Implementation of Video Visits During COVID-19 @ Weill Cornell Internal Medicine (NYC) |

At the height of the COVID-19 pandemic in New York City, researchers at Weill Cornell Internal Medicine Associates (WCIMA) implemented and retrospectively evaluated a video visit program at the primary care practice.

Weill Cornell Internal Medicine

This retrospective case study analyzed consecutive visits for COVID-19 symptoms and non-related symptoms that happened between March 16, 2020 to April 17, 2020.
Clinic staff reviewed upcoming visits to determine which visits should take place over video or in-person. WCIMA conducted video visits using Epic Systems technology. Providers used iPhones or iPads to connect (and the practice purchased iPads for providers who did not have an iPhone or iPad).
- Patients were able to connect using any brand through the Weill Cornell Connect App.
- The same management codes and rules were applied to video visits as are used for in-person.
- In addition, Weill Cornell physicians developed a Video Visit Handbook for practitioners to follow and the Information Services team provided an electronic health record template for COVID-19 assessments.
The researchers also evaluated the video visit program for its Reach, Effectiveness, Adoption, and Implementation (or the RE-AIM framework) by collecting data on the number of completed visits over time, the proportion of completion and satisfaction, the number of staff who assisted, and the frequency that the COVID-19 template or iPad technologies were leveraged. (The authors plan to evaluate M, maintenance, in the future).

Reach: WCIMA conducted 1,030 video visits during the five-week interval. Compared to the data collected before March on primarily in-person visits, data collected in the five-week interval shows patients who had video visits are younger, more female, more non-Hispanic, more White, and more commercially insured.
Effectiveness: Patients reported high satisfaction (mean score of 4.6 on a 5-point scale [SD: 0.97]) with video visits on a survey sent by email.
- 113 of 817 unique patients completed the satisfaction survey. 94.5% of these respondents reported satisfaction with their video visits in comparison to in-person visits and 49% preferred future visits to be over video.
Adoption/Implementation: 70 providers and 22 staff members scheduled video visits.
- 92% of video visits were associated with level 3 and 4 billing codes. 428 (42%) were potentially related to COVID-19 symptoms.
- 22.9% of video visits used the electronic health record template and 17 new iPads were provided for staff. Technology issues were not found to be a source of major challenges.
  - Only 2% of scheduled video visits had to be converted to telephone interviews and 13% of patients reported technology issues.

This study does not yet have patient outcome data from video visits or interview data from providers or staff on the outcomes of video visits.
Since patient satisfaction data came from only those who elected to use video, the study may be at risk of response bias. Older adults, Medicare beneficiaries, and non-English speakers were less likely to engage during video visits.
Providers have a limited ability to perform physical exams and measure vitals.

Sinha, S., Kern, L. M., Gingras, L. F., Reshetnyak, E., Tung, J., Pelzman, F., … & Sterling, M. R. (2020). Implementation of Video Visits During COVID-19: Lessons Learned From a Primary Care Practice in New York City. Frontiers in public health, 8.

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