MedStar Health Telehealth Team Marks One Year of COVID-19 Response Efforts

The MedStar Health telehealth and philanthropy teams have partnered to produce a summary titled, “One year of historic change and care: COVID-19 telehealth response.”

Leveraging nearly a decade of foundational telehealth work that culminated in the creation of the MedStar Telehealth Innovation Center (MTIC) years before the public health emergency, MTIC commenced its COVID-19 incident command center efforts on March 13, 2020 in support of the system’s remarkable overall pandemic response.

In the historic year that followed, more than 772,750 telehealth video sessions have been delivered, representing astronomical growth that has been both essential to the system’s ongoing COVID-19 response and that has helped transform the future of care.

The summary highlights:

  • the foundational telehealth work before the crisis that enabled this rapid and robust response
  • core services and other capabilities created and/or growing exponentially during the pandemic
  • key statistics that demonstrate the critical importance of telehealth during this time
  • telehealth expansion looking past COVID-19, serving as an essential aspect of an integrated, comprehensive system of care

Click here to read more as the MedStar Health pandemic response continues.

MedStar Health Research Reveals Counterintuitive Findings on COVID-19 Chatbot Use

As health systems deploy a variety of digital health tools in the fight against COVID-19, new MedStar Health research published in Nature Partner Journals npj Digital Medicine suggests one of the latest technologies may help in unexpected ways—chatbots, or conversational agent software programs that communicate via text and voice. 

The article released today titled, “Population subgroup differences in the use of a COVID-19 chatbot,” evaluates differences in use by age, race, and gender among 69,451 patients who used a COVID-19 chatbot for symptom screening and/or related learning of the more than 1 million invited.  

Within their analysis, the authors highlighted the following “non-obvious differences” in their findings: “In our patient population, a higher proportion of women, African Americans, and those aged 51-90 interacted with the chatbot, and used the learning module more than the symptom screener compared to their respective subgroup comparator.” They added this mirrored race and gender differences in COVID-19 positive cases over the same period, while reliable age data were not available. 

A team of MedStar Health authors made the article possibleLaura Schubel; Deliya Wesley, PhD; Ethan Booker, MD; John Lock; and Raj Ratwani, PhDwho represent our digitalresearch/human factors, and telehealth teams. 

These findings advance the healthcare community’s understanding of subpopulation and feature use of COVID-19 chatbots and can help inform future health education and screening strategies. 

The MedStar Institute for Innovation telehealth team joined in this research as chatbots have served as one of many technologies helping the team to advance connected care models, in addition to video and phone-based telehealth visits, patient portal messages, remote patient monitoring tools, and more. 

Click here to review the article.  

Agency for Healthcare Research and Quality Awards MedStar Health Almost $1 Million Grant to Lead a Telehealth Research Alliance with Two Other Top Health Systems

Senior African American woman using a smart phone app to consult with a doctor in real time while standing at home

Today MedStar Health announced launching a two-year telehealth research collaboration with Intermountain Healthcare and Stanford Health Care this month thanks to a nearly $1 million R01 grant award from the Agency for Healthcare Research and Quality. The team will study and address technology used to access U.S. primary care surrounding COVID-19 and any health disparities by analyzing related data across these three health systems that have collectively offered 4.5 million primary care appointments in a year.

R01 awards from the U.S. Department of Health and Human Services are among the most prestigious grant types, and this marks the first R01 that will be co-led by the MedStar Telehealth Innovation Center, part of the MedStar Institute for Innovation.

“As the initial surges of COVID-19 have massively disrupted traditional modes of care delivery, telehealth has helped us effectively bridge many potential gaps in care—especially in primary care—and we want to ensure that’s true in as many populations as possible,” said the grant’s co-principal investigator (PI) Ethan Booker, MD, medical director of MedStar Telehealth Innovation Center and MedStar eVisit. “Given the exponential growth of telehealth over this period, we now have an enormous amount of data that can help us inform policy and better invent the future. It will be a far greater opportunity for all if we share, expand, and apply what we’ve learned within the U.S. health system more broadly, which the AHRQ grant will help us achieve.”

In the initial months of the COVID-19 pandemic, outpatient telehealth visits at MedStar Health climbed from around seven to 4,500 per day at peak. To date, the system has delivered more than 600,000 telehealth sessions overall, with around 30% of primary care visits shifting to video.

This research will evaluate U.S. sub-populations’ primary care access and avenues, including virtual options such as telehealth video-based and phone-based visits, text messages, and patient portal messages. The team aims to disseminate findings and recommendations through journal publications, policy briefings, and other stakeholder outreach.

