Johns Hopkins Medicine Reaches Telehealth Visit Milestone

The Baltimore-based health system has provided more than 1.5 million telehealth visits since the beginning of the coronavirus pandemic.

Johns Hopkins Medicine has surpassed 1.5 million telehealth visits, and the health system expects virtual medicine visits to maintain a brisk pace over the next two years.

At most health systems, hospitals, and physician practices, telehealth visits have increased exponentially since the beginning of the pandemic. New regulations adopted during the pandemic boosted the ability of healthcare providers to offer telehealth visits; and as long as those regulations remain in place, the volume of telemedicine visits is expected to be significant.

Telehealth visits at Johns Hopkins Medicine have leveled off since the early phase of the pandemic, but the volume of visits is expected to be robust over the next two years, says Helen Hughes, MD, MPH, medical director of the Office of Telemedicine at the health system.

"Over the past six months, we have reached a steady state of about 30,000 to 35,000 outpatient telemedicine visits per month across Johns Hopkins Medicine. That is about 15% of our outpatient volume. If we assume no major regulatory restrictions in the near future, we think this is the level of telemedicine our providers want to offer, and our patients want to receive. This is about 400,000 telemedicine visits per year," she says.

Hughes says three types of investments were required to support the increase in telehealth visits at Johns Hopkins Medicine: technical, operational, and training.

• "From a technical standpoint, our Office of Telemedicine as well as our Johns Hopkins IT infrastructure quickly spread technical tools that we had prior to the pandemic. We used those tools in the spring of 2020, but we realized that some of those tools were not effective for our patients and providers. For example, we adopted a new video platform in August of 2020, which we continue to improve based on provider and patient feedback."
   
• "From an operational standpoint, it was amazing to see our clinics on the frontline need to pivot and incorporate this type of care into caring for their patients, who they also saw in-person. Our Office of Telemedicine needed to work with all of our operational teams that support outpatient care, including scheduling services, interpretation services, and our frontline clinical support staff to make sure patients were having a seamless telemedicine care experience. All of this was new at the beginning of the pandemic, but we adjusted to integrating telemedicine into the continuum of our usual outpatient care operations."
   
• "From the training standpoint, telemedicine was new to many staff members two-and-a-half years ago, and we needed to conduct a lot of training. Our Office of Telemedicine partnered with several of our training teams both on the clinical side and the education side to make sure our providers and staff knew how to use the technical tools in a way to provide high-quality care."

Clinicians had several options for telehealth training, Hughes says.

"We had training tip sheets, videos, and electronic learning modules, which covered both the technical and the clinical basics. We also partnered with many of the educational leaders—our educational leaders in primary care, our educational leaders in the pediatrics residency training program, our educational leaders in the medical school, and our educational leaders in specialties such as neurology. We wanted to make sure clinicians in their various content areas were trained to use telemedicine as a clinically appropriate tool. It has been multifaceted, from basic education such as how you get on a visit and how you act professionally during a visit to how you use this tool for a neurological exam or a gastrointestinal exam at a distance," she says.

Telehealth adoption by clinicians

About 60% of Johns Hopkins Medicine clinicians have conducted at least one telemedicine visit since March 2020. In April 2021, the health system surveyed its clinicians to understand how they wanted to use telemedicine in the future and how they had used telemedicine during the pandemic, Hughes says. "We found that there were some overall trends in what types of specialists wanted to do more telemedicine in the future—after the acute part of the pandemic. Providers in specialties that are less in-person, less physical exam-dependent or less in-person procedural-dependent such as psychiatry, nutrition, and genetics were more likely to want to do more telemedicine in the future."

When the survey data was examined by specialty, the health system found there was a wide variety in how much individual providers wanted to do telemedicine, she says. "In almost every specialty, we saw a range from providers who wanted to do 100% telemedicine to providers who wanted to do 0% telemedicine in the future, which indicated that there are some specialties where telemedicine works very well, but within each specialty there are early adopters who have loved using this tool and want to do it more in the future. Then there are providers who are hesitant about telemedicine and want to go back to the in-person visits they were doing before the pandemic."

The survey data indicated that female clinicians and providers who had fewer than 15 years in clinical practice tended to want to do more telemedicine, Hughes says.

Related: Telehealth Services Thriving at Providence Health System