Rapid Expansion Of Specialty Practice Telemedicine Delivers Time Sensitive Care During COVID-19

Abstract

Background: The unprecedented impact of SARS-CoV-2/COVID-19 worldwide pandemic on healthcare hasbeen profound At our large quaternary care pediatric healthcare system, in response to change how wedeliver care, a telemedicine strategy was rapidly developed with a priority to address the needs of patientsrequiring specialty time sensitive ambulatory care One obvious opportunity was to rapidly expandtelemedicine capabilities to address the impact quarantines and stay at home orders would have on thedelivery of care to children with chronic conditions We had some telemedicine capabilities in certainpopulations, however when our community shut down we responded with an immediate plan to expandtelemedicine services in a large multi-specialty practice During the first week of the stay at home order, ourambulatory volumes drop by 69% reinforcing concerns regarding delays care (Fig 1) Methods: We establisheda leadership model, task forces, and communication plan We rapidly adapted to ongoing changes andaddressed specific needs including clinic workflow, patient populations, patient capabilities to utilize telehealth, education of clinical teams, and daily visible tracking tools We measured daily telemedicinevolumes by practice, total visits, and proportion of telemedicine visits Results: The 69% decrease inambulatory volume was countered with a 42,300% increase in telemedicine visits Prior to COVID-19, weaveraged 4 telemedicine visits weekly and currently complete over 2,000 Through telemedicine, we aremaintaining a clinic volume of 57% of expected with 68% of all those visits being provided throughtelemedicine (Figure 2) All specialty services provide telemedicine Certain specialty clinics adapted totelemedicine easier than others;allergy/asthma (98%;n = 581), pulmonary (97%;n = 390), neurology (96%;n =1,004), dermatology (95%;1,175), and otolaryngology (91%;n = 1,314) clinics experienced the greatest degreesof success over the past month while ophthalmology (55%;n = 531), cardiology (35%;n = 576) and orthopedics(14%;n = 1,713) faced challenges Additionally, 30% of all completed telemedicine visits were for new referralvisits Conclusion: We rapidly expanded telemedicine to provide time sensitive care in a large ambulatoryspecialty practice Certain specialties were more amenable to telehealth for various reasons--vital signsavailable from home monitoring, ability to assess neurologic function in natural settings, etc We realized thatevery specialty could do some aspect of telemedicine yet for others it was more challenging due to the needfor ancillary tests (Echocardiogram, x-rays, ophthalmology adjuncts, etc ) or lack of a good substitute forphysical exam findings (murmurs, abdominal exams, etc ) We successfully completed new referral visits (aprevious concern in specialty practices) Future steps to sustain our telemedicine practice are to continue torefinine best telemedicine practices, identifying appropriate populations and visit types, track financial impact,and measure patient outcomes