P1018 - Rapid expansion of specialty practice telemedicine delivers time sensitive care during COVID-19

Background: The unprecedented impact of SARS-CoV-2/COVID-19 worldwide pandemic on healthcare has been profound. At our large quaternary care pediatric healthcare system, in response to change how we deliver care, a telemedicine strategy was rapidly developed with a priority to address the needs of patients requiring specialty time sensitive ambulatory care. One obvious opportunity was to rapidly expand telemedicine capabilities to address the impact quarantines and stay at home orders would have on the delivery of care to children with chronic conditions. We had some telemedicine capabilities in certain populations, however when our community shut down we responded with an immediate plan to expand telemedicine services in a large multi-specialty practice. During the first week of the stay at home order, our ambulatory volumes drop by 69% reinforcing concerns regarding delays care (Fig. 1).

Methods: We established a leadership model, task forces, and communication plan. We rapidly adapted to ongoing changes and addressed specific needs including clinic workflow, patient populations, patient capabilities to utilize telehealth, education of clinical teams, and daily visible tracking tools. We measured daily telemedicine volumes by practice, total visits, and proportion of telemedicine visits.

Results: The 69% decrease in ambulatory volume was countered with a 42,300% increase in telemedicine visits. Prior to COVID-19, we averaged 4 telemedicine visits weekly and currently complete over 2,000. Through telemedicine, we are maintaining a clinic volume of 57% of expected with 68% of all those visits being provided through telemedicine (Figure 2). All specialty services provide telemedicine. Certain specialty clinics adapted to telemedicine easier than others; allergy/asthma (98% ; n = 581), pulmonary (97%; n = 390), neurology (96%; n = 1,004), dermatology (95%; 1,175), and otolaryngology (91%; n = 1,314) clinics experienced the greatest degrees of success over the past month while ophthalmology (55%; n = 531), cardiology (35%; n = 576) and orthopedics (14%; n = 1,713) faced challenges. Additionally, 30% of all completed telemedicine visits were for new referral visits.

Conclusion: We rapidly expanded telemedicine to provide time sensitive care in a large ambulatory specialty practice. Certain specialties were more amenable to telehealth for various reasons--vital signs available from home monitoring, ability to assess neurologic function in natural settings, etc. We realized that every specialty could do some aspect of telemedicine yet for others it was more challenging due to the need for ancillary tests (Echocardiogram, x-rays, ophthalmology adjuncts, etc.) or lack of a good substitute for physical exam findings (murmurs, abdominal exams, etc.). We successfully completed new referral visits (a previous concern in specialty practices). Future steps to sustain our telemedicine practice are to continue to refinine best telemedicine practices, identifying appropriate populations and visit types, track financial impact, and measure patient outcomes.