Maintaining Healthcare Quality During COVID-19 and the Future of Care

With the onset of COVID-19, healthcare delivery organizations around the world were collectively faced with one primary challenge: How to effectively deliver quality healthcare to all patients, regardless of the entry point into the system, while protecting the well-being of non-COVID-19 patients and the healthcare workforce.

As health systems navigate challenges created through risk of exposure for patients and caregivers, rapidly changing regulatory paradigms and significant financial burden, digital medicine and virtual care are becoming critical tools for maintaining and improving quality healthcare while mitigating those barriers. As organizations become more adept at navigating the pitfalls associated with treating COVID-19 in a digital environment, the lessons learned now by healthcare providers will drive the adoption of digital strategies for managing chronic disease, health maintenance and wellness.

Governance for Quick-Turn Transformation

Effective digital transformation starts with governance. Organizations with structured, collaborative governance for IT adoption were more timely and nimble in responding to the challenges associated with delivering quality healthcare in a pandemic. Merely developing an enterprise-wide response plan and delivery model requires significant expansion of many health systems’ teleconferencing and digital communication capacities.

In order to facilitate social distancing, healthcare providers made significant investments in video conferencing and remote Wi-Fi capacity to ensure the appropriate collaboration between subject matter experts, front-line caregivers, information and technology staff, and C-Suite leadership can take place to create the framework for using technology to meet the standard of care in the new care environment. To be prepared to deliver quality healthcare in the face of future disruptive pandemics, health systems and providers will face the challenge of retaining the increased telehealth capacity during financial contraction.

Technology for Innovative Care Approaches

Most health systems determined that they needed to establish multiple virtual entry points for receiving COVID-19 screening data. Leveraging web questionnaires, chatbots and telehealth visits for patients, health systems could conduct risk stratified screenings to develop orders for patients at highest risk. Dually, these virtual entry points facilitated the allocation of limited testing supplies to the highest risk patients, while protecting clinicians and patients from large crowds gathering in emergency departments and testing sites.

In order to facilitate the huge transition of patient volume from face-to-face encounters to the virtual environment, organizations needed to significantly scale up virtual visit capacity. Organizations will also need to coordinate with their care partners in long-term and post-acute care to accommodate increases in virtual encounters. These non-acute care settings should expect to play an increasingly important role in facilitating and coordinating these interactions for their residents and adjusting their staffing, training, workflows and infrastructure to accommodate this new modality.

With as much as a 300% increase in virtual encounters at some organizations, and with clinical staffing impacted by the spread of COVID-19, virtual screening tools could be operated by non-traditional healthcare workers (school nurses, paramedics, etc.) provided those workers have a templated care workflow which ensures the same interventions are triggered, as if the patient was being screened by a physician or nurse practitioner. Adherence to a care plan or pathway which has structured fields guiding the provider through every step of care and documentation ensures that quality healthcare standards are met, regardless of the entry point into the system.

Telehealth for Non-COVID-19 Care

Once organizations successfully applied virtual screening capacity, they need to continue treatment of chronic disease and other ambulatory patients. Screening for COVID-19 validated that digital medicine was an effective method for monitoring wellness maintenance and managing chronic disease. Following the lead of organizations like HIMSS Davies Award of Excellence recipient Ochsner Health, who launched chronic disease and pre-natal care digital medicine programs several years ago, healthcare organizations transitioned much of their outpatient care to a digital environment.

The U.S. Centers for Disease Control and Prevention’s rule changes allowed interventions taking place in digital environments to count toward quality reporting metrics. And equal reimbursement for digital encounters helped drive the transition to digital medicine methodologies for wellness and chronic disease management.

In the European Union, COVID-19 has driven a significant increase in demand for digital health services and teleconsultations. Readiness, much like in the United States, varies significantly between member countries. In countries where regulatory oversight ensures effective information governance, privacy, and security, where full public reimbursement for digital health services existed before COVID-19, the foundation is in place for significant expansion of digital medicine in other areas. In countries where public reimbursement and a mature regulatory framework for information governance and security is still a work in progress, it will be more challenging to continue the transition into utilizing digital medicine for chronic disease management and health wellness.

Chronic disease management registries were a commonly utilized tool across the United States health ecosystem prior to the onset of COVID. The transition to digital environments for managing chronic disease requires the backbone of a chronic disease registry to facilitate risk adjustment, monitor care plan adherence, and intervene when appropriate.

The risk adjustment algorithms in many of these registry tools factor social determinants like housing, access to healthy food, and other risk factors. Tools then “visualize” the highest risk patients in dashboard interfaces with care coordinators and provides customized templated care plans based on the standard of care and risk.

Once the registry tool is in place, and an organization leverages the tool with the strong governance to ensure that care coordinators use the tool to effectively identify candidates for virtual care, organizations can then start to leverage the virtual platforms for care management that proved successful for screening and treating patients during COVID-19. Telehealth and digital communications platforms facilitate a patient encounter. Decision support-driven template care plans are utilized during these digital encounters to ensure that the standard of care for the disease state is being met regardless of the entry point into the system. Care coordinators can then use templated care plans to monitor and engage patients to ensure that the patient is following the prescribed care plan. Through the use of home monitoring technology, clinical data can be uploaded to the provider to monitor the patient’s disease state. Interoperable transfer of patient generated data from these devices can be interpreted through analytics interfaces which visualize potential patient deterioration. The clinician can then trigger a face-to-face encounter or a hospitalization to intervene.

Telehealth and the Patient Experience

With many patients experiencing a telehealth visit for the first time, some were confused while others found the visits a relief from travel and parking challenges at medical centers. Providers hit an accelerated learning curve on this technology and the patient experience suffered in some cases. However, especially for those who are immune compromised, telehealth provided the safety and comfort of care from home.

Now that telehealth has become a more routine part of care, some, such as Adrienne Boissy, MD, the chief experience officer at Cleveland Clinic, are training providers in this new mode of care. “New technologies, processes, and metrics are needed to enable us to deliver on both our timeless patient-centered promises, and actual caring.”

Patient preference for care via telehealth, now that many have had some experience, will make it a standard modality. While some may prefer face-to-face encounters in the future or require it for special tests and procedures, many, particularly younger patients, will demand virtual care as their first option. Those receiving ongoing care in long-term or senior care settings will also see a shift toward providing more services virtually. For these populations virtual visits, remote monitoring and virtual triaging will become common.

Sorting out what is missing from in-person visits will continue to evolve, but some solutions, such as remote monitoring devices, will enable more care including chronic care to be done virtually. Governance of these models and quality measures will need to be in place along with new forms of patient experience measures. Patient surveys after telehealth visits will be essential to get feedback on these programs to improve the digital experience.

Finally, mental health services via telehealth has been broadly adopted. Patients adopted to it quickly and providers learned how to show empathy over video. While studies of outcomes of telepsychaitry show promising results, particularly in the use of cognitive behavioral therapy, more research is needed on which diagnoses and techniques are most effective.