As MedStar Health launched its telehealth response to the COVID-19 pandemic, hundreds of the health system’s caregivers first rose to the challenge of meeting a historic surge in demand for the existing MedStar eVisit urgent care, on-demand telehealth offering.

Leveraging an existing telehealth platform, the health system responded to volumes that jumped from an average of seven visits daily in February 2020 to more than 500 visits in a day within the first week of the COVID-19 response.

THE PROBLEM

Next, as part of a health system that previously has delivered more than 4.9 million outpatient visits in a year, MedStar Health caregivers and patients had to address the world’s new reality that stay-at-home orders might lead to delays or cancellations for routine and nonurgent medical needs to stop the spread of COVID-19.

Also, patients had a continued need to reach out to their primary care physicians to get questions answered about COVID-19.

While the health system previously had a platform available for clinicians to deliver scheduled outpatient video visits as needed, demand in February 2020 only required supporting about two scheduled video visits weekly. Suddenly, thousands of MedStar Health clinicians now needed an alternative pathway to care for patients who could not be seen in offices due to COVID-19 concerns.

To address this challenge at such an incredible scale and speed, within days the health system had to stand up a new telehealth system that offered rapid provider provisioning, onboarding and training, among other qualities.

PROPOSAL

Telemedicine technology and services vendor Bluestream Health has served MedStar Health since 2016. Initially, MedStar Health was very focused on business-to-business telehealth in its work with the vendor. From the end user’s perspective, Bluestream’s prior B2B use cases with MedStar Health leveraged a simple technology to serve as a front door for delivering critical health care.

Bluestream Health has been the infrastructure for the MedStar Acute Care Coordination Center, MAC3, which links emergency physicians and physician assistants to emergency department triage nurses to improve safety and efficiency, as well as to allow emergency consultation from MedStar Health urgent care centers and the MedStar Visiting Nurse Association staff in the field. Bluestream Health, the health system noted, never tried to change MedStar workflows.

"We have partnered with our clinical service lines and business entities that are interested in establishing and scaling telehealth throughout their practices, providing telehealth infrastructure, best practices, subject matter expertise, project implementation and programmatic operational support."

Dr. Ethan Booker, MedStar Health Telehealth Innovation Center

“Bluestream brought a very agile video-to-video connection and ‘brokering engine,’ so we always envisioned doing more in the direct-to-consumer space together – and this was jumpstarted by the pandemic,” said Dr. Ethan Booker, medical director of the MedStar Health Telehealth Innovation Center and MedStar eVisit.

“As Bluestream has described it, its business-to-consumer offering is a lighter version of Bluestream that has been offered for free to small providers during the crisis. MedStar Health was its first enterprise direct-to-consumer customer.”

MedStar Health already had delivered tens of thousands of B2B telehealth sessions through Bluestream technology, and built several new use cases, so staff knew that the provisioning, onboarding and training cycle of a B2C use case would be fast enough to support scaling to thousands of providers within weeks.

The ability to rapidly upload the providers’ information into the telehealth system and then to provision it within the health system’s standard security approach was a key reason MedStar was successful. Bluestream was not trying to replicate MedStar’s provisioning, scheduling and billing processes in a separate system, Booker explained.

“The speed to onboard and train providers was just as powerful,” he added. “Rather than require a half-day training session to get providers up to speed, we were instead able to provide very concise training materials.”

The technology also did not require a great deal of training for patients, which is essential during a pandemic, Booker said.

“With some platforms, patients largely need to be contacted beforehand to ensure success via pre-visit encounters,” he noted. “This wasn’t feasible when we were scaling from two visits a week to more than 4,000 in a day. Based on our existing work with Bluestream, we had every reason to believe patients would successfully connect with little instruction. It is as easy as receiving a link via email or text, and a couple clicks to connect.”

The system is browser-based, not app-based, does not require a download for patients, and offers stability on a broad array of devices and operating systems, he added. The vendor also offers peer-to-peer encrypting in a browser, which is why one can securely connect quickly, he said.

MARKETPLACE

There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News recently published a comprehensive guide to telehealth vendors in the age of COVID-19. To access this special report, click here.

