Rather than deploying a solution with built-in scheduling, documentation, and revenue cycle functionality, the healthcare system expanded use of the Bluestream platform it was already using for emergency department teletriage services.
A decade before the coronavirus pandemic forced the nation's healthcare system to accelerate virtual care initiatives, MedStar Health began laying the groundwork for a comprehensive telehealth program. Yet the 10-hospital nonprofit health system experienced the same barriers to adoption that inhibited widespread use of the practice across the rest of the country: physician skepticism, minimal consumer awareness, lack of sufficient reimbursement, and licensing issues.
The foundation the organization had laid turned out to be exactly the right infrastructure needed when COVID-19 began shutting the country down. And, a platform previously only used by the emergency department, provided the backbone to scale a telehealth solution to thousands of providers.
The health system, which serves Maryland, Virginia, and Washington, D.C., and partners with Georgetown University, shares insights from their experience, which could help other hospitals and healthcare systems as they scale their own initiatives.
Built on a Foundation of Successful Telehealth Initiatives
The key steps in MedStar's telehealth evolution include:
- An initial foray into virtual care began with a telestroke program almost 10 years ago.
- In 2015, the organization launched MedStar eVisit, an on-demand urgent care video visit platform.
- The health system then launched a teletriage program in its emergency departments, which logs about 60,000 encounters a year, using a platform from Bluestream.
- MedStar also provided a separate technology solution for physicians who wanted to provide virtual care direct to their patients. Usage was minimal, with about two scheduled visits conducted weekly.
- In 2017, the health system chartered the MedStar Telehealth Innovation Center and appointed Ethan Booker, MD, as medical director of the Center and of MedStar eVisit.
Then, in early 2020, the threat of COVID-19 came knocking at the door.
An "Agile Technology" Enables the System to Quickly Scale for COVID-19
As the public health crisis heated up, urgent care visits immediately rose. Before the pandemic, MedStar eVisit managed 150 to 250 visits a month. During the first week of the pandemic response, daily volume sometimes exceeded 500 visits per day.
Ramping up the ability for physicians to provide direct-to-consumer care presented a more complex challenge. "Patients were canceling their primary care and specialist appointments," Booker says. "We knew that we needed a way to meet that community need to continue to deliver care."
"We had 10 years of pent-up expertise, knowledge, and systems already built into our revenue cycle, legal and compliance, and informatics groups in terms of being able to schedule, document, and bill [telehealth visits]," Booker says. To quickly scale virtual services for thousands of providers, "we needed a lightweight, agile technology."
The team decided the Bluestream platform used for emergency department teletriage services had the right capabilities and converted to it for rapid deployment and expansion of scheduled video visits.
About 10 days prior to the March 23 go-live date, the team marshaled the entire organization to prepare for the launch. "We created all of the structures within the health system that are necessary to be successful," Booker says.
The effort paid off. MedStar onboarded 2,000 providers, and during the first month, the peak daily volume hit nearly 4,000 visits a day, compared to the pre-pandemic volume of two a week.
A Streamlined System, Simple Functionality, and Training Were Essential
"Our success, and certainly our speed, was related to actually not trying to put [scheduling, documentation, and revenue cycle solutions into] a complete package," Booker says. "Rather than reinventing the wheel, it made sense for us to execute down the same pathways we already knew, but kind of driving a different car."
The system is simple for patients to use, he says. "When a patient has an appointment, they get a ping on their phone with a link. You click on the link and you're in video appointment. There are no apps, no schedules to remember, or anything like that."
Training and education were essential to the process, Booker says. Because the eight-person telehealth team is affiliated with the MedStar Institute for Innovation, they were able to pull in 112 people from the Institute to supplement their efforts, including trainers and educators from the Medstar Health Simulation Training & Education Lab (SiTEL). In addition, 80 volunteers from Georgetown University offered to help.
"The challenge was about speed and scale, and not so much about technology, and certainly not about the care delivery," says Booker. While the barriers to telehealth adoption are real, he says COVID-19 created a "massive set of incentives" for physicians and patients to try it, including stay-at-home orders and concerns about being exposed to the virus during a visit to the doctor. Once physicians and patients try telehealth, they like it, Booker says, and "the genie is now out of the bottle."
Looking to the Future
Whether virtual care usage continues at the high rates it is experiencing during the pandemic depends on numerous factors, Booker says—namely, reimbursement. Commercial payers "have been using telehealth themselves for cost control for quite some time; so I don't think that they need convincing," says Booker. The primary question is whether reimbursement will continue from the Centers for Medicare & Medicaid Services, which waived many regulations during the crisis to enable access to care.
But the challenge to the successful future of telehealth goes even deeper. "It's very important for those of us who are doing this work to collect good data to demonstrate the quality, safety, and value of telehealth," Booker says. The equation goes beyond consumer value and convenience to demonstrating that "giving patients rapid access to care in their homes doesn't add new costs and it decreases later costs because you can get to preventative issues quickly." That means decreased hospitalizations, fewer emergency room visits, and improved outcomes for those with chronic diseases.
Because the coronavirus crisis is keeping patients away from ERs and physician's appointments, it's currently challenging to gather meaningful data, Booker says. "It's difficult to tell that story yet, but I think that we will be able to tell that story."
“Rather than reinventing the wheel, it made sense for us to execute down the same pathways we already knew.”
Ethan Booker, MD, medical director, MedStar Telehealth Innovation Center and MedStar eVisit
Mandy Roth is the innovations editor at HealthLeaders.
A platform already in use for ER teletriage was expanded to enable physicians to schedule virtual care visits with patients.
The healthcare system onboarded 2,000 providers in a 10-day period.
Virtual visit volume rose to nearly 4,000 visits a day, compared to the pre-pandemic level of two a week.