'It's about people, process and tech': 1-year post launch, NewYork-Presbyterian innovation institute leaders talk telehealth growth, future

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Since establishing the Hauser Institute for Health Innovation in June 2019, NewYork-Presbyterian has significantly scaled its telehealth programs and trained thousands of physicians to provide virtual care during the COVID-19 pandemic.

Peter Fleischut, MD, senior vice president and chief transformation officer of the New York City-based telehealth innovation team, and Shauna Coyne, director of telehealth, have spearheaded the institute's telehealth services. While NewYork-Presbyterian ramped up outpatient telehealth during the pandemic, prior to COVID-19, outpatient visits made up about 5 percent of the innovation institute's telehealth services.

The health system has made significant investments in virtual care primarily within its hospitals, emergency departments, ambulances and ancillary services, Dr. Fleischut told Becker's Hospital Review.

Both Dr. Fleischut and Ms. Coyne credit the health system's collaboration with Weill Cornell Medicine and Columbia University Irving Medical Center, both in New York City, as major support to the expansion. In July 2016, the three organizations partnered to launch NewYork-Presbyterian's telemedicine suite NYP OnDemand, which allows patients to partake in virtual appointments with providers via smartphone, tablet or computer.

Here, Dr. Fleischut and Ms. Coyne discuss the Hauser Institute's key accomplishments over the past year and plans for future growth.

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

Question: It's been one year since launching the Hauser Health Innovation Institute. What have been some of your biggest telemedicine projects?  

Dr. Peter Fleischut: For about the past five years, telemedicine and virtual care have been a major focus for us and have been accelerated by the Hauser Institute. We've been heavily investing in this area with our partners from Weill Cornell Medicine and Columbia University Doctors to have a comprehensive suite of telehealth services, from urgent care to second opinions to outpatient visits, specialty visits, intra hospital consults, remote patient monitoring and mobile stroke treatment van or ambulances. Thankfully we made that investment because it's been a big part in treating and taking care of patients during the crisis. It is critically important that we can connect to patients during the crisis, which telehealth has helped us with. We saw significant numbers in telehealth pre-coronavirus crisis, but definitely afterwards and during we saw a spike in acceleration as well.

Shauna Coyne: We were very fortunate we invested in telemedicine so heavily throughout the organization over the past few years. It put us in a good position in March to be able to scale all our existing programs.

Q: Moving forward, do you expect to maintain the same amount of telehealth visits you're supporting during the pandemic?

SC: We turned outpatient telehealth on to about 4,000 physicians during the pandemic, whereas before we would have only had a couple of hundred physicians that were actively doing outpatient telehealth visits. The pandemic forced providers to think differently in how they were taking care of their patients while they were home. We definitely want to continue the trend. A lot of expansion requires adding on additional services to these outpatient visits, such as our interpreter services or navigator program but also thinking of during COVID-19 how we were able to send devices home to patients so we could continue monitoring them.

When we have a telehealth visit with our patient, we can ensure they have access to a pulse oximeter at home to really enhance the experience for the patient and provider. In terms of devices, we sent more than 7,000 pulse oximeters and more than 1,000 oxygen concentrators home with patients during the pandemic.

Q: Do you plan to roll out more remote monitoring tech to other patient populations?

PF: Yes. We were doing remote monitoring prior to COVID-19; we started around a year and a half ago. We're using Philips home monitoring kits that we send home to patients, and these include a blood pressure cuff, a pulse oximeter, a scale and a tablet. We targeted different populations, specifically around heart failure and hypertension. In terms of the scale and how we had to ramp up our program in the space of a couple of weeks, that's really when we had to kind of build up our own monitoring program on top of what we have with Philips.

Q: Can you share a specific experience or patient encounter where telehealth tech helped solve an issue or strengthened a human connection with a patient?

