UCHealth is a nonprofit health system with 12 hospitals and numerous physicians across Colorado, southern Wyoming and western Nebraska.
Today, patients expect to be treated when they want and where they want, said Dr. Christopher Davis, an emergency medicine specialist and medical director for UCHealth Virtual Health. While urgent care clinics are relatively convenient, treating someone in the comfort of their own home when clinically appropriate takes this type of care to a whole new level, he said.
“When seen virtually, patients can request a visit and see a provider often within 30 minutes,” he explained. “With drive time, a trip to an urgent care or primary care clinic could take upwards of half a day. Virtual urgent care was born out of a drive to provide more choice, and more convenience, for our patients.”
When a health system has made the decision to implement direct-to-consumer virtual urgent care, it has to make a relatively early and important decision that typically is framed as “build it or buy it,” Davis said.
“There are a number of off-the-shelf telehealth technology solutions available on the market,” he noted. “These solutions provide both the digital portal and the video software to make live, interactive virtual health possible. Alternatively, a health system can build its own platform, or at least piece together all the parts.”
Building necessitates a fair bit of IT expertise and has a longer runway to launch, but offers the advantage of integration and control over the ultimate solution, he observed.
“Our goal Net Promoter score was greater than 85%, and we’ve been able to meet that metric by prioritizing on-time appointments and a relatively seamless registration process.”
Dr. Christopher Davis, UCHealth
“Back in 2017, UCHealth was very close to pursuing a buy-it strategy, but we ultimately were persuaded by our engineers that we had all the necessary pieces to do this ourselves, and that building it would pay off in the long run,” he said.
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MEETING THE CHALLENGE
UCHealth integrated video technology called Vidyo into the digital patient portal offered through its Epic electronic health record system.
“Prior to the coronavirus pandemic, adoption of telehealth technology was relatively slow,” Davis noted. “The incentives to use telehealth simply weren’t particularly strong for either providers or patients. Accordingly, we had to rely on early adopters to drive progress. We felt that an integrated solution was critical for success, especially on the provider side.”
UCHealth wanted a caregiver to be able to stay within Epic to join the video consult room, see his or her schedule, document, and bill – all in one place.
“This is more difficult to do with off-the-shelf solutions, where providers often have to bounce back and forth between their EHR and the telehealth solution,” he contended. “At the time, our analysts and engineers had to do a fair bit of custom build to make this level of integration possible. Though these days, Epic has relatively robust off-the-shelf virtual care solutions.”
On the patient side, the integration has several advantages.
“First, patients can go to a single digital portal to schedule virtual or in-person visits, see lab results, request refills, and message their doctor,” he said. “Again, it goes back to this idea of one-stop shopping. Probably the biggest advantage is that a patient’s primary care doctor can see the note from the virtual urgent care visit and instantly know the plan of care involved.”
As for the digital experience, patients select a visit time within the portal and then fill out a quick symptom questionnaire. A technician reaches out to the patient just before their visit time to escort them into the video consult room and troubleshoot any technology issues, if there are any.
“The provider then joins the video room and completes the visit, just as if they had joined an actual exam room in an urgent care clinic,” Davis explained. “After the visit, the provider routes after-visit instructions, prescriptions and work notes electronically back to the patient.”
UCHealth’s biggest virtual care success story concerns its “time to provider” metric.
“In a busy urgent care clinic, this can be lengthy, and can result in patients being left without being seen,” Davis said. “Because of the way we queue patients in virtual urgent care, and our ability to assign patients an appointment slot, we’re able to set expectations – and meet those expectations – around when a patient will be seen. This ‘contract’ with the patient is gospel. Again, you can’t be late to an encounter with a patient when that encounter is predicated around convenience.”
Downstream, the time to provider has been less than five minutes, as opposed to 15-20 minutes. This drives down overall length of stay as well: This is typically less than 10 minutes in virtual urgent care, as opposed to 40-50 minutes in the health system’s brick-and-mortar urgent care clinics.
“We’ve also seen success in our patient experience metrics,” he noted. “Our goal Net Promoter-score was greater than 85%, and we’ve been able to meet that metric by prioritizing on-time appointments and a relatively seamless registration process. Our goal is to make the entire experience easy, so that patients think, ‘Wow, I’d do this again before going back to a clinic first.’”
ADVICE FOR OTHERS
The advice Davis offers peers implementing virtual care technology is to remember that the tech is never the hardest part.
“Most of my time as a medical director is spent in change management, not on the IT side,” he said. “These operational issues could be turf battles, staffing models or decisions around the clinical scope of what to see and what not to see in virtual urgent care.”
His second bit of advice goes back to the “build it or buy it” question.
“Have an honest conversation with stakeholders on what you want your virtual urgent care solution to look like,” he concluded. “If your organization is invested in innovation and making virtual care a pillar of strategy, then building your technology solution can pay long-term dividends. If there isn’t resource bandwidth, then buying your solution is a better fit.”