NewYork-Presbyterian surpasses 100K virtual visits: CIO Daniel Barchi reflects

NewYork-Presbyterian Hospital in New York City kicked off 2019 with a significant milestone: its 100,000th virtual visit.

NewYork-Presbyterian boasts an extensive virtual care program, comprising remote specialty care, urgent care and direct-to-consumer services, among other efforts. These services ramped up fairly quickly, according to NewYork-Presbyterian Group Senior Vice President and CIO Daniel J. Barchi, who said that the health system began "seriously investing" in its virtual care program in 2016.

"We see telehealth as being part of a coordinated care model that goes beyond urgent care for our patients," Mr. Barchi told Becker's Hospital Review in an interview. "Virtual platforms will become the first point of care for many patients, and I think provider organizations have to be prepared for a future that is dominated by virtual encounters."

Becker's Hospital Review caught up with Mr. Barchi to discuss how NewYork-Presbyterian has built up its telehealth program, from its first virtual visit to today.

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

Question: I'd love to take a step back and reflect on the hospital's telehealth efforts. When did you first roll out virtual visits? What specialty did you start with?

Daniel Barchi: We began seriously investing in telehealth in 2016, providing digital second opinions and developing virtual care options in the emergency department to reduce crowding and improve efficiency. Within a few weeks, we had installed video equipment in a nearby physician department to create NYP OnDemand Express Care, a convenient, fast-track option for patients with less serious conditions. ExpressCare patients are given the choice to wait, sometimes for over two hours, for a provider or to have a virtual visit in a private room with an emergency medicine physician in under 30 minutes. Telehealth at NYP grew from there — today, our programs encompass specialty care, direct-to-consumer telehealth, remote patient monitoring, virtual medication reconciliation and several other areas.

Q: What's an unexpected challenge you faced while building up NYP's telehealth efforts?

DB: Redesigning clinical workflows to accommodate telehealth. It is inefficient for a provider to see one patient in person, go into a private office to see a virtual patient and then go back to the floors to see a third patient. Instead, we have encouraged providers to create telehealth blocks in their schedule to see patients virtually, while ensuring our devices complement existing processes. We developed telehealth-specific care protocols to transition providers from diagnosing based on the physical exam to diagnosing virtually. This strategy has facilitated adoption and can be tailored to specific clinical sites across the enterprise. Our hope is that the dual forces of telehealth integration and increasing patient demand will minimize the challenges associated with launching new programs.

Q: How did you gain clinician buy-in for your telehealth programs? What about patient engagement?

DB: Clinician buy-in has been critical to our success — we have tried to make our programs as accessible to physicians as possible. We spend a lot of time thinking about how to fit telehealth into their workflow, making the convenience and efficiency of telehealth apparent, and compensating them effectively for their engagement. That being said, our telehealth efforts are ultimately patient-centered. Providing education to clearly convey the value of a virtual visit has been an important engagement strategy, and satisfaction with the visits has been high. I think it comes down to recognizing who our customer is and what they need. Our enterprisewide telehealth strategy aims to give all our patients a convenient and accessible way to make use of our services, whether through their phone, in-person at a kiosk, with a device sending information back to their physician, or during their visit at one of our facilities. Patients become engaged when they see how our service can make their life easier.

Q: Some have suggested 2019 is the year telehealth will become ubiquitous. Do you agree? If so, what do you think was the tipping point?

DB: I think telehealth today is a mile wide and an inch deep. It holds promise for transforming care delivery, particularly as consumers become more engaged and empowered in their care. I think we hit a tipping point with the fundamental recognition that the patient now has the ability to initiate care virtually — freeing them from the traditional brick-and-mortar care destinations has turned care delivery on its head. I also think that changing regulations and new payment models will enable telehealth in new ways, making limited reimbursement less of an issue.

Q: What advice would you give to hospital CIOs just starting on their telehealth journey? What's the first step to building up a successful program?

DB: My advice would be to be strategic and ambitious in choosing services and partners for your program. At NYP, we took an aggressive approach to implementing telehealth enterprisewide because we truly believe it holds promise for moving healthcare from a confusing, difficult-to-navigate environment to a consumer-oriented experience. I would advise that others think about how to get promising applications to telehealth to scale. At NYP, we firmly uphold the notion that the success of telehealth is 80 percent people, 15 percent process and only 5 percent technology. For CIOs that are just starting on this journey, focusing on the people — physicians, operators and patients — who will need to come together for telehealth to reach its potential will guide the process and remain a strong foundation for success.

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