NYU Langone rapidly expands virtual care amid 'explosion' of COVID-19 pandemic in New York

At the heart of the coronavirus pandemic in the U.S., NYU Langone Health is now experiencing record numbers of virtual visits between its patients and providers.

The New York City-based health system last week added 1,300 new providers to its virtual visit platform to help evaluate, diagnose and treat patients with COVID-19. As of March 30, NYU Langone Health completed 5,500 virtual visits in a single day, Andrew Rubin, vice president for clinical affairs and ambulatory affairs at the health system, told Becker's Hospital Review.

NYU Langone built its virtual visit program about two weeks ago to help limit the spread of the novel coronavirus by transitioning in-person appointments to telehealth. Armed with an iPhone or iPad, NYU Langone providers are able to virtually consult with patients for various issues, ranging from COVID-19 concerns to established appointments for cardiology, dermatology or other specialist care. 

NYU Langone's telehealth program runs on the same technology as its virtual urgent care service, which operates 24 hours as a virtual walk-in center. Before the COVID-19 pandemic, the health system had about 60 visits per day through the virtual urgent care program; the number has since skyrocketed to 1,000 visits per day, as of March 30. Patients who use the virtual urgent care service do not need to schedule an appointment.   

Here, Mr. Rubin, who has overseen the health system's shift to telehealth during the pandemic, discusses how NYU Langone Health was able to deploy the virtual visit technology so quickly and how patients and physicians are adapting to the program.

Editor's note: Responses have been lightly edited for clarity and length.

Q: 5,500 virtual visits in a single day is a steep increase from what NYU Langone was previously seeing before COVID-19. What has the experience been like with such a rapid shift to telehealth during the pandemic?

Andrew Rubin: Unrelated to virtual urgent care, we were doing very little with telehealth because the government regulations didn't allow for it to be reimbursed. With most of the commercial insurers, very few of them paid for telehealth and they had different regulations of what was allowed and not allowed. At NYU Langone, we were often doing telehealth on unbillable services such as postoperative visits or some fee-for-service consults where physicians were charging patients to have telehealth visits.

With the COVID-19 pandemic exploding in New York and a huge across-the-board relaxation of the rules allowing us to actually use telehealth and get reimbursed for it, we were able to within essentially a week take the technology that was used for virtual urgent care, which had about 20 physicians on staff who were providers, and scale it up to 1,300 providers in a matter of days. So, within a matter of two weeks, we went from zero telehealth visits to 5,500 visits.

Q: What has the physician onboarding process with the virtual visit technology been like?

AR: The training for physicians is only a 10-minute training module because they already know how to use Epic. So this was just an enhancement to the technology they were using. The rest of the workflow was already there. 

The patient engages in the virtual visit through Epic's online patient portal MyChart. They can log in through a handheld device or their desktop and then the physician logs in and they can both communicate through video. While the physician does the exam, the patient's entire medical record is on the screen so the physician has all the clinical information and can diagnose and treat the patient. They can then document in Epic and then the visit is done. It's literally that easy.

Q: How long did it take NYU Langone to pull the virtual visit program together?

AR: It took us a little less than a week to launch. The process was really more just building the behind the scenes 'guts,' if you will. We call it visit type; we had to create a new visit type for us to be able to schedule visits. We had to train the access centers because in the first week we had deployed you couldn't schedule your own visit electronically through the app; you had to actually call our access centers to make an appointment. On March 26, we went live with the tech where patients could actually schedule the visit themselves. 

Q: Have you experienced any challenges or issues with the virtual tech due to the large influx of visits?

AR: We have built our system pretty robustly, so in the two weeks we went live we had one downtime situation, which was not capacity related. We're configured to handle thousands upon thousands of visits, so our technology is stable and we've had no downtime as the numbers have grown. 

Q: What measures have you put in place to ensure there won't be downtime or glitches? 

AR: In this environment we're in, if you go down, you go down. At a hospital, if your EHR goes down, you convert to paper and you still treat the patient. For us, if the technology goes down, well there is no visit. You have to essentially scrap that visit and get the access centers to reschedule. We've worked through the procedures of what to do if we go down. If it's five minutes of down time we can recover because we will be able to still maintain the visit within the timeframes that are left because each visit is now 20 minutes. If we go down for more than that then people know that if a message comes up then we just call the patient back and we get them rescheduled for another visit day. 

With 5,500 visits per day, we still have room to maneuver within the schedule. Our capacity is probably more like 10,000 visits per day. I'm hoping this pandemic ends before get to the point that we're doing 10,000 visits a day.

Q: Would you say physicians have been able to see more patients by doing virtual visits or is it the same as in-person? 

AR: It depends on the provider. We have some providers who can follow up in 15 minutes; we have some who can follow up in 20 minutes; and we have some who follow up in 30 minutes. Because we could only create one visit type in the two weeks that we set it up, we decided we'd settle on 20-minute visits. For those providers who usually spend more time with the patient, for whatever reasons the specialty or the practice style, they're able to do it within 20 minutes. For those who do 15-minute visits, they are finding that they have extra time.

Q: How do you plan to continue growing the virtual care program?

AR: Phase one was turning the capabilities on, getting visits scheduled by phone. Phase two, which we completed last week, was allowing patients to schedule their visits through MyChart on their own. Phase three will be to keep using the web so you don't have to log onto MyChart or our traditional 'find a physician' website; we have our own technology that we built from scratch, so being able to use that for scheduling visits will be phase three. In the next few weeks we'll have different visit types built and quite honestly hopefully then the pandemic will be slowing up a little bit so we'll be able to take a breath and implement the tech in a less chaotic, rushed way.

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