Raj Ratwani, PhD, vice president of scientific affairs, MedStar Health Research Institute and director, MedStar Health National Center for Human Factors in Healthcare, is serving as co-PI in leading the seventh R01 award for the human factors center.

Read more in the MedStar Health press release: http://bit.ly/3pkMyHx

MedStar Health surpasses 500,000 telehealth sessions delivered during COVID-19 in October 2020

MedStar Health telehealth team members brief clinicians about new offerings at a training event.

In late October, MedStar Health surpassed a transformational care milestone of delivering more than 500,000 telehealth sessions during the COVID-19 pandemic, made possible by both a decade of foundational telehealth work and rapid crisis response and scaling starting in March 2020. 

According to The Washington Post’s coverage, the milestone “showcases how telehealth has transformed medical services such as primary care, behavioral health and even cardiology.” In a related story by WTOP News, Ethan Booker, MD, medical director of the MedStar Telehealth Innovation Center and MedStar eVisit, explains that the “half-million number of video visits is just an astronomical kind of expansion from a year ago.”

Examples of key telehealth services and use cases driving this historic milestone include:

  • MedStar eVisit, the system’s on-demand urgent care telehealth offering, which scaled from a daily average of seven visits in February 2020 to a peak of more than 530 visits per day. Read more on the related MI2 Featured Projects page.

  • MedStar Health Video Visits, a service developed during the pandemic with strategic technology partner Bluestream Health and launched on March 23 to provide scheduled outpatient video visitsrapidly accounting for roughly 80% of all MedStar Health telehealth sessions. Read more on the related Featured Projects page.

  • MedStar eConsult, which supports provider-to-provider connections for patient evaluation or consultation, including patient assessment and care in emergency departments and urgent care facilities 

  • Palliative care, including chaplain visits between MedStar Health hospitals

  • Communication with families for patients and providers

In parallel, MedStar Health has pursued the publication of recent telehealth studies and analyses as part of our commitment to advancing health within and beyond our system:

With new technology and infrastructure, and the support of a close to $1 million award from the Federal Communications Commission (FCC), MedStar Health has continued to advance our telehealth response to the COVID-19 crisis as well as our plans for other new offeringsall to protect our patients and providers while supporting the health of the communities we serve.

MedStar Health research highlights the benefits of integrating telehealth into the Emergency Department workflow during COVID-19

As Emergency Departments (EDs) work to best address unique challenges during the COVID-19 pandemic, a study recently published in The Journal of Emergency Medicine by a multidisciplinary MedStar Health team details how integrating telehealth into the ED workflow can reduce healthcare provider infection risk, personal protective equipment (PPE) use, and ED length of stay (LOS), among other benefits. MedStar Health has now delivered more than 500,000 telehealth sessions during COVID-19, with ED teletriage contributing to this important milestone. 

The study, titled “Preliminary Assessment of a Telehealth Approach to Evaluating, Treating, and Discharging Low-Acuity Patients With Suspected COVID-19,” examined a novel telehealth-enabled, Evaluate-Treat-Disposition (ETD) workflow in the ED. In this workflow, in-person ED triage nursing staff presented well-appearing, low-risk patients with suspected COVID-19 infection to a remote provider for evaluation, consideration of testing, and possible discharge.  

Three weeks after implementation, a retroactive chart review showed that 153 of the 302 patients supported through telehealth were evaluated and discharged by a provider via telehealth. Results included:  

  • 62.5% shorter ED LOS compared to other patients of equal severity seen in the same time period 
  • 413 saved sets of PPE 
  • 3.9% 72-hour revisit rate (similar to rates for other patients)  

These results, shared by experts in emergency medicine, telehealth innovation, and human factors, can help inform similar efforts that strive to conserve critical resources and protect the health and safety of patients and providers. Additionally, the model allows quarantined providers who are otherwise well to continue treating patients via telehealth. 

Congratulations to the authors, who include: David J. Carlberg, MD; Rahul Bhat, MD; William O. Patterson, MD; Saad Zaatari, MD; Vinodh Chandra, MD; Alexander Kolkin, MD; Raj M. Ratwani, PhD; Matthew D. Wilson, MD; Diana Ladkany, MD; Katharine T. Adams; Mary Jackson, PA-C; Kristi Lysen-Hendershot; and Ethan A. Booker, MD. 

A follow-up study is expected and this preliminary research can be shared with interested groups in emergency medicine and health policy. 

Click here to review the full research study for free, with thanks to the journal for making that possible. 

