A Simple Way to Identify Patients Who Need Tech Support for Telemedicine

A perform embedded in Johns Hopkins Drugs’s electronic-health-record system routinely identifies sufferers prone to want technical help so both somebody from central IT assist or a member of the medical assist or entrance desk groups can attain out to them earlier than their go to. It provides sufferers particular person scores primarily based on the next danger components: whether or not they have an account within the well being system’s on-line affected person portal, have accomplished an e-check-in course of within the earlier seven days, and have had a video go to within the final three months.

As telemedicine has shortly change into a major a part of ambulatory medical care, frontline suppliers and workers have struggled to adapt to at least one new assist function that had not been a part of their job descriptions: offering sufferers with technical help. A easy device developed by Johns Hopkins Drugs — whose hospitals and clinics in Maryland, metropolitan Washington, D.C., and Florida serve greater than 750,000 sufferers a 12 months — may also help.

It routinely identifies sufferers prone to want technical help so both somebody from a centralized IT assist staff or a member of the medical assist or entrance desk groups can attain out to them earlier than their go to. This method may also help make telemedicine extra equitable and ease the extraordinary burden that the pandemic has imposed on care suppliers’ assist staffs.

The Want for Focused Assist

Like different establishments throughout the nation, Johns Hopkins Drugs skilled an exponential enhance within the quantity of telemedicine visits in the course of the Covid-19 pandemic, and suppliers in addition to members of our entrance desk and medical assist groups struggled to assist sufferers navigate this new kind of care. Our conventional IT assist groups couldn’t adapt shortly sufficient. They continued to perform in a passive means: They supplied assist to sufferers who referred to as a assist line for technical help however didn’t proactively attain out to them.

With the intention to assist sufferers with new workflows, medical and entrance desk assist workers usually usually referred to as every affected person earlier than telemedicine visits to assist make certain they had been prepared at their appointment time. Nevertheless, these workers members informed us that this it was troublesome to tackle this additional technical assist work along with dealing with in-person sufferers visits and further security measures applied to guard sufferers and workers from Covid-19.

From sufferers’ and households’ suggestions, we realized that the phone-call-based assist we had been providing to stroll sufferers by means of the method of preparing for his or her go to wanted to be tailor-made: Some sufferers required extra assist whereas others felt snug with the method and located the additional telephone calls disruptive and pointless.

A Fast and Simple Technique to Goal Telemedicine Assist

This info prompted us, along with colleagues in well being IT and ambulatory operations, to develop an automatic “video go to technical danger rating” device in our digital well being document (EHR) system to determine sufferers who would require technical help previous to their visits. It has the next parts:

  • The rating ranges from 0 to 4, with 0 representing the bottom danger {that a} video go to could be unsuccessful and 4 representing the very best danger it could be.
  • The rating will be added as a column to be displayed on a schedule template and is color-coded primarily based on the extent of danger (0 = inexperienced, 1-2 = yellow, 3-4 = purple).
  • The rating relies on the presence of any of the next danger components: two factors for the affected person not having an lively account in MyChart, our on-line affected person portal; one level for the affected person not having accomplished our eCheck-in course of within the earlier seven days; and one level for both the affected person not having had a video go to appointment up to now three months or the affected person having had a phone go to within the final three months and no video visits.
  • The rating is routinely calculated primarily based on saved EHR knowledge and displayed as a column that may be added to a supplier’s or clinic workers member’s schedule views.

Once we developed the danger rating, roughly 15% to twenty% of sufferers fell into the highest-risk classes (scores of three or 4).


Implementing the Danger Rating

The device can be utilized by both a central IT assist staff or by frontline medical and entrance desk workers to allow them to proactively attain out to sufferers in want of help. Our well being system has employed each. As a part of an iterative enchancment pilot challenge, a central IT staff has supported sufferers at three specifically chosen ambulatory clinics (two specialty care, one main care) that had been recognized as having struggled to assist sufferers prepare for video visits. Starting seven days earlier than a scheduled go to, the central staff reached out to sufferers by way of textual content messages that stated: “Johns Hopkins Drugs: Setup for Video Visits will be difficult. Name XXX-XXX-XXXX anytime (24×7) for help in preparing.”

In Section 1 of this pilot (text-only outreach), textual content messages had been manually despatched to sufferers who had agreed to obtain textual content message reminders and had a danger rating of two or better seven days, three days, and in the future earlier than their schedule video go to. Textual content messages had been despatched to 384 out of 766 sufferers (49%) whose cellular phone numbers had been in our EHR. Out of those sufferers, seven out of 384 (2%) returned a name to the central staff for assist.

In Section 2 of the pilot (textual content + telephone outreach), the textual content on the day earlier than the appointment was changed by a phone name. With this transformation, 44 out of 98 (45% of sufferers) had been efficiently contacted by phone upfront of a scheduled telemedicine go to. Since we discovered it difficult to contact sufferers for set-up earlier than the time of their appointment, we plan to develop and implement processes to assist sufferers on the time of a scheduled go to relatively than upfront,

Exterior of this pilot program, most of our clinic websites have chosen to proceed to depend on their medical assist and entrance desk workers to assist telemedicine visits. From what we’ve realized anecdotally, utilizing the danger rating has improved the effectivity of those groups.

Well being programs leverage EHR knowledge routinely to spotlight which sufferers might have particular consideration throughout a go to (e.g., those that are due for vaccines or want an interpreter). Harnessing EHR knowledge to determine sufferers prone to expertise difficulties in accessing video visits is one other vital step in tapping the potential of those programs to supply a extra individualized method and make the very best use of well being care programs’ sources.

The authors wish to thank quite a few their staff members and colleagues at Johns Hopkins Drugs for his or her laborious work in creating the processes mentioned on this article. They embrace Deanna Hanisch, vice chairman of well being info expertise; Eric Brown, director of well being Data expertise; Cindy Diaz, Epic Programs growth supervisor; Steve Klapper, Epic lead software coordinator; and Kathy Sapitowicz, telemedicine challenge lead. | A Easy Technique to Determine Sufferers Who Want Tech Assist for Telemedicine


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