MEETING THE CHALLENGE

In recent years, MedStar Health’s telehealth team has gained tremendous technology and operational knowledge, so it was able to hit the ground running when the crisis came and the emergency eliminated previous barriers to telehealth adoption at this scale.

“Our MedStar Telehealth Innovation Center (MTIC) was established in March 2017 with the goal of supporting and coordinating telehealth activities across MedStar Health’s distributed care delivery network,” Booker explained.

“While MedStar Health had engaged in telehealth initiatives for many years prior, MTIC was established in response to requests from clinicians across the health system for expanded telehealth capabilities – and in recognition of the increasing role of telehealth in care delivery across the nation,” he added.

“Since that time, we have partnered with our clinical service lines and business entities that are interested in establishing and scaling telehealth throughout their practices, providing telehealth infrastructure, best practices, subject matter expertise, project implementation and programmatic operational support.”

In its work with Bluestream, the health system’s telehealth team members are really the experts in the workflow. As examples, the health system understands the billing requirements and necessary system integrations, and has an ability to connect someone’s working schedule to the video experience. To schedule a video visit, patients call a provider’s office just as they would for an in-person appointment.

The telehealth vendor provides MedStar with a video connection that is flexible, secure and can be built into existing operations to allow the health system’s providers to quickly connect with patients, Booker said. It also is integrated with the electronic health record system.

“To address both increased outpatient and inpatient telehealth needs triggered by COVID-19, we’ve worked to ensure more than 12,000 providers have access to the platform,” Booker said.

“In launching video visits, we initially prepared ambulatory providers to use the service, expanding it to thousands of providers on a rolling basis in the days that followed,” he explained. “Most recently, as we’ve built out new inpatient telehealth offerings in response to COVID-19, we’ve given bedside nurses access to Bluestream to connect patients to family members when it otherwise wouldn’t be possible.”

The bottom line here is that the core technology is very easy and secure for the patient and the provider – and the health system’s telehealth team can wrap other services around that, Booker said.

RESULTS

In February 2020, before COVID-19 was prevalent in MedStar’s area and via a prior telehealth platform, the health system delivered around two scheduled video visits weekly, with more than 100 providers ready to use the platform (and far fewer doing so). Since launching video visits with Bluestream Health, here’s how that picture rapidly transformed as part of the COVID-19 response:

• One week after the video visits' March 23 go-live, 425 providers were delivering 1,236 video visits in a single day.
• After the first month of the health system’s COVID-19 response (March 23 through April 12), and just weeks after the service launched, average weekday outpatient telehealth visits reached 3,626 in the week of April 12, more than 500 times growth when combined with MedStar eVisit urgent care telehealth volumes.
• In the first full month of offering video visits (March 23 through April 22), 51,731 sessions were delivered, with peak daily volume hitting 3,977 visits on April 21. By the end of this period, more than 2,070 providers were conducting video visits with their patients.
• This growth has continued since these initial week and month milestones. As of Sunday, May 10, total video visits already have climbed to 98,480+, recently surpassing more than 4,150 visits in a day delivered by more than 1,000 providers. On Friday, May 1, MedStar Health hit 100,000 telehealth sessions during the COVID-19 outbreak.

ADVICE FOR OTHERS

“My advice would be tailored to the healthcare organization’s goals, as well as its existing resources and expertise,” Booker offered. “Purchasing telehealth solutions that reproduce things you’re already doing can lead to inefficiencies and frustration.

“If your path is similar to ours, you’ve been engaged in telehealth for years; you’re willing to devote resources to further operationalizing telehealth around the health system; you’ve developed expertise in telehealth policy and revenue cycle; you employ many providers; and you’re also intent on making sure telehealth is tied to the in-person care experience.”

In this case, Booker advised finding a lighter, agile telehealth system to incorporate into all the systems and programs a healthcare organization already has been building. An organization does not need to reproduce things it already is doing, he added.

“Finding the right vendor is also really important,” he concluded. “You want to find an organization that can provide discrete and flexible technology solutions – and that is willing to enter into a deep, developmental partnership with you to help achieve your goals, in your systems, leveraging your expertise. Own as much of the telehealth journey as you can own – it can help enhance and differentiate your overall patient experience.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
Healthcare IT News is a HIMSS Media publication.