Troubleshooting the rapid growth of telehealth, data-sharing during COVID-19: Key insights from Kaiser Permanente & Keck Medicine of USC

As the number of COVID-19 cases surges in California, with 11,126 confirmed cases as of 9:15 a.m. CDT on April 3, clinicians are turning to telehealth and virtual visits with patients to remain accessible without spreading the virus.

The California Department of Insurance issued a notice on March 30 to require health insurers to increase access to telehealth services during the COVID-19 state of emergency.

The transition to secure virtual visits and email communications for a large volume of providers in a short period of time presents several challenges for IT leaders. Kaiser Permanente Executive Vice President and CIO Dick Daniels said his top three areas of focus to expand digital operations during the pandemic include anticipating and meeting the growth demand for virtual encounters with patients through email, call centers and video visits. The health system now has an average of 65,000 telehealth encounters per day.

His team is also focused on obtaining and distributing thousands of laptops for employees to use for telecommuting and expanding the system's network and VPN capacity to support the growth in telecommuting and data sharing.

"We have been leveraging our electronic health record system in order to gather data and create reporting around our COVID-19 patients," said Mr. Daniels. "This gives us the ability to pull the most accurate and real-time information across our more than 12.2 million-member base."

It also takes time for clinicians to become familiar with the virtual visit workflow and effectively meet the demand for visits. Health systems are rapidly training clinicians to use technology for telemedicine as CMS and private insurers expand coverage for telehealth visits. At Keck Medicine of USC, the leadership convened to agree on a workflow for appointment scheduling, patient education and training for clinical teams and developed templates to ensure clinicians completed notes and documented verbal consent.

"It was important to make this a priority and be open to change," said Carolyn Kaloostian, MD, a family medicine specialist at Keck Medicine of USC. "We had to get out of our comfort zone and be ready to learn, as well as help patients and families during an already uncertain time. Weekly group meetings also were very helpful to discuss telemedicine and help trouble-shoot common issues."

Dr. Kaloostian said it has been easier to make timely and accurate documentation during telemedicine visits than in-person visits because she can take notes while facing the patient. Audio-visual quality may provide some limitations for virtual visits, but during the pandemic the benefits of telemedicine outweigh the technology limitations, she said. And patients may decide they prefer telemedicine in the future.

"This pandemic will have many long-lasting impacts on healthcare," said Dr. Kaloostian. "In our practice, I would expect Keck Medicine of USC clinicians and staff, who are getting more familiar with telemedicine, to continue to use these options to provide more convenient care to our patients and their families. It would be important for the practice to have regular and dynamic assessment of sustainability with this model as well."

Note: COVID-19 data is from the Johns Hopkins Coronavirus Resource Center

More articles on healthcare:
What CIOs need to know about sharing COVID-19 information
Trump administration requests daily COVID-19 data from hospitals: 5 things to know
How Providence outfitted its EHR within 24 hours of its 1st COVID-19 patient

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