Intermountain Telehealth: A Million Virtual Connections and Counting

The Utah-based healthcare system's experiences provide a blueprint for other organizations seeking to scale their virtual care initiatives.

How does a healthcare system achieve a milestone of one million telehealth interactions? You get a significant head start before a worldwide pandemic impacts your 23-hospital organization operating in three states. 

Like many large healthcare systems, Salt Lake City–based Intermountain Healthcare already had a solid telehealth program in place before the coronavirus pandemic. Yet the dynamics of the disease rapidly accelerated adoption of the technology.

A look into Intermountain's initiatives provides a road map for other organizations seeking to scale their own programs.

Building on Established Infrastructure and Partnerships

According to Brian Wayling, MBA, assistant vice president of telehealth services, Intermountain had been using virtual care in three primary ways before the health crisis: for urgent care, for acute care consultations with other physicians, and, more recently, for scheduled visits between physicians and patients.

• Calls to Connect Care, the organization's urgent care telehealth service offered in partnership with Boston-based telehealth company Amwell since 2016, doubled after the disease began to spread, Wayling says.
   
• Before the pandemic, about 500 physicians in disciplines including critical care, neurology, oncology, infectious disease, newborn critical care, and pediatric trauma service, along with some advanced practice providers (APP) and nurses, employed telehealth on a regular basis for acute care, according to Wayling.
   
• In 2019, the 23-hospital nonprofit health system began using the Amwell platform for scheduled physician visits with patients. The organization was slowly deploying the service throughout the system, routinely logging a couple hundred such visits a week. "Once COVID hit, we suddenly had a lot more interest," Wayling says. By the end of May 2020, these visits hit the 100,000 mark.

To accelerate the practice of virtual care during the pandemic, Intermountain purchased 600 Microsoft Surface Pro® computer tablets and distributed them to the system's hospitals and clinics. Nurses and providers involved in bedside care began using telehealth to conduct rounding to reduce exposure to patients and save PPE. Specialists, nutritionists, interpreters, and cultural advisors could all be brought into the patient's room virtually. While the preference is to deliver in-person treatment, says Wayling, virtual visits "save a lot of time and are much more efficient and safer." 

Altogether, by the beginning of June 2020, the health system surpassed a million telehealth interactions. Users include an estimated 2,000 physicians, 2,000 nurses, 1,000 APPs, 500 nursing assistants, and 300 behavioral health clinicians.

Preparing for COVID-19: A "Herculean Effort"

Onboarding and training was a "Herculean effort," says Wayling. Adding thousands of new users to the platform involved much more than creating usernames and passwords. With 23 hospitals in multiple states, there were complexities related to provisioning and credentialing to ensure providers only had access to facilities where they were authorized to provide care.

"A clinician might provide care in Wyoming on one call, and then in the next call they're providing care in Arizona," says Wayling. In a large health system like Intermountain, having to access a variety of EMRs creates "extra time and burden" for providers as they jump from "Cerner to Epic to athenahealth," each requiring unique usernames and passwords, as well as different approaches to navigation. To enhance interoperability, enabling clinicians to bypass these barriers and extract key points of information for faster treatment, Intermountain uses a platform from Redox, a Madison, Wisconsin, company the health system has invested in.

Training so many new users also presented a challenge to the 50-person telehealth department. "We basically stopped all our other projects and we redeployed everybody [to focus on] this effort," Wayling says. Additional people were brought in to help. 

"As a result of COVID-19," says Wayling, "the biggest change was a much more rapid adoption of telehealth delivery by caregivers across a much broader spectrum on both acute and direct-to-consumer or direct-to-patient care management."

"The use cases and their creativity of integrating telehealth into their workflows has been very positive," says Wayling. One of these uses caught the telehealth team by surprise.

ER video handoffs ensure continuity of care

The emergency department had occasionally used video consults to communicate with care teams on the units where patients were being transferred. With access to new tablets, the practice flourished. 

"Typically the patient would just be rolled out and taken up to that unit," Wayling says. "Then, that unit would have to prepare and catch up in the note." Telehealth helps bridge that gap and establishes direct communication between the ER and ICU or med-surg unit where the patient will be transported. "We now use telehealth to have that direct communication so the receiving unit can be better prepared and understand any of the nuances that might be more difficult to obtain strictly through the EMR."

During the video handoff, caregivers in the ER speak directly to providers in the receiving unit. "One of the advantages," Wayling says, "is that we can convey very quickly the condition of the patient, any nuances that the patient might be experiencing, or history of the patient and family members." The process enables practitioners to "really listen to each other," he says, and the ER physician can relay essential precautions. "Both parties understand what's going on with the patient and ensure that no misses [occur]."

This process accelerates care delivery to patients who are frequently in need of critical care, Wayling explains. The unit is better prepared to receive the patient, he says, and more immediately able to provide services. 

The overall experience with telehealth in recent months has removed a lot of concerns providers had about using virtual care, "effectively validating that telehealth is a safe, effective way of delivering care," Wayling says.

As the industry moves into the next phase of telehealth, developing a one-touch connection and fully integrated model would be ideal, he says, along with payment models that support the use of telehealth after the pandemic ends. Also needed: a better way to handle interstate licensing, which is costly and time-consuming in many of the states where Intermountain
facilities are located.

"The investment has proven itself," Wayling says. "The challenge for us, and for the provider industry going forward, is to continue making it easier to use."