Overview

• Due to restrictions placed by COVID-19, Yale New Haven Health System (YNHHS) was able to efficiently scale up virtual visits and overcome system-wide challenges by working alongside operations teams, scaling technologies compatible with EHR, and ensuring all stakeholders were updated through a centralized communication system.

Organization Name

Yale New Haven Health System (YNHHS)

Organization Type

• Academic Medical Center
• Community hospital
• Physician's organization

Tech Involved

• Electronic medical record
• Telemedicine software
• Virtual meeting platform

Team Members Involved

• Clinical Informatics Specialist
• MAs
• Medical Scribe
• Physicians

Workflow Steps

• To address the need for a HIPAA compliant software which could be used even after the pandemic, YNHHS opted for MyChart’s video platform over other alternatives, such as Facetime or Zoom, for single patient visits. 
  • MyChart also allowed for all patient-provider communication (such as messages, e-consent, after visit summary) to be documented in the EHR. For group sessions, YNHHS chose Zoom as the preferred platform initially but later switched to Vidyo (an EHR compatible software) following an upgrade of the software. 
• The Yale Medicine Telehealth team (YMTt)  assisted with scheduling visits, converting visits to virtual ones, and supporting patients. 
  • A Telehealth Conversion Center (TCC) was established to support the 22 decentralized departments that self-scheduled their own clinical visits prior to COVID-19 and could not keep up with the requirements. 
  • YMTt also called patients before their virtual visit to address their technological needs. Lastly, YMTt set up the virtual rooming assistant (VRA) that informed the physician that the patient had “arrived,” annotated vitals directly onto the EHR, and provided real-time IT troubleshooting. 
• All stakeholders were kept informed regularly of the operational and regulatory changes through a weekly COVID-19 Telehealth Update. Data such as the volume of video visits was shared along with training materials on how to provide virtual care. 

Outcomes

• In a patient survey about satisfaction with MyChart, 94% of respondents agreed that the MyChart App made it easy to have the virtual visit and 58% of all respondents shared that they saved more than one-hour of travel time due to the virtual visit (n=10,422). 
• In total, 50% (10,757 visits) of all patient visits were converted to virtual visits by the access center, 43% were converted by the self-scheduling departments, and 7% (1,578 visits) were converted by the TCC.
• The implementations of the VRA workflow received positive patient and physician feedback.

Unique Challenges

• Even though there was an organization-wide communication system in place, the frequently changing regulations made it hard to provide consistent information.
• MyChart placed a strain on both patients and providers with limited technological skills. 
• MyChart could not support multiple participants and the Epic video system Vidyo similarly did not support multiple participants initially. As a result, interpreters were not included in patient visits.
• The VRA requires better clinical data elements such as better vitals and blood glucose monitoring.
• While providers were given guidance on converting their appointments to virtual ones, the timeliness of provider responses was a barrier to quick and effective conversion.

Sources

• Hoffman, P. E., London, Y. R., Weerakoon, T. S., & DeLucia, N. L. (2020, October). Rapidly scaling video visits during COVID-19: The ethos of virtual care at Yale Medicine. In Healthcare (p. 100482). Elsevier.