Overview

An academic medical center responded to the threat of COVID-19 by rapidly developing and deploying a patient-portal embedded self-triage and scheduler for primary care patients.

Organization Name

University of California, San Francisco (UCSF)

Organization Type

• Academic Medical Center

National/Policy Context

• The COVID-19 pandemic forced healthcare organizations to rapidly alter their triage and care management processes to lower patient volume in ambulatory and inpatient settings and minimize virus transmission. 
  • A growing national disease burden and rapidly changing information and guidelines magnified the crisis, challenging clinicians to provide consistent medical advice. 
  • Ambulatory settings saw huge surges in phone calls, patient portal messages, and appointment requests from patients, which inevitably led to delayed care and reduced patient satisfaction. 
  • Additionally, health systems realized that triage by front-line clinicians and staff wasn’t as valuable a use of time and resources. 
• Prior to the pandemic, some health systems deployed symptom checkers as the first point of contact for patients with new symptoms. 
  • These programs could be redirected towards COVID-19 management.
• EHR symptom checkers have some limitations. If patients have questions about their health status, the only way to contact their care team is by securely messaging through the portal.
  • •  This asynchronous process is time-consuming and unhelpful for patients with urgent and/or emergent concerns.
    •  In addition, portal messages do not get filtered by clinical status, reducing efficiency for triage and overall patient management. 

Local/Organizational Context

• The United States reported its first case of community-spread 2019 novel coronavirus (SARS-CoV-2) in Northern California on February 28th, 2020. 
• Community-spread disease directly raised the threat of increased volumes across healthcare settings, leading organizations both locally and nationally to quickly adopt new protocols for patient management.

Patient Population Served and Payor Information

• UCSF is a large academic health system spanning three campuses, with approximately 1,000 inpatient beds and nine primary care practices that serve about 90,000 patients.
• Annually, the system handles around 45,000 hospital admissions and 1.7 million outpatient visits. Overall primary care patient demographics include:
  • Median age: 46.5 yrs
  • 67% female
  • 47% Caucasian
  • 48% commercially insured
• Demographics of patients who benefited from the self-triage and scheduling tool include:
  • Median age: 42 years 
  • 62% female
  • 49% Caucasian, 23% Asian, 12% Hispanic, 7% non-Hispanic black, 10% other
  • 73% of patients were commercially insured

Leadership

• The ideal team structure consists of shared leadership between clinical and technical product managers. 

Funding

• No external funding was used.

Research + Planning

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Tools or Products Developed

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Training

• As this was primarily a patient-facing tool, the team did not develop formal training. However, key stakeholders were kept abreast of updates as necessary. 
  • Patient schedulers learned that some patients were scheduling through the tool; doctors caring for these patients in designated clinics or via video visits received email communications and tipsheets about the scheduling/triage tool.

Tech Involved

• Electronic medical record
• Epic
• Patient Portal

Team Members Involved

• Administrator
• NPs
• Physicians
• RNs
• Specialists
• Support Staff

Workflow Steps

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Budget Details

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Where We Are

• UCSF expanded tool access to greater than three times the number of patients than at initial launch. 
• The tool is now used in pediatric clinics, affiliate locations, and by UCSF specialty care patients with PCPs outside the UCSF network.

Outcomes

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Future Outcomes

• Other EPIC EHR customers can now access the UCSF’s customized Toolkit to address their needs brought on by COVID-19.
• With respect to a follow-up study, there’s a need to understand the proportion of triage traffic that’s been redirected from other sources and the extent to which the tool usage was organically derived (i.e., did friends/family recommend that patients access the tool?). Research about this would help drive future marketing practices.

Benefits

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Unique Challenges

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Glossary

• Toolkit: embedded add-on programs that Epic subscribers can incorporate into their platform.

Sources

• Judson, T. J., Odisho, A. Y., Neinstein, A. B., Chao, J., Williams, A., Miller, C., … & Gonzales, R. (2020). Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19. Journal of the American Medical Informatics Association.
• Judson T.J., personal communication, May 11, 2020.