Healthcare is Going Virtual
By Dr. Demmer
When COVID-19 spread throughout the world, the healthcare field required drastic changes to meet new demands.
Now, healthcare can’t return to the old ways of doing things. And it shouldn’t.
At Atrium Health, an unexpected side effect of the pandemic has been a surge in utilization of technological advances. Virtual technology has allowed patients to receive world-class care without stepping foot in a hospital or doctor’s office – and without risking exposure to the coronavirus. It’s allowed babies to go home with their mother’s sooner, for cancer patients to meet with oncologists from the comfort of home and for critical care units at the smallest hospitals to offer the advantages of the biggest ones.
“COVID-19 will radically change healthcare faster and more drastically than September 11th altered the airline and travel industries,” says Cynthia Lauer, MD, a trauma surgeon at Atrium Health. “COVID-19 will be the catalyst that totally changes how we deliver healthcare across all disciplines.”
Atrium Health met this challenge with a head start. A collaborative spirit and embrace of technology is part of our DNA. For years, providers across all of our locations have shared real-time data through a system-wide platform. They already met with patients via virtual visits and telemedicine consultations. But during COVID-19’s spread, Atrium Health needed to scale up these operations and to design new virtual tools.
Atrium Health is transforming healthcare delivery at an unprecedented rate. Within weeks – and sometimes just days – our teammates have created new services, upgraded existing systems and streamlined processes. The results will improve healthcare accessibility for years to come, putting our patients first, wherever they are.
Introducing New Services. Quickly.
To protect patients, providers and visitors from the risk of exposure to COVID-19, Atrium Health needs to keep as many patients home as possible. This requires new tools to allow our current patients to continue treatment without interruption and to initiate care for new patients. Our teammates have designed these tools in record time, and the community has embraced them immediately. Healthbot, which launched in March, hosted more than 350,000 self-triage sessions within two weeks. The RN Screening Practice, which also launched in March, had more than 1,500 sessions in its first week alone.
Levine Children’s Virtual Platform began on March 2, and since then, hundreds of patients a day log on to meet with providers over two-way video or phone appointments. Patients can schedule appointments with their own pediatrician and pediatric specialists or have an on-demand visit for urgent needs. Levine Children’s works with patients and families to match the type of appointment to their needs.
“We've been able to move mountains for our patients and families and make sure that we can take care of patients, no matter where they are and what their needs are, even in the midst of the coronavirus pandemic,” says Jennifer Terry, MHA, FACHE, CMPE, Vice President, Atrium Health Levine Children’s.
Virtual Hospital at Home launched in late March. In April, Atrium Health added a pediatric version of this tool. Virtual Hospital at Home allows patients – including COVID-19 patients with mild symptoms – to recover at home. Monitoring kits allow doctors to track patients’ blood pressure, oxygen levels and temperature remotely. Our care teams call these patients daily, and some even offer home visits, proving that virtual care and a personal touch go hand in hand.
Scaling Up Existing Services
Virtual care and telemedicine aren’t new to Atrium Health, but these services – once seen as complements to traditional systems – have taken on greater importance during COVID-19. Virtual Visit urgent care sessions have increased ten-fold, and 90% of those sessions were first-time Virtual Visit patients. Patients have scheduled eight times as many eVisits, receiving care for minor conditions from a provider over a computer, tablet or phone. Virtual care incorporates less high-tech measures, too: Atrium Health providers make more than 4,500 phone calls to patients at home each day.
Even patients in need of specialty care can transition to virtual appointments. Prior to COVID-19, only 1% of visits to Levine Cancer Institute were virtual; by the end of March, 43% were virtual. For patients with immune systems suppressed by chemotherapy and other treatments, minimizing exposure risk is crucial.
“Patients appreciate that they can continue to see their care team, but from the safety of their home,” says Derek Raghavan, MD, PhD, FACP, FRACP, the president of Levine Cancer Institute. “The numbers speak for themselves. In just a few weeks, the tremendous increase in virtual visits shows that this is an effective way to continue caring for our vulnerable patients in the midst of the coronavirus pandemic.”
