Cloud-based telehealth, linked with Epic EHR, helps one hospital scale up virtual care

The combination helped the Florida-based Lee Health ramp up to tens of thousands of telemedicine visits per month as it dealt with the constraints of the coronavirus pandemic.
By Bill Siwicki
12:46 PM
Cloud-based telehealth, linked with Epic EHR, helps one hospital scale up virtual care

Lee Health’s Golisano Children’s Hospital.

Lee Health, a health system based in Fort Myers, Florida, has had inpatient telemedicine infrastructure in place since 2014, ambulatory telemedicine since 2015 and a direct-to-consumer system since 2019.

THE PROBLEM

But the health system needed to rapidly ramp up ambulatory support to address challenges brought on by the COVID-19 health crisis. It immediately recognized a need for virtual employee-health-screening to clear staff for work each day and minimize spread of the coronavirus.

It was equally important for Lee Health to identify a scalable platform that could be quickly implemented to support the clear and immediate need for broader virtual care offerings. The health system needed a platform to remotely connect clinicians, patients, families and community partners, within the inpatient setting and from home.

Patient visitation restrictions brought on by the pandemic prevented families from being with their newborns in the Neonatal Intensive Care Unit. It kept COVID patients in isolation. The health system needed a new mechanism to help these patients engage with loved ones. It needed a means to connect its physician network with non-emergent patients at home. It also needed an alternative avenue to support behavioral health and emergency department patients without putting clinician or individual health further at risk.

PROPOSAL

Lee Health’s goal was to find a telemedicine system that could traverse its different verticals and that was scalable. If Lee were going to spend the money, it wanted to do it right.

“We developed a short list of telehealth solutions that could support the full spectrum of our needs – ambulatory, inpatient and direct-to-consumer,” said Jon Witenko, system director, virtual health and telemedicine, at Lee Health.

"Our administrative team first focused on employee health, conducting daily staff health screenings via telehealth. This gave clinical staff an opportunity to get familiar with the technology."

Jon Witenko, Lee Health

“The Caregility UHE platform would allow us to immediately integrate telehealth into our Epic EHR platform and quickly roll out virtual visits to clinicians and patients. The cloud-based, mobile-enabled solution meant we could use existing resources and keep implementation hurdles to a minimum.”

The scalable telehealth system would lay the groundwork for “the new normal” in healthcare delivery without Lee Health having to juggle a multitude of vendors or constantly reevaluate licensing needs, Witenko added. The UHE system would allow Lee Health to immediately extend virtual care to support employee health and ambulatory patients.

The system is designed for flexibility and future growth, he said. One goal was to extend the telehealth system to community partners that do not have a telehealth system in place to further support population health efforts.

MARKETPLACE

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MEETING THE CHALLENGE

Roughly one week after signing the contract, Lee Health began rolling out new telehealth programs.

“Our administrative team first focused on employee health, conducting daily staff health screenings via telehealth,” Witenko explained. “This gave clinical staff an opportunity to get familiar with the technology. We then ramped up our inventory of hardware cameras and rolled out virtual visits to our ambulatory providers – family practice and specialist physicians alike – for engagement with patients at home. Clinicians placed in mandatory quarantine due to exposure were able to continue to engage with patients remotely using the platform.”

Integration with Lee Health’s Epic EHR MyChart patient portal made it simple for clinicians to launch telemedicine sessions from within the patient record. Patients receive secure, one-time text or email invitations to join sessions without having to download an application.

“It’s as seamless as possible for patients and clinicians,” Witenko stated. “Our inpatients were given telehealth-equipped smart devices with one-click functionality that allows them to dial out to clinicians or loved ones. We dramatically increased the number of mobile telehealth carts to triage ED patients, limit exposure and perform rounding, specialty consultations and urgent assessments in our acute facilities and skilled nursing facilities.”

The health system extended access to its telehealth platform for both internal physicians and community physicians to provide care to patients in the hospital. Outside of the hospital, access to quick “drive-through” behavioral telehealth visits also have been made available to those without smart devices.

RESULTS

Lee Health fielded 200 employee health visits in a single clinic on day one and continue to use virtual visits to clear clinicians for work and monitor those in quarantine.

Lee Health’s 600 ambulatory physicians were systematically turned on to start virtual patient-appointments within the EHR. The platform was rapidly expanded to dietitians; physical, speech and occupational therapists; home health nurses; lactation; patient outreach; educators; and other ancillary services. In one week, virtual visits soared to 1,200 sessions per day with capacity supporting 200 concurrent calls.

“We performed 500 visits in the first five days of virtual health,” Witenko recalled. “We performed almost 50,000 in April and May. Our virtual visits are taking place from any private patient location to any secured clinician location where there is an internet connection. Both clinicians and patients have reported that virtual sessions tend to be shorter and more focused than traditional care visits, improving patient experience and staff productivity.”

ADVICE FOR OTHERS

“As social distancing continues and the nation lays out tentative plans to reopen businesses and schools, telehealth will continue to play a key role,” Witenko said. “Lee Health views virtual care as a permanent fixture in care delivery and plans to continue expansion. With that in mind, I’d recommend identifying a platform that can grow with your organization.”

Lee Health quickly learned it needed a robust support plan as this was a new experience for both patients and most of its providers. Its support team grew from one person to a team of 20 members fielding calls and guiding participants through the process.

The calls were often time-intensive as patients were anxious and not very comfortable with technology. The Lee Health team walked them through the process, performed test visits with them, and ultimately reassured them this was a new experience for everyone, but the provider organization was there to help them.

“Device-agnostic, cloud-supported platforms reduce implementation and support burdens,” Witenko advised. “Offer engagement tips to staff and patients to get parties comfortable with the solution. Build a strategy that allows you to work with what you already have and minimizes resource redundancies. Get creative. Perfection is the enemy of the good. If we had waited for everything to be ironed out, we would have never gotten started.”

Nothing is future-proof, he added.

“Seek out a solution and more specifically a vendor that continues to adjust as workflows and technology evolve,” he concluded. “Look for technology that is versatile not only for current state, but can be incorporated into multiple permutations, otherwise you’ll have dozens of disparate programs.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

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