April 8, 2020

Rapid Expansion of Telehealth Allows Clinicians to Provide Quality Care at Home

By Annie Yueh

As the COVID-19 pandemic brings nonessential travel to a near standstill, health-care systems are innovating ways to utilize technology and continue to provide high-quality care. The rapid establishment and expansion of telehealth services can be attributed to real-time communication, multidisciplinary teamwork, and long hours logged.

The UCHealth Experience
At UCHealth, one of Colorado’s largest health-care systems, telehealth had already been rolled out for stroke, urgent care visits, and there was some use of home telehealth visits by primary care providers and a limited number of specialty care providers. When COVID-19 hit, 92 clinics were live. UCHealth was tasked with expanding telehealth services to cover all clinic visits.

“In a very amazing short amount of time—less than 2 weeks—we added 600 more clinics to that functionality,” said Kathy Deanda, Senior Director of Virtual Health for the UCHealth System and Senior Director of Neurosciences for University of Colorado Hospital. With dual backgrounds in nursing and computer programming, Deanda has incorporated her medical and technical experiences in various roles throughout her 10 years at UCHealth. 

It Takes a Village
Before the virus outbreak, UCHealth had been using Vidyo, a telehealth platform integrated with the institution’s EMR, on a small scale. But telehealth capability now needed to be rolled out to several thousand more staff members and providers, quickly. However, expanding telehealth meant training providers and clinic staff with an added obstacle: social distancing. Trainers were providing guidance virtually to providers hour after hour. “In that 2-week period of time, we trained over 1,500 people,” Deanda said. 

Everyone worked together in the effort to expand telehealth: virtual health operations and technical teams, Epic trainers, ambulatory leaders, and billing, compliance, and legal team members, as well as system leadership. “We were fortunate that the village came together,” Deanda said.

The most complex challenge, according to Deanda, is communication, especially making sure that provider teams understand the regulations around telehealth. “Telehealth, even with COVID-19, is not straightforward as far as where we can practice, how we can practice, and what billing looks like.” A communication pathway was set up where UCHealth system and regional command centers pass down information from the government, allowing Deanda and her team to put together tip sheets and work with providers in nearly real time.

Provider Acceptance
Initially unconvinced that telehealth could substitute for a physical exam, Keri Halsema, a nurse practitioner at the Blood Disorder Center for the University of Colorado, says she’s since changed her mind. “In this moment, this has become an incredibly valuable tool for connection between provider and patient.”

Not only can many functions be performed by communicating over video, but Halsema tries to have patients get bloodwork done via local labs or primary care offices to have those lab values available during telehealth visits, especially for her hematology patient population. “I’m really interested in what their neutrophil counts are, are they still thrombocytopenic, are we having to make arrangements for them to go get blood counts and possibly transfusions locally; those are all important pieces for my day-to-day care of these patients,” Halsema explained.

Halsema experiences some barriers when patients’ technological capabilities make it difficult for them to fulfill system requirements and get logged in. She can usually switch gears and conduct these visits with patients over the telephone.

Transitioning to Telehealth Visits
At her facility, Halsema describes the process of rebooking patients who don’t necessarily need to come in for a visit. Advanced practitioners and physicians look ahead in the appointment schedule to identify patients who are candidates for telehealth visits. Nursing assistants call those patients and inquire if they want (and are equipped) to conduct their appointment through telehealth. If so, the appointment time slot is switched to a telehealth visit. At the appointed time, the provider sees the patient using a computer with equipped with a camera in the outpatient clinic in an area designated for telehealth visits.

Enduring Potential of Telehealth
Both Halsema and Deanda see telehealth as a lasting fixture even after the COVID-19 pandemic has passed. In the winter, mountain roads in Colorado can be treacherous, and neither providers nor patients want to risk travel in those conditions.

In addition, patient acceptance has been positive. “They’ve been excited and welcoming,” Halsema describes.

“We still have to bring patients in, and we’re still open for business,” Deanda adds, “but when we can do a telehealth visit, why not?”

Read more from the APSHO Advance: Special COVID-19 Series