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What One Health System Learned About Providing Digital Services in the Pandemic

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During the Covid-19 pandemic the importance of technology in our health care system’s capacity to care for people has been essential. The benefits are indisputable, the advancements vast, and the connection to scientific knowledge continually growing.

Intermountain Healthcare, where I serve as CEO, has a range of digital health services, including a virtual hospital, a far-reaching telemedicine program, and a popular consumer-facing app. Here are seven lessons we’ve learned as we’ve used them.

Lesson 1: Telehealth has expanded access to better and faster care.

Intermountain had a head start on telehealth. Before the pandemic began, we’d set up 24-7-365 digital medical and behavioral health networks and were approaching a million telemedicine consults. The pandemic hit us hard, but we were ready; we took our existing network and put it on steroids.

Intermountain’s telemedicine service had 830,000 total patient interactions from 2015 to 2019, an average of 454 per day. So far in 2020, we’ve had 1.3 million interactions, or 4,300 per day. In addition, our online AI-based Covid-19 symptom checker is getting 1,800 clicks a day.

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Telehealth has increased access to care in three ways: First, consumers and patients can get the care they need at their convenience in their home or community. Second, highly trained specialists — including neurologists, intensivists, neonatologists, and oncologists who previously never would have been able to treat patients in remote areas — are now only a couple of clicks away. Local primary care providers are treating seriously ill or injured patients in local hospitals with highly trained, board-certified specialists standing virtually right next to them.

And third, instead of transporting more patients to an intensive care unit (ICU) in a referral center in a big city, the patients can stay in their local hospital — which is incredibly important during the pandemic since it is helping us free up as many of our ICU beds as we can for Covid-19 patients.

Lesson 2: Digital care is safer during the pandemic.

A patient who’s tested positive for Covid doesn’t have to go see her doctor or go into an urgent care clinic to discuss her symptoms. Doctors and other caregivers who are providing virtual care for hospitalized Covid patients don’t face increased risk of exposure. They also don’t have to put on personal protective equipment, step into the patient’s room, then step outside and take off their PPE. We need those supplies, and telehealth helps us preserve it.

Intermountain Healthcare’s virtual hospital is especially well-suited for Covid patients. It works like this: In a regular hospital, you come into the ER, and we check you out and think you’re probably going to be okay, but you’re sick enough that we want to monitor you. So, we admit you.

With our virtual hospital — which uses a combination of telemedicine, home health, and remote patient monitoring — we send you home with a technology kit that allows us to check how you’re doing. You’ll be cared for by a virtual team, including a hospitalist who monitors your vital signs around the clock and home health nurses who do routine rounding. That’s working really well: Our clinical outcomes are excellent, our satisfaction scores are through the roof, and it’s less expensive. Plus, it frees up the hospital beds and staff we need to treat our sickest Covid patients.

Lesson 3: Telehealth’s clinical quality is excellent.

We’re one of the nation’s leaders in providing evidence-based care. Our clinicians use detailed protocols that show how care for over 100 common conditions should be provided, then we track the results so our processes and outcomes can be continually improved. The result: We’re better able to deliver excellent outcomes without the variation and waste that reduce quality and drive up costs.

Our telehealth service uses the same protocols as our hospitals. If you have a stroke and need a clot-busting drug to open a clogged artery, you can be in a 25-bed hospital in a rural town in southern Idaho or our 510-bed Level 1 trauma center in Salt Lake City, and your caregivers will follow the same steps to get the drug to you faster than the nationally recommended time. Other examples of telehealth’s clinical benefits:

  • In an internal review of seven community hospitals, Intermountain’s tele-critical care program was associated with 36.5% reduction in mortality in one year, which means approximately 125 fewer deaths.
  • Intermountain’s rates of appropriate antibiotic use are as good in our telehealth service as they are in our brick-and-mortar clinics.
  • A study of 481 people with increased likelihood of colorectal cancer showed that 35.4% of those who had a risk assessment via telehealth with a certified genetic counselor completed a colonoscopy within nine months, compared to 15.7% in the control group.

Lesson 4: Digital tools support the direction health care is headed.

Telehealth supports value-based care, in which hospitals and other care providers are paid based on the health outcomes of their patients, not on the amount of care they provide. The result is a greater emphasis on preventive care — which reduces unsustainable health care costs.

Intermountain serves a large population of at-risk, pre-paid consumers, and the more they use telehealth, the easier it is for them to stay healthy — which reduces costs for them and for us. The pandemic has forced payment systems, including the government’s, to keep up by expanding reimbursements for telehealth services.

