Laura Mrazik, manager of telehealth at MaineGeneral Health
Photo: Laura Mrazik
When the COVID-19 pandemic hit in early 2020 and everything shut down, it became imperative for healthcare provider organizations to adopt telemedicine to deliver care. But so many organizations had no telemedicine programs, and thus technology, in place.
So, many provider organizations scrambled and turned to what they could. In so many cases, this was Zoom – a video conferencing technology that today practically everyone is familiar with. It is ubiquitous, easy to use and requires very little infrastructure or education. And it did the trick.
MaineGeneral Health, a health system based in Augusta, Maine, had telemedicine technology in place at the beginning of the pandemic, but it was impressed with what others were doing with Zoom and soon turned to the video technology.
Healthcare IT News interviewed Laura Mrazik, manager of telehealth at MaineGeneral Health, to discuss best uses and best practices with Zoom so others can learn from MaineGeneral's lessons.
Q. You've had great success in telemedicine using Zoom technology. Please talk about what first got you to Zoom and why you decided to stick with Zoom.
A. We closely monitored Zoom from the time the pandemic hit, although we already had a signed contract with another company for synchronous telehealth services. In early 2021, Zoom had done a great job highlighting the security measures they had taken to ensure HIPAA compliance for health system clients.
We decided to pilot Zoom on a small use-case (staff-to-staff) that did not fit within the scope of our existing platform’s capabilities. We quickly saw value in Zoom’s flexibility and inherent familiarity for many users, both staff and patients.
Our initial pilot quickly evolved into four active telehealth services. We then made the business case to pilot switching existing services over to Zoom, including all primary care practices.
We have since transitioned all synchronous “virtual visit” telehealth services to Zoom. Volumes have continued to rise since we shifted all services. It has now been one year since primary care switched to Zoom.
Looking year over year, we more than tripled monthly visit volume in 2022: 35 average monthly in 2021 to 150 monthly in 2022 – 216 in December. We were able to streamline our interpreter services process by integrating with our existing interpreting platform.
We now can pull a live interpreter into the virtual visit session within a few clicks. For our next project to improve the experience for existing services, we are integrating our scheduling/registration and patient reminder systems with Zoom to create a more streamlined workflow for staff to schedule visits.
We also are improving the branded experience. It’s been great that Zoom allows MaineGeneral to hold the keys in branding adjustments.
Other key factors for sticking with Zoom include: We appreciate Zoom’s ability for the client organization to control settings at the account level, internally, and the application’s flexibility to meet the needs of different use cases. Zoom’s support portal has both a forum to ask other clients questions, and a library of instructions for how our own team can troubleshoot or make configuration changes appropriately.
Patients are not required to create and remember a username and password to join their virtual visit, and many have already become familiar with Zoom in their distance communication with friends or family. We are excited about exploring Zoom’s API capabilities, and the ability to build out our integrations in-house.
Q. Please describe how you use Zoom with one particular clinical use case, and some of the success you've achieved here.
A. Behavioral health has been a champion group since the beginning of MaineGeneral’s telehealth rollout, leading the organization in telehealth volume. In general, behavioral health departments often have higher in-person no-show and 24-hour cancellation rates.
Virtual visits help save many of those visits, particularly for patients with transportation or childcare barriers. These visits also often lend themselves well to a virtual visit, as they do not require physical examination.
MaineGeneral’s pediatric behavioral health specialty practice, Edmund Ervin Pediatric Center (EEPC), went from an average of 28 visits per month in calendar year 2021 to 121 visits per month in 2022, with an average of 165 visits in November and December.
In calendar year 2022, virtual visits represented more than 12% of the pediatric center’s overall volume. Most recently, the EEPC team added their physical, occupational and speech therapy clinicians to the virtual team, where they have not only avoided late cancellations, they’ve been able to better serve their patients.
Here are two examples of patient visits with unanticipated outcomes due to delivering the visit virtually, while the child remained at home in their own environment:
- A young patient was suspected to be on the autism spectrum. Upon the first Zoom visit from home, the child was very animated and interactive, and the clinician was able to gather enough information to rule out Autism Spectrum Disorder.
- On a virtual visit, a small child in feeding therapy ate more in their own home for the clinician to observe than when they ate at the practice in feeding therapy.
The ability to see patients in a setting where they are most likely more comfortable and relaxed has proven to be a major benefit to behavioral health services in the home.
Q. Please describe how you use Zoom with another particular clinical use case, and some of the success you've achieved there.
A. We recently switched our direct-to-consumer telehealth platform to Zoom. In December, our Express Care practices switched to Zoom for MaineGeneral’s virtual urgent care service, “eCare.”
In the first full month of switching platforms, the service volume is up, quadrupling the average visit volume (average of 14 visits per month, up to 62 visits in January). We anticipate volumes will continue to rise in 2023.
We had spent almost three years using a model, which required MaineGeneral to only accept credit/debit cards, billing a flat rate for services. After the transition to Zoom, the organization was able to begin billing insurance for this service and bring the service back into the medical center.
Patients and staff using the application have found Zoom to be a very user friendly solution.
We initially built out a mobile app, where patients came to us virtually for the first time, downloaded the mobile application or visited our website from their computer/laptop. With Zoom, we shifted that model. We now have schedulers on the phone, registering patients for their visit.
For now, patients are prompted to press a number in the existing phone tree to schedule a virtual visit. This has been a great way to offer the service to patients who do not have telehealth top of mind, yet are interested when given the option. As we continue to increase awareness around the service, we are excited about the opportunities this platform provides.
Q. What are your plans for Zoom and telehealth this year and beyond?
A. We plan to continue expanding telehealth services to our specialty practices across the health system, with surgical specialties up next. We have also embarked on projects to make efficiencies in the process through integrations, and improve consistency across the experience with elevated branding and communication.
We will also pilot a newer use case this calendar year with the emergency department and Delta Ambulance Emergency Medical Services (EMS). This pilot project will virtually connect EMS with our ED physicians during patient transport to our EDs (and inter-facility transport), to improve quality of decision-making during transport for stroke patients and pediatric seizures, for example.
Beyond this year, we will continue to explore different telehealth use cases to meet the needs of our community and to improve the patient experience as we evolve digitally. We will explore ways to make efficiencies on the staff side as well, with EHR integrations and more.
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