NEW ORLEANS—Health systems that were early virtual care adopters have evolved their telehealth organizational strategies following the COVID-19 pandemic to scale up tech initiatives.
By centralizing and strategically aligning their telemedicine initiatives, OSF Healthcare, the University of Pittsburgh Medical Center and West Virginia University Medicine have been able to better stand up new virtual care programs and secure buy-in from different parts of their organizations, executives said at the American Telemedicine Association (ATA) Nexus conference.
The systems are all part of the ATA’s Center of Digital Excellence (CODE), which it launched with 12 health systems and vendor partners in December. CODE was launched to provide guidance and frameworks to the telehealth industry.
Avasure is one of the vendor partners of CODE. Its chief clinical officer, Lisbeth Votruba, explained that the partner organizations of CODE have recently discovered similar trends in leadership evolution in their telehealth programs.
“We just really recognized that the leadership is evolving in a very good way in telehealth,” Votruba said on stage at the Nexus conference. “Many telehealth solutions started in small projects that were reactive, and many of these showed success in addressing specific problems, but they lack the long-term alignment and scalability. That's where we are here today, really centralizing the digital care leadership to bring structure, strategies and decisions to it,” she said.
OSF Healthcare started investing in its data capabilities and building a data warehouse 15 years ago. The system wanted to scale, move out of the piloting phase for virtual care and get digital solutions to patients.
When the system created OSF OnCall, its 24/7 365-days telemedicine business, it structured it like it was another one of its hospitals, Jennifer Junis, president of digital health of OSF OnCall and digital health strategy and operations clinical transformation leadership at OSF HealthCare, said at the ATA Nexus conference.
Junis came from an operations background in nursing, which was an asset to the division when the COVID-19 pandemic hit. The program rapidly scaled telemedicine, hospital-at-home and other digital programs, taking a five-year telehealth roadmap and implementing it in a matter of months.
The University of Pittsburgh Medical Center is a system of more than 40 hospitals, 800 ambulatory care sites and a health plan with 4 million members. UPMC had a smattering of telehealth programs before the COVID-19 pandemic like a B2B telemedicine program and a virtual urgent care with its health plan.
Because the system was rapidly responding to the pandemic, it was not acting in a coordinated manner to roll out virtual care programs.
“We were really in a panic, as I think most folks were, and so when we were trying to scale, there were a lot of just silos right throughout the organization. People saying, ‘I've got to put in this grant and buy this iPad,’ or, ‘I've got to go start this on my unit.’ You know, we're really struggling," said Carla Dehmer, senior director of telemedicine and digital solutions at UPMC and an early employee of the telemedicine program.
By 2022, her department was better able to take stock of the programs that had been stood up. Independent of the telemedicine center, one of its hospitals had started a virtual nursing pilot, she said.
From there, the system began a massive coordinating effort to bring all of its virtual care under one operating umbrella. The telehealth department started creating best practices for the virtual care programs that started during the pandemic.
But, as the system was trying to scale programs, it ran into issues. Hospitals and clinics in the system were using different technology vendors and were running the programs in different ways.
Once the whole system transferred onto Epic’s electronic health record system, the vertical integration of its virtual care programs became easier, Dehmer said.
Instead of the telemedicine department reporting up to the chief medical information officer, the system created a vice president of access position—a dedicated executive who thinks about how patients can get better access to care, which includes the availability of telemedicine.
From there, the system has much more easily been able to create strategic initiatives, make new investments in technology and learn from different groups in various specialties and regions.
“When we want to invest or think about new products or new initiatives or new practices, we can have that flow through one strategic committee with all those different people who are so thoughtful to put all of that work together,” Dehmer said. “But now we don't have competing priorities. Now we're not trying to compete against one another for something. We're all working collaboratively together to create one strategy.”
West Virginia University Medicine found success with its rural clinic telehealth program it started before the pandemic. It was able to increase access to care for children living in rural areas, Charles Mullet, Margaret T. and Lary K. Pickering Chair of the Department of Pediatrics at WVU Medicine Children’s said. The clinic soon proved cost-effective based on a financial analysis by the system.
In 2017, WVU Medicine’s CEO, Albert Wright, set a goal to have 30% of the system’s visits be conducted virtually by 2022. When the pandemic hit, the executive leadership’s support of virtual care allowed the programs to be fast-tracked.
Shannon McAllister, who serves as assistant vice president of telemedicine and population health at WVU Medicine, helped get the clinicians iPads to do telehealth during the pandemic and was able to fast-track virtual care programs.
Marrying telehealth and population health under one leader has served the system well for large-scale technology projects, Mullet noted, adding that without the buy-in of leadership, telehealth would have been much slower to roll out.
“We're rolling out in-patient consults at one of our larger regional hospitals in the southern part of the state. It's not going to be a high-volume program. They don't have a ton of kids, but Shannon and the team have already solved the privileging process, the legal practice ... so we're able to just kind of ride the coattails … It's just another appendix. And so that's just fantastic," Mullet said.
Mullet described how the telehealth and population health position used to be located under the chief financial officer, but it’s now moved to be located under the chief information officer. That move has been working well for the system because the CIO understands digital care technologies and population health, he noted.
Under Junis’ leadership at OSF OnCall are three divisions: digital experience, digital care and retail. Digital experience deals with the front end of patient care like its AI chatbot, online scheduling, virtual triaging and its contact center.
The digital care division handles virtual ambulatory care and acute care. The retail division oversees the virtual urgent care platform, retail imaging, primary care and mobile strategy.
Junis said while this seems like a lot for her to oversee, the organizational structure reflects the patient journey in the organization, from entering the front door of a virtual care organization to getting treatment.
Dehmer with UPMC explained how the system once structured its telehealth solutions within different parts of the organization. She said that the system's remote patient monitoring program sat in a different part of the system than its virtual urgent care, which was owned by the UPMC health plan.
“Really, they need referrals to each other,” Dehmer said. “Yes, you can work with different teams and put that together, but then oftentimes, then you find yourself with different products or different vendors, working with different teams, and you miss that. There's a disconnect there.”
Having virtual care unified under a strategic team also allows teams to model their projects off of one another and to use existing structures within the organization to build out programs, executives said.