By Megan Headley
UW Health, the integrated health system of the University of Wisconsin-Madison, had a robust set of virtual care services prior to the COVID-19 pandemic, ranging from telestroke and e-ICU to some inpatient specialty consults and urgent care on demand. However, as the pandemic and subsequent staffing and PPE shortages began to impact services in March 2020, it became clear that the system would have to rapidly scale up its inpatient and ambulatory virtual care services.
As most health systems found out in the early days of the pandemic, scaling up virtual services was both critical and challenging. For UW Health, this process began with the need to rapidly boost the care team’s ability to work from home, providing virtual consultations and attending virtual rounds that would conserve PPE and reduce contact between team members and patients. The health system also wanted to ensure patients could connect virtually with family and visitors. All told, this shift meant creating an ecosystem that supported video visits across 17 clinical departments and every specialty service.
Rapidly rolling out a plan this broad confronted the team with a number of initial obstacles. There was a need to select a single platform to support a wide range of services. There were unknowns around care providers’ home internet bandwidth and growing cybersecurity risks.
The shift also meant moving beyond the health system’s typical approach of slowly building up services. “When COVID came, it forced us as a culture to be nimble and get going fast,” says Chero Goswami, system vice president and chief information officer at UW Health.
Since the rapid-fire scale-up, the system has had time to closely examine and improve its virtual experiences and workflows. As Teresa Neely, MBA, BSN, RN, senior vice president and chief ambulatory officer at UW Health, puts it, “We’ve learned a lot through the process.”
Four of those lessons are detailed below.
- Integration drives a consistent care experience
“All of us got creative in those days of March and April of last year,” Goswami says. Although the system knew a virtual care solution that integrated across platforms would best serve the patient and care team experience, the primary goal was to scale up fast. Necessity drove the team to use an inpatient virtual care platform already in place in certain facilities.
“We had to go with a product just to get going,” Goswami explains. However, by December 2020 the system began its journey to launch a platform that integrated its EHR and video solutions, working with telehealth partner Amwell. In June 2021, the integrated platform rolled out.
“Having the integrated platform has been a significant improvement in patient and provider care team experience,” Neely says.
For starters, patients are able to access services in a familiar way. “It’s integrated so that patients who already were used to connecting with us through the MyChart application are able to come in through the same mode and launch into our system,” Neely explains.
Similarly, the team built an approach to virtual visits that mirrors in-person visits to create a consistent care team experience across all service lines.
“Patients and families have the same care team experience,” Neely says. “With the integrated platform, we were able to bring multiple people into the visit. The patient can include family members and, within our care teams, our medical assistants can complete their rooming role. They now have the ability to link on the same link as the provider so they can start that visit ahead of time, as they do in person. They can do the medication verification, review of symptoms. They can also help the patient from a technology standpoint, if patients have any issues. Then they can do a warm handoff to the provider. When the physician is ready, he or she has an ability to notify our nursing staff; if they need to connect and complete patient education, we can do all of this now through that integrated structure.”
- Virtual care can optimize scheduling
Through more targeted scheduling, UW Health has found it can more efficiently utilize its brick-and-mortar facilities and available staff. “From an efficiency standpoint, it works best if we can have providers block off several hours to do virtual visits and then come in and do their in-person care,” Neely says.
While not all specialties have enough back-to-back volume to allow for this blocked scheduling approach, the ability for teams to work from home for portions of the day has boosted provider satisfaction.
Most critically, this balanced approach has helped the system expand workforce availability for individuals who, Neely says, would likely have had to leave the system’s workforce due to childcare or other lifestyle issues. “We’ve been able to retain these individuals by allowing them to work from home and participate in virtual care,” she says.
- Workflow investments are critical
While COVID-19 drove UW Health to adapt quickly, the system never lost sight of the importance of creating a seamless transition between what Goswami calls the “digital front door” and the in-person experience. With patients growing more accustomed to omnichannel experiences that smoothly link virtual and real-world services, it’s become increasingly important for healthcare to mirror this approach.
However, creating this experience takes time and investment. “A Zoom® or WhatsApp® call is good to start with, but take the time and integrate it with your back end, because that’s what’s going to drive the sustainability of these solutions for the long-term,” Goswami advises.
Investing time in creating an efficient workflow will help ensure that solving one problem on the solution’s front end won’t create an additional host of problems on the back end, he adds.
- Feedback allows a system to learn and adapt
As Goswami points out, this process has clearly shown that health systems and technology teams should prevent perfect from becoming the enemy of good. Rapid implementation, to continue serving patients, was more important than creating a perfect experience right away. However, this rapid transition made it more critical to put a robust process in place for securing platform user feedback. With feedback, problems could be swiftly identified and updates made.
At the end of a visit, UW Health providers using the virtual care service have the ability to complete a survey or provide feedback on the technology directly in the EMR system. Patients are also sent a post-visit survey.
“We have very robust patient and family advisory councils that we’ve been tapping into throughout this process for guidance and feedback,” Neely adds. “We’ve also got a very robust physician informaticist group and EMR operational improvement teams that are integrated in our various clinics and hospital systems, gathering real-time feedback.”