, but also our physicians, who will become better positioned to leverage virtual care for improved outcomes."

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