During March, Sanger Heart & Vascular Institute converted 95% of in-office visits to visits over the phone or two-way video. “More than 60% of our patients are on Medicare, so this means that more than 300 patients per day do not have to leave their homes to receive specialty care. Connecting with our patients through telemedicine is not only achievable, but the early returns suggest it is clinically effective and greatly accepted by both patients and clinicians,” said Geoffrey A. Rose, MD, president of Sanger Heart & Vascular Institute.
Virtual care isn’t new to Atrium Health’s Surgery Care Division. Since 2018, it’s maintained a successful virtual video visit model, led by Kristen Harkey, DNP, that enables low-risk patients to have postoperative visits with providers over the phone or computer. Having this platform up and running when the COVID-19 pandemic arrived allowed for rapid expansion of this model. Now, providers are able to schedule more pre-operative and post-operative appointments virtually. No longer must a patient go to a hospital to have a doctor look at an incision or drain. Additionally, insurance restrictions that lifted during the pandemic allowed the providers to treat patients across state lines for the first time. “Since COVID-19, we’ve expanded virtual care to more patients so they do not have to travel and can avoid emergency department visits,” says Will Miles, MD, Director of Critical Care Outreach for Atrium Health Surgical Services. “It is a great way to triage patients."
Technology has even minimized patient transfers between critical care units. Through sharing data and video, the smallest hospitals can access the resources of the biggest ones. Every critically ill or injured patient, no matter which facility they visited, can receive the same quality of care while staying close to home.
Virtual technology also expands at-home care options for soon-to-be mothers, new mothers and their babies. Doctors can monitor babies born to mothers with COVID-19 remotely, with telemedicine carts equipped with tele-stethoscopes and high-resolution cameras.
"The Women's Care Division made changes to prenatal visits to ensure our patients and their babies are safe during this time,” says Katie Borders, MD of Shelby Women’s Care. “The technology allows us to continue to interact and engage with our patients and provide them the best care where they are.”
Outreach, Near and Far
Although all groups are susceptible to COVID-19, some are more vulnerable to its effects. People experiencing homelessness don’t have the ability to isolate at home. Many who work essential jobs lack subsidized childcare while their kids are home from school. Those who don’t speak English face language obstacles. Patients with mental illnesses and chronic diseases experience COVID-19 with heightened levels of concern.
To reach our vulnerable patients, Atrium Health has expanded services. Virtual visits allow people without childcare or sick leave to keep their medical appointments. Language translators coordinate virtually with providers, allowing them to offer care to patients in multiple languages.
Still, virtual visits exclude some members of the community. “If you have no data plan, or if you don't have Wifi in your house, it's going to be very difficult to do a virtual visit,” says Sveta Mohanan, MD, a family medicine physician at Atrium Health.
Mobile testing units travel to neighborhoods to offer screening & testing closer to home. Community clinics continue to care for vulnerable patients, and providers do all they can to minimize these patients’ exposure risks, whether taking new patient visits over the phone or writing extended prescriptions when possible. Coordination with local agencies connects patients in need with nutritional food resources.
“We will take care of every single one of our patients, regardless of cost or insurance,” Dr. Mohanan says. “No one will be turned away for care.”
Treating a pandemic requires not just local care but worldwide collaboration. Atrium Health’s outreach efforts have extended far beyond the system’s Carolina footprint. Through International Medical Outreach, we use virtual portals to collaborate with care teams in Latin America. We work with providers in resource-scarce facilities to share best practices and new information, expanding our efforts to fight the spread of COVID-19.
Taking the Best of What We’ve Learned
Even as COVID-19 demanded big changes, our mission – to improve health, elevate hope and advance healing for all – has never wavered. Loyalty to that mission, however, means that we have to do things differently.
The virtual technology that has allowed us to reduce COVID-19 exposure risks will offer a ripple of positive effects: for patients without transportation or childcare, for patients with compromised immune systems, for patients who can’t afford to take time off from work. These innovations will allow us to treat more patients in new ways, increasing accessibility to quality healthcare. For all.
COVID-19 has forced us to question what’s possible in healthcare delivery and to challenge our thinking. Patients and providers have offered overwhelmingly positive responses to these innovations, and we will take the best of what we learned during a hard time to continue to offer the best care possible at all times.