The COVID-19 pandemic led to a 2,200 percent increase in the use of telehealth at Nemours Children’s Health System as approximately 30,000 patients used telehealth visits in April compared to 800 the year before. The provider had telehealth as part of its electronic health record (EHR), however pivoting the documentation process and other cultural change management issues perhaps precluded widespread adaption. How the pandemic has changed that. The providers informatics group did a good job of readying supportive infrastructure, hence with the huge takeoff in usage, the process has gone fairly smoothly. The story is shared with TrialSite Network as the same explosion of telehealth in Nemours is coming to clinical trials.
In traditional in-person visits, the experience patients have with the front desk, the nurse or physicians assistant and the physician are to some extent standardized but also personalized. Telehealth changes all of this and although it could become that way there is information sources and infrastructure that aren’t necessary integrated into what becomes a holistic encounter between provider and patient in the new telehealth facilitated encounter. Documentation, interoperability and change management all will evolve to make for a more consistent and high quality experience in the virtual encounter.
One challenge to overcome for Nemours has been the “documentation” associated with the provider encounter. Questions as basic as “Where is the patient” are never in need of documentation when they are visiting the actual doctors office. But in the world of remote visits, the provider has no idea. And certainly other details not heretofore relevant all of a sudden are very relevant. In a recent EHRIntelligence interview with Dr. David West, medical director of health informatics at Nemours, West shares how COVID-19 really forced groups involved with the coordinated care of patients to ensure continuity of care. From associated documentation to interoperability, the pandemic over the long run will have pushed the conditions for a truly seamless digital health care experience to in fact become a reality. Undoubtedly that the informatics staff under Dr. West have been planning, building and anticipating this progression has helped the cause.
Documentation in some ways in this health system becomes even more important with the exponential growth of telehealth. From all aspects of the encounter to regulatory compliance elements to payment implications.
Providers are used to having access to more than just charts now but also electronic health records, lab info, access to pharmacy data bases and the like. A physician may need to look at incoming lab data for example and want to have not a flat report but a holistic overview—what if the current electronic health record doesn’t have seamlessly integrated telehealth platform with other various health data feeds? Moreover what if partner provider organizations are involved with the caring of a patient. The urgency for interoperability standard, such as HL7 and FHIRE, become even more important. David West notes how important integration in fact is for superior care.
At Nemours they use InterSystems, which is working with the provider ongoing to enhance the performance of the platform, including the telehealth module, for compelling patient care and high impact encounters over telehealth.
The research department becomes another area of telehealth and other technology-enabled rapidly facilitated change, due to COVID-19, to include standardization, documentation practices, integration and interoperability and change management. COVID-19 halted up to 50% of the clinical research in the United States causing unprecedented slowdown. Academic medical centers around the united States are updating their policies and procedures to embrace decentralized, remote or virtual clinical trials, as are commercial sponsors.
TrialSite News is conducting research into that effort ongoing and will be publishing the results of those findings to include a survey of the emerging virtual clinical trials landscape.