This is worth emphasizing: If we can deliver care in lower-cost settings, we can reduce the cost of care. Some examples:

  • The average cost of a virtual encounter at Intermountain is $367 less than the cost of a visit to an urgent care clinic, physician’s office, or emergency department (ED).
  • Our virtual newborn ICU has helped us reduce the number of transports to our large hospitals by 65 a year since 2015. Not counting the clinical and personal benefits, that’s saved $350,000 per year in transportation costs.
  • Our internal study of 150 patients in one rural Utah town showed each patient saved an average of $2,000 in driving expenses and lost wages over a year’s time because he or she was able to receive telehealth care close to home. We also avoided pumping 106,460 kilograms of CO2 into the environment — and (per the following point) the town’s 24-bed hospital earned $1.6 million that otherwise would have shifted to a larger hospital in a bigger town.
  • By keeping local patients in their community and rural hospitals, we help those hospitals and their communities stay vibrant, which is especially important because those hospitals are often the largest employers in their communities.
  • Our behavioral-health crisis-management telehealth service costs $230 for a patient’s first visit and $150 for a follow-up visit, which compares to an average cost of $2,000 for a behavioral health ED visit. That’s important, because the ED is where a lot of people who are experiencing a mental health crisis — especially those who are uninsured or homeless — end up.

Lesson 5: Many doctors tried telehealth and liked it.

When I asked our leader of telehealth to describe how our physicians have responded to the new technologies we’ve used during the pandemic, he responded: “There’s been very, very, very little screaming.” That’s a major victory given that we’ve trained 3,000 providers in how to do video visits.

About 30% of our medical staff uses telehealth on a regular basis. That number is increasing, but we don’t expect everyone to use it, either in primary care or our medical specialties. But the technology sells itself. One of our surgeons talked about doing his post-op follow-ups virtually, and he said the care is better because he can see patients where they live. If there’s a concern about a patient’s diet, he can say: “Can you show me what’s in your cupboards and your fridge?”

Our physicians also understand how much their patients like it: During the pandemic our satisfaction scores have averaged 4.5 on a 5-point scale. One of our oncologists said, “I was the biggest skeptic in the world, but telehealth works in a very complex discipline like oncology. It’s much more rewarding than you can possibly imagine. The patient satisfaction scores we get from these patients who are being able to stay in their own hometown, not having to travel, is just off the charts. It’s a real service you don’t really get to capture unless you try it.”

Lesson 6: Security, privacy, and fixing technical flaws are ongoing priorities.

When will upgrades not be a part of technology? Probably never. We’ve worked hard to install the highest security standards. To keep our platforms safe and secure, we’ve standardized a single consumer identity (username and password) all patients can use to access services like patient records and telehealth, increased our firewall capacity to support increased telehealth volumes, and added training and guidelines to support remote work configurations.

Lesson 7: Technology should be kept simple but should be comprehensive.

When we set up our video visits at the start of the pandemic, we were proud of ourselves because our platform worked better than what we saw in other health systems. But that was the wrong standard. Some people were struggling with it; they had to create an account, log in, enter their password, re-enter their password, wait in a virtual waiting room, etc. We should have compared ourselves to Google or a weather app. People wanted the same experience they had when they FaceTimed their grandkids. We redesigned our process and made it much simpler, and now, about 90% of our visits require only one click from our patients and our providers. Patients get a text saying their doctor is ready to see them, they click the link, and they’re in.

Well before the pandemic began, we took that approach in creating an easy-to-use “digital front door” to help consumers access our services. Our vision at Intermountain was broader; we wanted to meet our consumers where they start their health care journey and support them throughout their entire experience.

We launched a personalized digital experience, called My Health+, that helps consumers use a simple app to manage their health — whether they’re finding the care they need, scheduling virtual or in-person appointments, managing their care, or paying for care. My Health+ extends to Covid: It helps people understand their symptoms, get tested, get their test results, and know how to follow up.

Since we launched My Health+ in July, it has had more than 207,000 users and is the top-ranked medical app offered by a health system in the Apple App Store. My Health+ also reminds people about preventive care check-ups;helps them manage their prescriptions, monitor their blood pressure, and other key health measures; and allows them to track their deductibles and out-of-pocket maximums. It’s like a personal medical clinic right there in your phone.

One family’s experience shows the impact of the lessons we’re learning. A young mother of four I’ll call Jenny was diagnosed with breast cancer at the beginning of April. As she considered how her treatment would compromise her immune system, she was threatened not just by cancer, but by Covid. “Our family was absolutely terrified,” Jenny’s husband told me. “We were locked down the best we could, but how could she get the care she needed without increasing her risk of exposure to Covid?”

Jenny needed chemotherapy, which was delivered in traditional appointments at the hospital, but most of her other care was delivered virtually. She had regular appointments with a genomic counselor, a dietitian, and a palliative care physician, all online. “We’ve had lots of follow-up visits, and it’s been great to stay out of the clinic,” her husband said. “We felt cared for, and we felt safe. If Jenny had to actually go in for all of her ancillary appointments, I think she would have said, ‘No thanks, I’m good.’ The quality of her care was better because so much of her care was provided through telemedicine. We’re passionate about how well it works.”

That’s the bottom line about how technology enhances health care. People like Jenny are doing better because of it.

https://hbr.org/2020/12/what-one-health-system-learned-about-providing-digital-services-in-the-pandemic

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