MedStar Health Shares COVID-19 Telehealth Insights in Two Recent Publications

MedStar Health’s telehealth, human factors, and research teams authored two recently-published research articles to share lessons learned while helping the system navigate telehealth’s exponential growth during the COVID-19 pandemic.

Most recently, on July 23, 2020, the Journal of Telemedicine and Telehealth published “A descriptive analysis of an on-demand telehealth approach for remote COVID-19 patient screening,” by MedStar Health’s Raj Ratwani, PhD; David Brennan; Bill Sheahan; Allan Fong; Katharine Adams; Allyson Gordon; Mary Calabrese; Elizabeth Hwang; Mark Smith, MD; and Ethan Booker, MD.

Underscoring how on-demand telehealth helps effectively respond to COVID-19, the team analyzed 9,270 patient on-demand telehealth requests, the majority of which were found to likely be COVID-19 related. Importantly, 42% of patients who completed a related telehealth session stated they would've otherwise sought in-person care and 9% said they wouldn’t have pursued care without this option, among other findings about how telehealth helped patients, providers, and communities. This research increases the data available to demonstrate on-demand telehealth is a productive and low-barrier approach to screening patients for COVID-19.

Earlier this month, on July 3, the Journal of the American Medical Informatics Association published “Case Report: Rapid Development of Visualization Dashboards to Enhance Situation Awareness of COVID-19 Telehealth Initiatives at a Multi-Hospital Healthcare System,” authored by MedStar Health’s Ram Dixit; Stephen Hurst; Katharine Adams; Christian Boxley; Kristi Lysen-Hendershot; Sonita Bennett; Ethan Booker, MD; and Raj Ratwani, PhD.

The report details the five-step process the team employed to quickly design and deliver user-centered visualization dashboards supporting MedStar Health’s COVID-19 telehealth response, helping improve both situational awareness and operations. Examples of critical information featured on the dashboards include patient telehealth session volumes and wait times, patient and provider experience ratings, and telehealth platform performance statistics, with the dashboards serving three distinct stakeholder groups. Insights shared can help inform similar efforts within the broader healthcare community.

These MedStar Health teams have a unique window into scaling telehealth offerings during the pandemic, making their contributions to healthcare research both important and powerful. As of mid-July, MedStar Health had delivered more than 305,500 telehealth sessions during the COVID-19 pandemic. MedStar eVisit, on-demand urgent care by video, offered 24/7/365, drove about 10% of the volume with more than 29,500 sessions since the March 13 COVID-19 response start. MedStar Health Video Visits, scheduled video appointments with primary care and specialty providers—a platform built and launched at scale in just days during the pandemic—now drives about 83% of telehealth volume with more than 253,600 scheduled outpatient video visits delivered since the service’s March 23 launch. MedStar eConsults, inpatient/facility-based telehealth connecting providers to one another and patients, and patients to families, comprised the remaining roughly 7% of the total with more than 22,400 sessions since March 13.

Stay tuned for additional telehealth research expected in the coming months.

FCC awarded MedStar Health close to $1 million to advance telehealth response to COVID-19 crisis

The Federal Communications Commission (FCC) has awarded $976,679 to MedStar Health to provide additional support for the exponential growth of the system’s telehealth offerings in response to COVID-19. As of early July, MedStar Health had delivered more than 275,000 telehealth sessions during the pandemic.

“This FCC award will support telehealth investments we’ve made to transform care delivery during the pandemic and will also help fund related work in the coming months to continue to treat and protect our communities,” said Bill Sheahan, vice president of telehealth at MedStar Health and the leader of the MedStar Telehealth Innovation Center, part of the MedStar Institute for Innovation. 

The award will enable the system to sustain and expand its core telehealth offerings—MedStar eVisit, MedStar Health Video Visits, and MedStar eConsults—while continuing to develop connected care solutions that will serve patients, providers, and communities throughout the pandemic and beyond. The FCC’s support will assist MedStar Health in offering telehealth solutions to an estimated 1.6 million system patients, with a focus on investments in telehealth platforms and equipment.

“COVID-19 has transformed many telehealth aspirations into urgent needs, and this FCC funding will help us continue to scale and build telehealth offerings at the pace required to serve our communities during the pandemic,” said Mark Smith, MD, chief innovation officer of MedStar Health and director of the MedStar Institute for Innovation. 

Read the full press release from MedStar Health for more on the award from the FCC’s Wireline Competition Bureau through its COVID-19 Telehealth Program, and for additional information about MedStar Health’s COVID-19 telehealth response.  

