With 15,000 team members, 3,000 providers and $3.1 billion in annual operating revenue, Memorial Healthcare System is one of the largest public health systems in the U.S. A South Florida-based academic medical center, Memorial operates six hospitals, including the Joe DiMaggio Children's Hospital; numerous primary, urgent and 24/7 care facilities; a health specialty center; and a nursing home.

THE PROBLEM

Memorial began offering on-demand virtual urgent care to its employees and patients via a third-party vendor in 2016. With the COVID-19 pandemic in 2020, Memorial launched telehealth for all its primary care and specialty centers, and today conducts about 100,000 virtual visits per year.

Previously, Memorial's providers observed that relying on a third-party vendor solely for on-demand urgent care resulted in an inconsistent patient experience and raised concerns about quality due to limited data sharing.

For example, the third-party virtual providers did not have full access to patients' medical records, creating a disconnected patient experience and annoyances for patients who must submit their medical histories and medication lists as if they were obtaining care at an entirely separate health system. 

In addition, all data from these visits was lost to Memorial and its provider team as it didn't flow back to Memorial.

"With our previous virtual vendor, we could brand the service as our own to patients, but virtual providers were unable to 'know' patients because they lacked access to patients' full medical records," said Bill Manzie, administrative director of telehealth at Memorial Healthcare System.

"The result was patients had to enter their medical history or medication lists and wonder why the doctor didn't know it already, leading to patient frustration and feelings of disconnection."

PROPOSAL

In January 2023, Memorial began working with KeyCare, an Epic-based virtual care company (Memorial uses Epic for its EHR).

"With KeyCare, Memorial could offer its patients a seamless virtual care experience, patients and staff could be reassured patient data was shared between KeyCare and Memorial providers, and Memorial could save money by taking advantage of Epic's built-in interoperability features that minimized technical needs from their staff," Manzie explained.

"KeyCare offers health systems access to a nationwide network of virtual care providers working on its optimized Epic instance, which then connects easily to other Epic-based health systems," he added.

Ultimately, the challenge Memorial faced was to widen its digital front door and expand its capacity with a virtual workforce vendor in a manner that provided a seamless experience for patients, maintained the health system brand and relationship with the patient, ensured robust data interoperability between the health system and its partner, could be implemented quickly with minimal IT lift, and could create a positive ROI, he said.

MEETING THE CHALLENGE

Memorial was an early adopter of Keycare and became the first site to go live with pediatrics. The project, which included weekly meetings, and sessions focused on billing, reporting and marketing, kicked off November 15, 2022.

Notably, the service was successfully launched just two months later, beginning on January 17, 2023. Today both adult and pediatric patients nationwide have access to KeyCare providers offering on-demand virtual urgent care 24/7 via MemorialDOCNow, Memorial's online portal.

"Additionally, KeyCare providers have access to each Memorial patient's data as they provide care and complete their notes on KeyCare's Epic instance," Manzie noted. "Upon completion of the visit, the encounter information is automatically sent to Memorial via Epic's Care Everywhere and Telehealth Anywhere functionality.

"Additionally, an in-basket message can be sent to the primary care provider, or any Epic pool designated by the health system," he continued. 

"The Memorial providers and patients thus have a truly coordinated experience, as all encounter details can be viewed natively in their Memorial instance of Epic, and Memorial providers can review and reconcile any new allergies, medications or problems placed by KeyCare."

Today, the scope of the work between Memorial and KeyCare includes:

• On-demand, 24/7 urgent care

• National coverage for consumers and employees

• Ensuring new and existing users stay connected to Memorial's digital front door instead of going to an external third party for care

• Built-in interoperability between KeyCare's Epic instance and Memorial's Epic instance

• Consultation from KeyCare executive and marketing teams for the program's design

RESULTS

By working with KeyCare, Memorial has been able to augment its care team, optimize capacity and widen its digital front door, Manzie said.

"After going live with KeyCare, virtual visit volume grew quickly, with more than 4,000 visits completed in the first ten months after the program launched," he reported. "Via MemorialDOCNow, KeyCare providers have conducted visits with patients across more than 30 different states."

In addition, he noted:

• Average wait times are approximately 10 minutes

• Decreased low-acuity visits going to valuable office or emergency room slots, as 54% of these patients indicated they otherwise would have gone to urgent care, 18% to primary care, and 9% to the emergency room if this virtual service were not available. This additionally decreases chance of leakage to outside health systems

• Patients rated the experience very highly, with a net promoter score (NPS) of 87, and 91% of patients identifying as promoters

ADVICE FOR OTHERS

In the rapidly evolving landscape of healthcare, working this closely with a vendor has set a benchmark for integrating technology to enhance patient care and provider coordination, Manzie said.

"As we navigate this journey, there are several lessons and pieces of advice we can offer to other healthcare provider organizations considering a similar path," he said. "Ensure the technology integrates seamlessly with your existing systems. Using an advanced platform, combined with functionalities like Care Everywhere and Telehealth Anywhere, allows for real-time access to patient data. This seamless integration is crucial for maintaining comprehensive and continuous care, minimizing disruptions to existing workflows.

"Prioritize solutions that offer robust data sharing capabilities," he continued. "The ability to access a patient's data and share encounter information automatically ensures every care touchpoint is informed and up to date. This level of accessibility fosters a coordinated care experience, crucial in a telehealth environment where continuity is key."

And adopt technologies that enhance communication among providers, he advised.

"The capability to send in-basket messages to providers or designated pools within our health system exemplifies how technology can facilitate direct and efficient communication among care teams, ensuring everyone is informed and can act promptly," he concluded.

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Email him: bsiwicki@himss.org
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