The receiving desk of the Mass General Clinical Microbiology Laboratory is always bustling. “But when COVID-19 hit, routine work plummeted, and the avalanche of COVID specimens began,” says Heather Wilson, receiving desk supervisor.
- Virtual rounding reduces the number of providers entering patient rooms while allowing care team members to actively participate in patient care remotely
- Virtual consults allow smaller community hospitals to tap into the expertise at larger institutions
- Telehealth services are launching quickly, due to COVID-19 urgency
Telehealth allows health care providers to use phone, video, email and mobile applications to support their traditional medical services. While it was a convenient tool under normal circumstances, during the COVID-19 global pandemic, telehealth has become a crucial safety measure for physical distancing and personal protective equipment (PPE) conservation. Most importantly, telehealth allows for continued access to clinical expertise when and where it is needed.
The teams that develop telehealth solutions and services are being asked to urgently and under increasing demand devise ways to address new challenges brought by COVID-19. However, it's not as simple as handing a clinician a phone to videoconference with patients. There are important privacy, scheduling, workload constraints, regulatory requirements and reimbursement considerations.
The Center for TeleHealth collaborates with many departments across Massachusetts General Hospital to make solutions practical and scalable. This typically includes coordination with diverse teams, such as Information Systems, the Office of the General Counsel, Compliance, the Professional Billing Office and, most importantly, physician and patient care services leaders from across the institution.
Moreover, there have been more legal and regulatory changes around health care technology in the past few weeks than the previous three years.
"Right now the need is so pressing that the way that these programs are being conceived is a little bit different," says Juan Estrada, MSc, MBA, senior director of the Virtual Consult program at Mass General. "They are launched in a very preliminary stage and then evolve based on the needs and considerations uncovered as use of the service expands every day or every week."
Two of the big projects that Mass General is focusing on right now are virtual rounds and virtual consults.
Typically, five to ten different health care providers "round" together in hospitals, meaning providers from various disciplines meet at the patient’s bedside to discuss his/her condition and coordinate care. This could include the attending physician, plus several specialists, nurses and other clinicians. In the current climate, rounds expose too many providers to potential risk.
Virtual Rounds were conceived by Lee Schwamm, MD, director of the Center for TeleHealth, executive vice chair of the Department of Neurology and vice president of Partners HealthCare Systems (PHS) Virtual Care, after conversations with Michael Bowley, MD, PhD, associate director of the Neurology Residency Program at Mass General.
Virtual rounding enables physicians to collaborate through group videoconference and screen sharing meetings, allowing providers to practice physical distancing while treating patients and reducing the number of providers entering a COVID-19 patient's room. A single doctor can see patients and connect with the rest of the team through connected devices, such as a smartphone, laptop and workstation on wheels. One person handles the in-person checkup, while remote participants can place orders, write progress notes and suggest treatment. The model’s expansion is now led by Information Systems, after several weeks of work with physician leaders and Center for TeleHealth team members.
"The number of people who are meeting admitted patients in person is reduced and they can still collaborate," Estrada says. "They can share their screen, they can distribute the work.”
Another version of telehealth helps close the gap between large research hospitals and other health care locations, including smaller community hospitals. Virtual consults are a way to share resources and expertise without being physically in the same place by enabling phone or video interaction between physicians located in different hospitals in a structured and compliant way.
In a recent extension of the program, intensive care specialists from Mass General and Brigham and Women's Hospital are available around the clock to provide intensive care unit (ICU) support to community hospitals. A service led clinically by Kathryn Hibbert, MD, vice chief of Pulmonary Critical Care, and Jason Wasfy, MD, medical director of Massachusetts General Physicians Organization, in collaboration with the Center for TeleHealth—with support from the Center for Innovation in Digital HealthCare as well as the Health Data Initiative—and PHS Patient Experience, and sponsored by Elizabeth Mort, MD, senior vice president of quality & safety, chief quality officer, the service ensures community facilities have the support they need for complex clinical decision making when they need it.
In a virtual consult, a physician who needs support pages other specialists to discuss a case. The ICU program connects Mass General intensivists with community hospital ICUs via phone. The intensivist can view the community patients’ medical record and talk with the local physician. They will receive a call from the intensivist to discuss the case and view the patient's charts, if necessary. Currently, the program doesn't include video technologies or screen sharing, but eventually, additional capabilities and support will make the program even more robust.
More recently, the Center for TeleHealth has worked with various other Mass General and PHS groups, including the Office of the General Counsel, Compliance, Care Continuum and Patient Experience to expand this model to infectious diseases consults for Mass General family hospitals and to post-acute care facilities for access to different specialty groups from across the Partners HealthCare Systems.
The Intersection of Technologies
Currently, virtual rounds and virtual consults are two distinct programs. However, in the future, they are likely to intersect as the programs develop. For example, the intensive care group at Cooley Dickenson Hospital in western Massachusetts might have a case to discuss during virtual rounds. To supplement their own resources, they could invite specialists from Mass General to join rounds and share their expertise.
"Then they can round together and discuss the cases," Estrada says. "And they can engage using screen sharing and video chat or exchange information, write a summary of what happened and then disconnect and part ways."
Proceeding with Urgency and Caution
The telehealth team is working to launch services as quickly as possible without overwhelming providers or overloading infrastructure. Estrada is cautious about making sure that new solutions aren't counterproductive.
Since COVID-19 is drastically changing the way telehealth is launched, there is a cultural shift in the way technology is adopted. Before the pandemic, the telehealth team would develop programs and then push them out to care providers. Now, they're being used to address the needs that providers are raising as the situation escalates.
"It's obviously very demanding," Estrada says, "But it's incredibly rewarding to experience this increased interest and seize this opportunity to develop and deploy tools in support of our providers. It’s a privilege being part of such a wonderful community of experts and collaborators."
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Please note that no visitors are permitted in outpatient settings.