Health system uses telehealth to steer patients away from ER, urgent care
WakeMed Health and Hospitals is based in the heart of a dynamic, fast-growing market – an area known as the Triangle, which includes Raleigh and Durham, North Carolina, and surrounding communities. This area has made a name for itself – renowned universities, constant opportunity, cutting-edge technology and an impressive range of health services and healthcare options.
Hospitals and health systems across the country are rolling out telemedicine services for patients. The existing landscape of telehealth vendors means there certainly is no shortage of plug-and-play options, but WakeMed Health’s goal in implementing virtual care was to not only provide more access and options for high-quality care, but also to engage with more residents in the community and across the state, and make the healthcare experience easier for everyone involved.
“When we think about engaging people who seek health services, it’s not just about our services,” said Valerie Barlow, vice president of clinical and support services at WakeMed Health and Hospitals.
“As a growing health system, we need to make sure our patients get to the right place for their point of care within the WakeMed system – hospitals, health-plexes and physician practices as well as our website and virtual presence.”
"Providing optimal care in the digital world means analyzing the right data at the right time and using it in the right way to increase access to care and to ensure improved health outcomes."
Valerie Barlow, WakeMed Health and Hospitals
The provider organization recently unveiled the WakeMed All Access App, a wayfinding and patient-engagement app. It wanted to offer a singular platform for patients – one that put all the tools, features and advanced capabilities, including virtual care, in one place.
For the telemedicine piece, the organization needed a platform that was compatible with the app and could be integrated within the app. That was the challenge.
WakeMed Health turned to RelyMD, a telemedicine technology vendor, for the telehealth piece. With the WakeMed All-Access App, patients have access to their WakeMed MyChart patient portal and medical records, as well as a Find a Doctor database.
In addition to wayfinding, app users can schedule an appointment, reserve their seat in urgent cares, check up-to-date emergency department and urgent care wait times, and, with the RelyMD service, access virtual urgent care.
“While a key element to the entire proposal was RelyMD’s ability to integrate with our existing wayfinding and patient engagement app, it was necessary to work with our Epic EHR,” Barlow said.
RelyMD is staffed by Wake Emergency Physicians PA (WEPPA), the same providers who staff WakeMed’s seven emergency departments. That means they are familiar with the WakeMed system and understand the patients and the organization’s needs and challenges.
“RelyMD proposed a privately labeled telemedicine platform – branded as WakeMed Virtual Urgent Care – that could function within the WakeMed app as well as through the WakeMed website,” Barlow explained.
“In addition to being staffed by physicians and advanced practice providers who are already familiar with treating local patients, RelyMD offered to use their pre-existing care coordination template to redirect patients who enter through WakeMed’s online service back to the WakeMed system.”
This was done by working with the clinical team to establish physical locations and appropriate contacts for conditions that would require follow-on, in-person care, she added.
The telemedicine vendor’s proposal also included the delivery of monthly reports that track metrics and provide additional insight about patients and care delivery: for example, how many patients who utilized the virtual urgent care needed follow-on care, whether they would have sought care elsewhere had they not had access to this service, and whether or not a patient has an established primary care physician.
There are many vendors on the market today offering telemedicine technology, including American Well, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services and Tellus.
MEETING THE CHALLENGE
Prior to expanding its virtual care services to the public, WakeMed turned to RelyMD to help implement a telemedicine option for WakeMed employees. The organization’s benefits plan already included existing in-house telemedicine offerings, but it knew it needed an experienced partner to help build out a robust virtual care program, Barlow said.
“We wanted to further expand our virtual health services with a vendor that already specialized in care coordination,” she explained. “Given our successful working relationship with WEPPA, we knew that RelyMD would take the time to build what we needed and what we wanted as a health system: a solution and product that was unique to WakeMed.”
The WakeMed leadership team recognized that the vendor was started with a different view on virtual care – what it brought to the table would not be a cookie-cutter, plug-and-play platform, she added.
“By initially offering telehealth to our employees, we were able to ensure that the program was working and provided all of the components and access we envisioned, while also helping our human resources and benefits teams save on healthcare costs,” she said.
“The initial rollout was a great focus group to measure utilization rates and satisfaction rates, and better understand how care coordination would work, and what we would need to do on our end, outside of the technology, to really utilize the information collected through virtual health for the benefit of our patients.”
A few months after employees had started using the service and adopting the technology, WakeMed Virtual Urgent Care was launched to the public. Overall, the service is able to operate fairly autonomously. The vendor handled the CCDA-feed with WakeMed’s Epic EHR system, and their physicians and providers started seeing patients through the telemedicine platform immediately.
Prior to the public launch, WakeMed worked together to establish the mapping of the care coordination referrals throughout all facilities.
“Each month, we connect with our customer success manager at RelyMD to go over utilization rates and post-consult surveys, and discuss any changes that need to be made internally or externally,” Barlow said. “Providing optimal care in the digital world means analyzing the right data at the right time and using it in the right way to increase access to care and to ensure improved health outcomes.”
The telemedicine system includes post-consult surveys that automatically are posted at the end of every telemedicine visit. Post-consult surveys provide an avenue for metrics and to gain additional insights. Typically, 60% of patients complete the survey.
“61% of patients who used WakeMed Virtual Urgent Care and completed the survey would have gone to an urgent care facility had they not had access to this telemedicine option,” Barlow reported. “14% of patients who used virtual care and completed the survey would have gone to an emergency room had they not had access to the service.”
Some 27% of patients who used telemedicine and completed the survey did not include a primary care physician when entering information in the telemedicine application/questionnaire prior to starting their consult, she added.
“Another success story was the ability to offer WakeMed Virtual Urgent Care for free during Hurricane Dorian in September 2019 for North Carolina residents in need or who were unable to travel during the storm,” she noted.
“WakeMed and RelyMD wanted to help our communities weather the storm. Additionally, WakeMed and RelyMD provided free telemedicine care services to state-operated shelters, which in turn are caring for coastal evacuees.”
ADVICE FOR OTHERS
Ensure a telemedicine vendor has the proper back-end capabilities to easily function with existing internal systems, Barlow advised.
“Be sure the vendor is able to perform the tasks your hospital or health system wants to function now, but also in the future,” she said. “Our community-based telehealth service is integrated deeply in the WakeMed system, and it would be a painstaking process to switch vendors down the road.”
Really get to know the vendors being considered, she added.
“We were lucky that we had previous partnerships in place and were very comfortable with who and what we would be working with,” she said.
“If that’s not possible, it would be important to gather a wide range of testimonials and candid feedback from other systems who have used the vendor in similar ways. Additionally, hearing from patients who have used the service, and also using it personally, really helped us feel comfortable that the service would be satisfactory for our own patients.”
WakeMed, she concluded, intentionally chose a service that was willing to create new systems for the provider organization’s unique use cases for telehealth, ideally from a single platform.