Expanding a solution already in use for other purposes enabled the Wisconsin health system to rapidly scale a virtual rounding to protects employees, conserve PPE, and ensure that patient information is secure.
This is excerpted from an article that appears in the July/August 2020 edition of HealthLeaders magazine.
The coronavirus pandemic not only accelerated the expansion of traditional approaches to telehealth, it has also ignited new ways to use existing technology. Numerous healthcare systems are employing telehealth solutions to deliver virtual care inside the hospital walls.
As UW Health prepared for COVID-19, one of the health system's priorities was to protect caregivers from unnecessary exposure to the disease, says Tom Brazelton, MD, MPH, FAAP, medical director of the UW Health Telehealth Program and professor of pediatrics at the University of Wisconsin-Madison School of Medicine and Public Health. This concern eventually evolved into a method to conduct virtual rounds, a practice that has created numerous advantages for providers and for patients, he says, and will continue after the COVID-19 crisis abates.
As other healthcare systems consider the advantage of deploying similar solutions, Brazelton shares a look at the actions and considerations behind the scenes that enabled the organization to scale a virtual rounding initiative.
Before the pandemic, the Madison, Wisconsin–based health system had employed a cloud-based, HIPAA-compliant platform from Vidyo for about eight years for a limited number of use cases. For example, the technology was used to conduct inpatient consultations between physicians and certain specialists and to communicate with physicians at community hospitals who were transporting patients to UW Health's pediatric or neonatal ICU.
To rapidly accelerate these capabilities, the health system decided to expand access to the Vidyo app. While CMS temporarily relaxed many rules that enabled healthcare providers to communicate with patients via consumer-facing apps like FaceTime, "I was very worried about the wild, wild West," Brazelton says. He explains that there can be unexpected downsides to using a familiar technology for a new purpose. Security and protecting patient privacy are paramount, he says, but they're only part of the issue.
"We are responsible for the patient's confidential information as much as we are for your health," says Brazelton. "We can't be irresponsible about it. When the dust settles, we do not want to be that exposed as an organization. If we told our providers to just go crazy, we would have ended up with … providers providing a lot of IT support to patients to get their devices functional," he says. "That is not the best use of their time. We had to be very conscious of what we could do quickly." Vidyo was HIPAA-compliant and encrypted, and it passed the health system's security tests. "The devil you know," he says, "is better than the devil you don't."
The ability to conduct bedside virtual visits involved providing Vidyo access points in all patient rooms and physicians' devices via an app. Because every patient at UW Health's University Hospital is assigned an Apple iPad® upon admission, the team simply added the app to each of the system's 600 bedside tablets.
Rolling the initiative out to the organization's 2,000 physicians was more complex. Initially, UW Health targeted infectious disease specialists, ICU doctors, and hospital-based physicians, Brazelton explains, because their services were considered most essential to address a surge of COVID-19 patients. Another concern was to mitigate the impact of a diminished workforce if these crucial providers became sick or had to quarantine.
"We wanted to provide physicians with the ability to spread their cognitive abilities as ICU or infectious disease docs," Brazelton says. "We know from our eICU programs that one doctor can command a whole [unit of] non-ICU physicians and run it virtually."
Once the priority physicians were armed with the app, UW Health loaded it onto secure devices for all physicians affiliated with the health system, as well as other personnel, including pharmacists, nutritionists, and the spiritual care team. The app is now available on 6,000 devices.
Part of the process included ensuring each device was secure. And, if a smartphone or tablet is lost, a mobile device management system can remotely wipe the missing device of all clinical applications.
Once the app was installed, the practice of virtual rounding evolved quickly. The technology allows the creation of virtual "rooms" where multiple providers can gather through their secure device while a nurse or other provider uses the iPad at the patient's bedside.
"In the peds ICU where I work, we could have up to 15 different providers," Brazelton says. "We would all gather at [a specified time] in this virtual room." Participants might include a cardiologist, a cardiac surgeon, the ICU physician, and residents, as well as a pharmacist, a nutritionist, a social worker, and a member of the spiritual care team.
"It's a very streamlined system where there's collective knowledge at one time on rounds about that patient," he says. "We also were conserving PPE (personal protective equipment) and reducing the chance of unnecessary exposures."
The process improves the patient experience, Brazelton says. "One of the problems being a patient [is that] providers don't coordinate their exams. You're woken up from 4:30 a.m. until 8:00 a.m. with people from different services coming in and doing the same exam on you. This way we could perform one exam, and everyone's witnessing it."
Virtual rounding delivers other benefits, he says. "We are now location-agnostic. With broad national adoption of telehealth, one of the lessons for all of us is that now it shouldn't matter where the patient is. It shouldn't matter where the provider is. If the standard of care can be met using video—and we know it can in many, many instances—then it should count. And by count, I mean that it's legitimate patient care. Video may not meet the standard of care in every instance, but in many cases it can."
UW Health physicians have embraced virtual rounding, Brazelton reports. "I have a lot of providers who say, ‘We're not going to ever end this; we're going to continue to use the system.' " They no longer have to travel to the hospital to see one patient, then rush to see a different patient in their office, he says. It frees up time and makes their workflow more efficient. "It provides access in a way that we've never had before—both for us and the patient," he says.
"Prior to the pandemic, we had several barriers to expanding and accelerating telemedicine," says Brazelton. "We had separate telemedicine programs that all started a dozen years ago but had not been aligned, making our work difficult to scale."
As the threat of the pandemic loomed, "our leadership moved extremely quickly and efficiently," says Brazelton. "I've been at UW Health for 20 years, and I've never seen us move like that. It is amazing how fast issues of alignment can be resolved when the mandate is there from leadership and so are the resources, both human and equipment."
“We are responsible for the patient's confidential information as much as we are for your health.”
Tom Brazelton, MD, MPH, FAAP, medical director, UW Health Telehealth Program
Mandy Roth is the innovations editor at HealthLeaders.
While CMS relaxed rules enabling providers to use apps like Facetime, UW Health determined security and protecting patient privacy were paramount.
Up to 15 providers can participate in a virtual consultation, a practice that will continue once the pandemic abates.
The process improves the patient experience by limiting the number of exams performed.