PF: We don't want to implement technology for technology's sake. At the end of the day, it's really about the people, process and technology, with people making up 80 percent of it, the process taking 15 percent and tech making up the remainder. The most critical part for us was that we're very fortunate to work with the providers at Weill Cornell Medicine and Columbia University and use the expertise they have to connect with their patients. I think overall, as all of us were a little challenged through the crisis, rapidly adapting to virtual meeting and video conferencing and doing everything virtual, it was the same for patients connecting with their providers via telehealth. They were also relieved to be able to do it and frankly, we were honored to be able to even provide the service because at the end of the day, you just want to be able to serve the community.

I think overall patients had a great experience and still have a great experience. The satisfaction with telehealth is very high. Areas where satisfaction is lower are usually, ironically, when we have limitations of what we can do via telehealth — meaning patients want to do more via telehealth once they realized the capability. That's why it was a natural progression into remote monitoring because the patients would be at home and able to connect but they wanted to give their vital information or be able to get labs or imaging done, so all the additional things that come along with a visit.

Q: What are some of the challenges associated with telehealth, especially during rapid expansion?

PF: There are challenges to get on the technology and to login to the patient portal. At NewYork-Presbyterian, we take care of one-third Medicare, one-third Medicaid and one-third commercial insurance patients. Our CEO Steven Corwin is very thoughtful to make sure when we introduce new technology that we're not worsening any disparities. We really want to make sure that we have the right services so if a patient speaks Spanish or Chinese, we can get an interpreter or go through and have bilingual instructions, so the patient can download all the technology they need so that they can access it just as well as an English speaking patient.

Q: What are your top concerns heading into a potential second wave of the pandemic?

PF: Awareness. It's critical that patients are educated, meaning they're aware that technologies exist like this so they can be able to connect with their providers. It is really important people feel comfortable reaching out to their provider and can call and say they'd like to do a new visit or follow-up visit via telehealth. My advice is to encourage people to call their physicians to ask them if they can do follow-up visits through telehealth.

SC: I think awareness is definitely a huge piece to this. If we do experience a second wave, I think the fact that we already have our providers enabled and using this technology means we would definitely be in a better place than if we were trying to turn this on for everyone back in March. Also, being able to monitor the demand and the volume is important — how we can ramp up providers even for our urgent care in the stake of a couple of hours and make sure our providers still see a full panel of patients from being remote or not necessarily in our facility.

Q: What have been some of the Hauser Institute's biggest accomplishments over the last year?

SC: We've been fortunate that we had invested in telehealth, but I feel like in the month of March we probably did three years of work in three weeks. Standing up many new programs in the crisis has been something I've been very proud of in terms of how the team and how the whole organization has really adapted. Other personal accomplishments have been educating and training physicians, setting up additional services for outpatient video visits, building a new remote monitoring program for COVID-19 patients that were sent home from our ED because we were overwhelmed with volume.

PF: Standing up an infrastructure to connect patients to providers before and during the crisis, and also sharing best practices with health systems throughout the country have been big accomplishments. We're very excited. We love collaborating with other health systems. We thought it was critical before, during and beyond the crisis. The capabilities of telehealth and technology are limitless in terms of healthcare. That being said, I'm most excited about the work to really make sure that as we do this, we're doing it in a way that not only does not increase disparities but actually helps level some disparities.

Q: What are some of your goals or what do you hope to accomplish at the institute in the next year?

PF: Right now it's really learning and identifying the best practices that we've learned over the past three months and looking at how to sustain, scale and accelerate those operations while we're also preparing for any potential increase in cases for the fall. We want to make sure we really take those best practices and solidify them but also advocate nationally for the benefits of telehealth and scale them so that we can be able to help meet the needs of our patients throughout the summer and throughout the fall. And it's critically important we do this not just at NewYork-Presbyterian but also with Weill Cornell and Columbia.

SC: I agree. Without Weill Cornell Medicine and Columbia Doctors, we definitely would not have been able to do any of this. I also think how we scale and continue to ramp up new programs, but also tying in the actual care models, so we keep seeing more patients at home, more remote monitoring, more video visits and how we're able to connect the different care teams for a patient when they are at home.

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