EHR v Covid-19. From the front lines: Virtual Visits take off at UCHealth. The Covid-19 burning platform

In-person clinic visits by week (red) and virtual visits (blue) at UCHealth, part of 2019-2020: UNVALIDATED DATA (red blips are likely Thanksgiving and December Holidays)

As recently as 2 months ago, we, the virtual visit leadership team, sat in a conference room bemoaning our fates: HOW will we get our 4000 providers (doctors and advanced practice providers) to start conducting Telehealth or Virtual Visits with patients? In all of 2019, our organization conducted about 2700 visits between providers and patients. This was a disappointing number, having spent a year integrating a 2-way video system (Vidyo) inside our Electronic Health Record (Epic). This was also disappointing because the state of Colorado passed the Parity law requiring insurers to reimburse healthcare providers the same rate for video visits as with in-person visits. What else could one want? Video visits for everybody!

Not so fast.

Turns out, doctors are humans too: you figure out a way to do something well (in-person visits with all your equipment for vital signs, sensors, gee-gaws, tests, fine-tuned teamwork honed over decades of practice), you don’t wanna change.

“If it ain’t broke, don’t fix it.”
CT’s inscrutable high school coach, to an uncomprehending student

We came up with all sorts of leadership plans to increase video visits: more education to front-line physicians (not helpful); sending experts to clinic to tout the benefits (nope); introducing video visits to clinicians already on bundled payments, such as surgeons whose post-op visits were no-fee (slight adoption). Video visit adoption was a local phenomenon: a few docs found it useful and did several hundred visits that way over the course of a year, and most others did not try it. Finally, we did get some traction by dedicating some urgent care docs to Virtual Urgent Care, for either a flat $49 fee or co-pay with participating insurers. For the most part though, bupkis.

In the graph above, the blue line indicates fewer than 100 video visits a week leading up to … March 2020.

And then, we know what happens next: PANDEMIC. Social Distancing. Stay-at-Home order from the governor. Suddenly clinic in-person visits plummet. And all across our 600 clinics: “Hey, wasn’t there someone here last year talking about some kind of video-thingy that we could use to see patients? Anybody have their phone number?”

We are luckier (or perhaps more prepared) than most other healthcare organizations:

We already integrated video into our EHR
We have a high-functioning IT infrastructure on a single EHR
We have a strong informatics group (physicians, APP’s, nurses)
Our clinical and administrative leaders collaborate well, and nimbly

And, okay the Feds helped:

CMS relaxed the rule prohibiting Medicare from paying for video visits
HHS relaxed the rule for HIPAA-regulation on providers of video (allowing for Skype, Zoom, even FaceTime), not that our organization needed this.

As a result, within a week of that first pandemic-related request from our providers, we scaled from 2700 visits in ALL of 2019, about a dozen per day, to 3000+ visits PER DAY. Lets say that again:

Video visits went from a dozen per day to 3000+ per day within a week

That’s just crazy talk. And also proof that John Kotter is STILL right, from his book Leading Change: Your first step is a creating a sense of urgency: a Burning Platform. And boy do we have one now, thanks to a microscopic life form .

And now? Now, I sit here in my home office, with my laptop and my smartphone connected, waiting for my next patient, who is visiting me from their home, arranged by my medical assistant, sitting at her home. Our bricks-and-mortar medical office is 2/3 empty, with a reduced crew seeing in-person visits for those without video visit tools, or needing physical exam or other services.

When we connect, every interaction feels like a victory. Every “return visit” feels like re-connecting with an old friend. In fact, I reflexively raise both arms like our team scored a goal:

“You made it!”

“Yes, I did!”

“It is GREAT to see you!”

“Yes! And how are YOU, doctor? Are you doing okay?”

The empathy of patients toward ME and my colleagues, is touching, and genuine, and so much appreciated. Unbiased opinion: longitudinal primary care internal medicine has the BEST patients in the world. Truth.