How Cleveland Clinic rapidly scaled its telehealth program during the pandemic: 8 key notes

Cleveland Clinic released its COVID-19 Digital Health Playbook, including a guide for healthcare organizations to rapidly scale their telehealth offerings.

At the beginning of the year, telehealth represented 2 percent of the total care delivered at Cleveland Clinic; however, when it became clear that in-person visits were no longer safe amid the COVID-19 pandemic, patients turned to remote care and virtual visits. Cleveland Clinic had to rapidly scale its remote care program. Here are key steps it took:

1. Cleveland Clinic's legal department developed guidance for providers to deliver virtual care to established patients in any state using multiple modalities, in accordance with state and federal guidelines. It also provided information to clinicians about prescribing controlled substances to established patients during the virtual visits.

2. The health system needed to expand its digital platforms to accommodate its 19 clinical institutes that include around 4,000 physicians. IT leaders ramped up platforms that providers and patients could use for remote interaction including FaceTime, Google Duo and Doximity Dialer.

3. The health system provided training to the primary care and specialty physicians and clinicians about how to use the telehealth technology. There were 350 providers trained in six virtual sessions during the first week who learned how to navigate the virtual portal and access Epic workpools as well as interact with patients over the video or telephone Cleveland Clinic developed a "unified dynamic playbook" within its internal COVID-19 website, which improved use and efficiency in the platform.

4. Daily leadership huddles across workgroups improved communication and the transparency promoted innovation, quick uptake and initial success.

5. The finance and legal teams worked together to remove payment barriers for telehealth services so patients could quickly access care. CMS and private payers updated their policies to allow virtual care during the pandemic.

6. The system created new documentation templates within its Epic EHR for virtual visits, eVisits and phone encounters to track activity. Cleveland Clinic also used Express Care Online, a third party platform, to provide patient-initiated visits, primarily by those who were exposed or potentially exposed to COVID-19.

7. The team also developed specialty-specific documentation templates and workflows to shift outpatient care to telehealth. The teams now schedule virtual visits two to four weeks in advance and enroll patients in the MyChart portal. Cleveland Clinic had to implement changes to its scheduling template for both central and practice-based teams to offer the virtual visits.

8. A workgroup developed a system for remotely monitoring COVID-19 patients to monitor their symptoms and escalate concerns quickly. The program has enrolled more than 1,000 patients.


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