Virtual Visits: Innovation at Mass General

As COVID-19 causes communities around the world to embrace physical distancing, Massachusetts General Hospital's Center for TeleHealth staff in collaboration with groups including Ambulatory Management, eCare and Clinical Informatics quickly jumped into action to provide an option for thousands of patients to connect with hundreds of providers. With the backdrop of Mass General's long history of groundbreaking research and innovative techniques, staff members across departments quickly scaled the way they care for patients remotely over the course of a few weeks, enabling more virtual visits than ever before.

"Virtual visits are real-time, video visits with providers, leveraging audio and visual capabilities. It's similar to FaceTime, except it's HIPAA-compliant and secure," says Marcy Simoni, director of the Mass General Virtual Visit Program. "Through the platforms we utilize, the provider can also be documenting the visit in the medical record."

Before the Pandemic

Virtual visits aren't new to Mass General, as they first started offering them to patients in 2013. Starting in the late summer of 2019, providers were able to host the visit via an Epic-integrated platform, and patients would log into Patient Gateway to connect with the provider via video.

"COVID-19 has increased the adoption of virtual care at Mass General scale at a speed we could never have imagined. It's been in incredibly high demand," Simoni says. As federal and local governments instituted shelter-in-place orders, a significant portion of the population was suddenly working from home. Likewise, providers had been asked to conduct routine follow-up care and other non-critical services remotely. As many states begin to reopen, more visits and procedures that were either deferred or deemed non-urgent will now be able to be done in person, but virtual visits will remain a critical part of maintaining physical-distancing measures and continuing care for at-risk populations.

"Virtual visits offer providers a way to connect with patients outside of just the telephone, which they already had at their disposal," Simoni says. "It's really clear that there's a greater need for virtual visits; having that face-to-face video component is necessary in some visits where they're having a complicated discussion or there's a need to review labs or imaging. Seeing the patient enhances the interaction."

Quickly Scaling Virtual Connections and Expert Care

In 2020, prior to the COVID-19 pandemic, there were about 1,000 virtual visits (by video) per month, with approximately 230 providers completing at least one visit per month. From March to the end of August, there were more than 440,000 virtual visits either by video or phone at Mass General.

To rapidly scale, Mass General is using a special version of Zoom designed for health care that has been built with privacy and security in mind. Each appointment uses a new meeting link available only to the provider and patient. There is a waiting room function which providers use to admit people into the visit so that no uninvited guests may join. All visits are encrypted, video and chat cannot be recorded and personal health information is not saved by the video system. Patient Gateway integrated Zoom virtual visits are designed to make seeing a provider easy, while keeping patients and their health information safe and secure.

A Team Effort

Through the collaboration of multiple Mass General areas including the Center for Telehealth, Ambulatory Management, Clinical Informatics, the Business Transformation Training team and eCare along with Mass General Brigham Virtual Care and clinical department leadership, in-person care quickly shifting to virtual visits in the ambulatory setting and volume continued to grow significantly week over week from mid-March to present.

"It's been a massive shift," Simoni says. The shift required collaboration from stakeholders across the organization to bring so many providers and patients with no prior experience using virtual care, up to speed rapidly to ensure care could continue to be delivered.

“We have had a wonderful collaboration with the Center for TeleHealth and as virtual visits are incorporated into routine ambulatory care, we are enthusiastic to bring in our support for virtual care, as we do for all other ambulatory care” says Inga Lennes, MD, MPH, MBA, SVP, Service Excellence and Practice Improvement for the Mass General Physicians Organization.

"We had to be much more efficient in how we could deliver support to so many more users on the patient and provider side," Simoni says. Prior to COVID-19, every patient and provider using a virtual visit would need to perform a test call with a member of the Virtual Visit team, an option that was completely infeasible when the majority of patient-provider interactions moved from the physical doctors' offices to an online environment within days. Now, the team offers support to those who experience technical or other issues with the platform on an as-needed basis. Resources are available within Patient Gateway including visit instructions, a “self-test” feature, along with videos to help prepare patients for their virtual visits. In addition, patients can contact Mass General Brigham Patient Gateway with any questions at 1-800-745-9683.

“One very good thing about the COVID-19 pandemic is the acceleration of virtual care and the advancement of technologies surrounding virtual care. We look forward to weaving in virtual care into all aspects of ambulatory care and making it a permanent feature,” says Lennes.

“Our greatest strength is our collaboration and working as a true team; this effort highlighted the best that can happen when all of the stakeholders are brought together to make important change.”

Looking Beyond Virtual Visits

Moving appointments to a telehealth platform addressed the issue of conducting routine, necessary medical care while reducing the number of patients visiting the hospital and reducing the likelihood of COVID-19 transmission between staff members and patients. Another benefit: since hospitals are facing a shortage of personal protective equipment (PPE), virtual visits allow PPE to be allocated to patients in more acute need in an in-person setting.

The innovative work of the Mass General Center for TeleHealth, combined with the willingness of leadership across the organization and medical providers to pivot quickly, has allowed Mass General to continue providing care for patients while keeping them off campus and reducing potential exposures. At a time when both flattening the curve and physical distancing is essential, every participant in the virtual visit process is contributing to the reduction of cases within the community.

“I couldn’t be prouder of the work that Mass General has done to come together across multiple different areas to support meeting our patients where they are, literally and figuratively, to ensure continued access of health care,” says Lee H. Schwamm, MD, director of Mass General's Center for TeleHealth and vice president of Virtual Care for Mass General Brigham. “COVID has shown us what we can do when we all put our minds to it, and it is a powerful lesson for the future.”