At a time when broad swaths of society are keenly focused on health care due to the COVID-19 pandemic, patients are wary of setting foot in an actual clinic.
Oregon Health & Science University has dramatically expanded its ability to provide health care through telemedicine. OHSU has gone from 1,100 digital health visits completed during the entire month of February to nearly 13,000 in March alone.
When it comes to telemedicine, the future is now.
“Telehealth is definitely part of the way we do business now,” said Steve Kassakian, M.D., associate chief health information officer and a primary care physician who has helped to lead the effort.
All OHSU ambulatory faculty – a total of 1,200 licensed health care professionals – can now conduct virtual visits with patients. The initiative cuts across all OHSU primary and specialty care service lines, including oncology and behavioral health. It also affects standard follow-up visits for patients who underwent surgery.
In fact, most believe the shift to telemedicine will outlast the novel coronavirus.
“The notion of having somebody drive in from Fossil, Oregon, all the way to OHSU for a 20-minute follow-up appointment, I can’t see that happening ever again,” said Mark Lovgren, director of telehealth services at OHSU. “Getting in your car and driving four hours for a wound check is hopefully not going to happen as much.”
Telemedicine is unfolding rapidly across the country, yet OHSU stands out.
Lovgren and Darren Malinoski, M.D., professor of surgery (trauma, critical care and acute care surgery) in the OHSU School of Medicine, were invited to share their experience in ramping up OHSU’s telehealth program during a nationwide webinar hosted the week of April 6 by the Association of American Medical Colleges.
A huge effort
OHSU acted quickly once the need became apparent.
As the novel coronavirus spread into Oregon beginning with the first confirmed case on Feb. 28, a core group of telemedicine experts engaged OHSU’s Information Technology Group to ensure the hundreds of clinicians had the technical capacity to conduct virtual visits.
“The teams dropped everything they were doing and worked on this problem nonstop,” Kassakian said. “It was a huge effort.”
At the same time, the group expedited training for providers with online videos. A group of 25 medical scribes fielded troubleshooting calls from both patients and providers.
On pace to exceed 10,000 video visits in April
That effort is resulting in a huge surge of virtual visits, a two-way video connection between patients and their health care provider through OHSU’s online patient portal MyChart. In February, OHSU logged 300 such visits.
That number ballooned to 3,725 in March and now is on pace to exceed 10,000 for April.
“We had a five-year plan that we are accomplishing in a few weeks,” said George Keepers, M.D., chair of psychiatry in the OHSU School of Medicine. “So we’re still seeing patients, but just not in person. People should know that help is still available.”
In fact, his group has actually increased the overall number of visits – counting both in-person and remote visits – since the crisis began.
“Our no-show rate has dramatically decreased,” he said.
Other providers have noticed the same thing.
Kevin Winthrop, M.D., M.P.H., professor of infectious diseases and public health in the OHSU School of Medicine and the OHSU-PSU School of Public Health, said the migration to telehealth had started well before the current crisis. Like other practitioners, he said telehealth visits have ramped up exponentially in the past month.
He expects the use of telehealth will endure after the crisis abates.
“There are a lot of things you can take care of virtually as opposed to in person,” Winthrop said. “It won’t replace a face-to-face visit, but it will be used selectively and it will become more commonplace.”
Face-to-face visits will still remain necessary for obvious reasons: Chest pain, stroke, acute trauma will always require a provider to lay hands on the patient directly. Yet clinicians are discovering that many of the in-person visits they conducted in the past can be effectively and conveniently handled with a phone call or a virtual visit online.
“A lot of what I do in primary care is chronic disease management,” Kassakian said. “I can talk with my patient over the phone about how they’re doing with their blood pressure medication. You don’t necessarily need to come into the office for that.”
“I don’t think we’ll ever go back to the pre-COVID days,” he said. “We’ve crossed into a new era of medicine now.”