Marshfield Clinic Health System based in Marshfield, Wisconsin, has nine hospitals – plus Marshfield Children's Hospital inside the flagship hospital – and more than 60 healthcare centers in more than 30 communities across Wisconsin.

THE PROBLEM

MCHS had multiple telehealth platforms prior to COVID-19. Two additional platforms were launched in response to COVID-19. MCHS has offered telehealth services for almost 25 years, which prepared the organization to respond to COVID-19. Serving a rural and economically disadvantaged population, access to care has always been a significant limitation for the patients the health system serves.

Back in 1997, as a result of barriers to access such as lack of transportation, paid time off from work, childcare and more, MCHS launched telehealth with the assistance of a Health Resources and Services Administration grant. That started in 1997, expanded with a continual partnership with the HRSA through to today.

Prior to COVID-19, MCHS offered 45 of its more than 90 specialties via telehealth in its clinical facilities. With more than 60 physical locations, patients saved significant time and money by being able to present to locations nearest their home, even when they need to see a specialist at a specific site.

In 2019, MCHS completed 15,000 patient encounters via telehealth and an additional 60,000 tele-pharmacy consults.

"Up to the start of COVID-19, almost all telehealth services were offered in facilities; the place of service was a clinic, hospital and skilled nursing facility," said Chris Meyer, director of telehealth at Marshfield Clinic Health System. 

"Only with the expansion of waivers by CMS did we expand to offering care via video and phone with a patient not in a clinical location. Since 2014, we have offered low-acuity episodic care via telehealth on both telephone and video for a specific set of conditions.

"Satisfaction scores were very solid for an entirely new service launched so quickly. We are taking lessons learned and building them into our new Amwell platform with full integration with our Cerner EHR in 2022."

Chris Meyer, Marshfield Clinic Health System

"For COVID-19, MCHS launched the ability to offer video visits for 1,500 providers in nine calendar days," he continued. "Operationalizing this took a significant effort, and as MCHS closed facilities due to the pandemic starting on March 16, 2020, teams from across MCHS stopped work on other projects to launch telehealth services to meet our needs for COVID-19."

MCHS had been using vendor Amwell's telehealth technology and services and will be moving to Amwell as its permanent vendor for video visits. But the vendor, according to Meyer, lacked the ability to bulk onboard providers quickly back in March 2020. For that reason, MCHS launched with a HIPAA/HITECH-compliant platform it already had in place, WebEx.

"We launched WebEx on March 23, 2020, and telephone care a few days later," he said. "Neither were available prior to the PHE, and by the end of 2020, we had completed nearly 130,000 visits between these two new services, with about 60% being phone-based, underscoring the rural nature of our service area and inherent broadband access challenges.

"These visits have shown that our patients can both consume care in this modality and that they see the value," he continued. "Satisfaction scores were very solid for an entirely new service launched so quickly. We are taking lessons learned and building them into our new Amwell platform, with full integration with our Cerner EHR in 2022."

MCHS anticipates a similar volume in 2021 to 2020. However, in 2020, it only had these services for about nine of the 12 months, compared with all 12 months in 2021. As a result, volumes have dropped as facilities reopened.

Prior to COVID-19, less than 1% of visits were via telehealth. Today, about 10% of daily outpatient volume continues to be done via either a telehealth at-home visit with WebEx or via phone care visit.

PROPOSAL

MCHS had the immediate ability to launch video visits across the organization with WebEx.

But Amwell is being used because it corrects a number of deficiencies with WebEx, Meyer explained:

• Patient waiting room (where staff can communicate with the patient if they are running late)
• Ability to automate more of the intake process
• Reduced bandwidth needs compared with WebEx
• Designed for healthcare and consumer use

"MCHS has an enterprise contract with Amwell through Cerner," Meyer noted. "We plan to maximize our use, and the only reason we did not launch with them in 2020 was because of the limitation I previously noted. That limitation has been corrected at Amwell."

MARKETPLACE

There is a wide variety of vendors of telemedicine technology and services on the health IT market today. Healthcare IT News has published a special report listing many of these vendors, with details about their products and services. Click here to read the special report.

MEETING THE CHALLENGE

WebEx was already integrated in the organization. MCHS had licensing in place and the ability to rapidly roll it out to 1,500 providers.

All 1,500 providers were provisioned, training sessions were offered, and staff developed workflows to make everything flow as best as they could. About 900 providers ultimately had visits on WebEx – mostly follow-ups, but also initial visits. Visits were full-spectrum, with providers trying to do as much as possible.

"Lesson learned? Providers need exposure to clinical evaluations via telehealth," Meyer said. "This is not learned in med school, and learning to do a physical evaluation in a telehealth visit can drastically increase the ability for a video visit to be sufficient."

WebEx was launched as the initial platform. Amwell is rolling out this year.

RESULTS

Provider and patient satisfaction has been strong.

"We have two encounters in each telehealth visit, the patient and provider," Meyer noted. "Both must leave the visit happy if we expect them to use telehealth again. We surveyed patients via Press-Ganey and did our first ever provider satisfaction survey in December 2020, and plan to run it again."

Meyer and his team learned:

• Generally everyone was happy that a solution existed to keep them connected when facilities were closed
• Everyone understood that broadband and digital literacy were barriers
• Everyone agreed that telehealth should stay and that it provides a lower cost way for patients and providers to connect to deliver care

Specifically, patients and providers did provide feedback on how to improve video visits:

• Increase access to broadband – MCHS is active in the State of Wisconsin broadband expansion efforts
• Increase technical support – specifically for patients. Many health systems have an IT help desk, but generally internally focused. MCHS has to drastically increase its external support as well
• Add capabilities – heart/lung auscultations often are needed

On the results front, there were numerous operational efficiencies, including:

• No-show rates decreased as telehealth volumes increased. The takeaway: telehealth appointments are easier to keep
• Providers could see more patients in a given unit of time (per hour or day)
• Providers could expand access by offering early, late or weekend visits

"Overall, with almost 250,000 completed telehealth visits since COVID-19 started, we can say our strongest metrics have been patient/provider satisfaction and improvements to provider efficiency. Both of which we can continue to improve upon."

FCC AWARD FUNDS

MCHS in 2020 was awarded $1,000,000 from the FCC telehealth funding program for videoconferencing equipment and software, a telehealth platform subscription, laptop computers, and network upgrades to focus telehealth efforts on restoring primary and specialty care services impacted by COVID-19 and maintaining healthcare provider access to the most critical patients with chronic illnesses at 81 healthcare facilities in Wisconsin and upper Michigan.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.