The telemedicine program of the Charlottesville-based University of Virginia Health System was established in 1995 to enhance timely patient access to healthcare services, particularly for patients in rural regions of the Commonwealth of Virginia.

With funding support from a broad range of federal agencies – Department of Commerce, HRSA, USDA and FCC – the health system has worked with more than 150 community hospitals, clinics, medical practices, schools and other healthcare entities to bring specialty care to underserved communities and patients.

THE PROBLEM

"We already had developed a virtual personal protective equipment model in our special pathogen unit of our Medical ICU, or iSOCOMS," said Dr. Karen Rheuban, cofounder and director of the Center for Telehealth and medical director of telemedicine at the University of Virginia Health System.

"In addition, in 2012, UVA Health launched a remote patient monitoring program to improve patient compliance and clinical outcomes, and to reduce hospital readmissions, hospital length of stay and emergency department visits.

"Since 2013, we had provided e-consults as one of the original AAMC Project CORE institutions," she added. "In 2019, UVA Health created a multi-stakeholder strategic plan for telemedicine."

With the onset of COVID-19, UVA Health pivoted as an academic health center to scale telehealth technologies that addressed the challenge of clinic closures and the need to limit exposure to COVID-19 both for providers and patients, and provided critically important continuity of care.

The organization was bolstered by its longstanding history as a telehealth provider and with its strategic plan in hand. In addition, as a federally designated Telehealth Resource Center, UVA Health also worked to provide expanded technical assistance to providers and health systems across the nine-state Mid-Atlantic Region.

"The operational challenge of deploying equipment to community partner sites during the early stages of the COVID-19 public health emergency were significant," said Dr. Eugene Sullivan, cofounder of the Center for Telehealth at the University of Virginia Health System. "We were forced to teach and train our partners from a distance.

"Delivering the equipment often involved meeting in the facilities' parking lots, then waiting while the site contact brought the equipment inside so we could conduct the training," he recalled. "Throughout our history, when it comes to caring for patients, our guiding principle has always been, 'Failure is not an option.'"

PROPOSAL

UVA Health's response to COVID-19 has been multipronged. It deployed standards-based telemedicine technologies across the health system and enabled the scheduling of virtual visits in lieu of in-person visits across every clinical department and service line.

"We procured an enterprise-wide solution integrated into our Epic EHR," Rheuban said. "We deployed headsets and webcams to every clinic workstation, and scaled our iSOCOMS virtual PPE model to 180 in-patient and emergency department rooms.

"In addition, we responded to requests from our telemedicine partners and expanded our work with community hospitals, FQHCs, and particularly with skilled nursing, long-term care and correctional facilities, congregate settings in which the prevalence of COVID-19 was disproportionately high," she added.

The health system established a virtual urgent care model enabling patients across Virginia to receive care from its emergency medicine providers. It scaled training through its CE-accredited portal Telehealth Village, though webinars with providers, tip sheets and training videos, and hosted Project ECHO programs across multiple disciplines with community partners.

"UVA Health expanded remote patient monitoring for vulnerable patients, and launched remote patient monitoring for COVID-19 patients enhanced by video-based check-ins by advanced practice providers," she said. "We were fortunate to have secured additional federal grant funds through the FCC, from the USDA and HRSA to enable us to procure devices, support connectivity for patients, distribute devices to our community partners such as FQHCs, hospitals and correctional facilities.

"In addition, we built other innovative applications of virtual services to improve patient compliance, such as a virtual cardiac rehabilitation program," she continued.

MARKETPLACE

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MEETING THE CHALLENGE

Telemedicine services have been provided by clinicians across all disciplines. Pre-COVID-19 programs focused on specialty care access. Following the public health emergency, primary care providers massively scaled the use of telemedicine.

"We have used a range of technology to support our efforts," Sullivan noted. "We procured enterprise-wide, Epic-integrated Zoom for Healthcare for our direct-to-consumer telemedicine services. We also work with VitalNet to support integration across multiple hospital disparate electronic medical record systems in our tele-stroke program, and use Amwell carts and Cisco Room kit minis for partners.

"In addition, we use Cisco video technologies, Jabber, to connect with our facility partners," he continued. "Locus Health is our remote patient monitoring vendor, and we also have deployed peripheral devices from TytoCare, JedMed, Eko and other vendors."

RESULTS

"We track data from Tableau, pulling ambulatory utilization data-based visits documented in Epic, and have paid attention to those clinics where utilization has been lower than expected to work with them to scale telemedicine for their patients," Rheuban said.

"We also track patient-satisfaction data and are delighted that 'Recommend UVA' for telemedicine is nearly the same as in-person services, 92.5%," she added. "As an organization, we have set a dashboard for expected utilization."

USING FCC AWARD FUNDS

The University of Virginia Health System was awarded $767,139 by the FCC telehealth grant program for telemedicine carts, tablets, video monitors, a telehealth platform, remote patient monitoring equipment and network upgrades to support clinical videoconferencing with remote patient-examination tools, to help build a virtual urgent care platform, and to expand the remote patient-monitoring program as patients are diagnosed with COVID-19 or are discharged from the hospital.

"We are utilizing these funds to improve access to care for patients at risk for adverse outcomes, including low-income patients, veterans, rural patients, patients in congregate care settings and those with COVID-19," Rheuban reported.

"We have provided services to patients in every region of the Commonwealth of Virginia enabled by state and federal policy waivers, and have worked with the Virginia General Assembly to codify many of these changes for Medicaid, commercially insured and uninsured patients," she continued.

"We are grateful for the Medicare waivers and hope that Congress will take action to eliminate the 1834 restrictions in the Social Security Act that hampered the scaling of telemedicine prior to the PHE," she concluded. "Importantly, the FCC awards invested in health systems across the Commonwealth of Virginia, with the resultant scaling of telehealth, [have] contributed to the Virginia General Assembly and our state agencies, enabling transformational permanent policy changes related to telehealth."

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