MI2’s MedStar Telehealth Innovation Center fuels system delivery of 100,000+ telehealth sessions during COVID-19 response by May 1, 2020

During the peak of the spring 2020 COVID-19 outbreak, MedStar Health conducted more than 4,500 telehealth encounters each weekday to ensure safe and efficient care for our patients, providers, and communities. By May 1, the system had reached the significant milestone of more than 100,000 telehealth sessions delivered in total during the pandemic.

Fueled by MI2’s MedStar Telehealth Innovation Center (MTIC)—and achieved in collaboration with providers and other partners across and beyond our system—here’s a look at how three MedStar Health telehealth service areas contributed to this exceptional care milestone: 

  • MedStar Health Video Visits represented about 78% of the 100,907 total sessions with 78,267 scheduled outpatient video visits delivered from the service’s March 23 launch through May 1. Read more about how MTIC supported the launch of MedStar Health Video Visits on the related Featured Projects page.
  • MedStar eConsult, which represents inpatient telehealth offerings often conducted between two providers for patient evaluation or professional consultation, comprised the remaining 7% of the total with 7,109 sessions.

As these services have scaled, so too have MedStar Health efforts to educate patients and address questions related to telehealth services. Examples involving MI2’s MTIC Medical Director Dr. Ethan Booker include his MedStar Washington Hospital Center Center View blog post educating the community about telehealth options that are offered across our system, as well as his video demonstration of a MedStar Health Video Visit.

Additionally, you can read more about MedStar Health’s initial telehealth response to COVID-19 in a sampling of news and other online coverage from March through May 2020:

Please note: General MI2 website updates were paused in recent months as our team focused on the COVID-19 response. As we resume updates in late June/July 2020, we are ensuring that select historic milestones that have passed are still represented in our newsroom.

MI2’s MedStar SiTEL Mobile Simulation Lab deployed in April 2020 for COVID-19 response

Initially established in January 2016, the MedStar Simulation Training & Education Lab (SiTEL)’s Mobile Simulation Lab has played a critical role in MedStar Health’s response to the COVID-19 pandemic. As the system prepared for a possible surge of coronavirus patients in spring 2020, MedStar SiTEL’s Mobile Simulation Lab traveled to numerous MedStar Health hospitals in April to prepare clinicians from other specialties to work in intensive care through a hands-on “ICU Provider Mobile Bootcamp.”

The Mobile Sim Lab is a fully-equipped, 40-foot truck-based simulation laboratory with two simulation bays that can hold up to six learners each, two control rooms, and a group debriefing space. During the ICU Provider Mobile Bootcamp, MedStar Health providers prepared for potential redeployment in ICU settings by reviewing the latest in ventilator management, personal protective equipment use, and other equipment and treatment strategies, including provider-to-provider eConsults made possible by the MedStar Telehealth Innovation Center

Between April 9 and April 23, the Mobile Sim Lab travelled to five locations throughout Washington, D.C. and Maryland, reaching 138 providers from six MedStar Health hospitals including MedStar Georgetown University Hospital, MedStar St. Mary’s Hospital, MedStar Good Samaritan Hospital, MedStar Union Memorial Hospital, MedStar Southern Maryland Hospital Center, and MedStar Franklin Square Medical Center. 

When an emergency comes up like this, we’re ready to go,” said Dr. John Yosaitis, medical director of MedStar SiTEL and the ICU boot camp director, as quoted by WTOP. In talking about MedStar SiTEL’s Mobile Sim Lab, he added, “It can go anywhere. We have 10 hospitals and over 300 ambulatory care centers in MedStar, and we take it all over to bring a sim-center, to bring training to the associates,” 

Learn more on our related Featured Projects page, and in a sampling of news coverage about how the MedStar SiTEL Mobile Sim Lab helped the system respond to COVID-19:

Please note: General MI2 website updates were paused in recent months as our team focused on the COVID-19 response. As we resume updates in late June 2020, we are ensuring that select historic milestones that have passed are still represented in our newsroom. 

MedStar Health launches first patient-facing, interactive EHR heart risk calculator

Heart Risk Education: This aspect of the heart risk calculator EHR application is an interactive visual aid that a physician and patient can use to explore how the patient’s risk may change with certain medical or lifestyle interventions—and to thus inform shared decision-making.

MedStar Health is launching the first patient-facing, interactive heart risk calculator that will be integrated in its patients’ electronic health records (EHRs). An estimated 575 cardiologists and other doctors across the system will be able to more easily show patients their personal risk for heart disease, stroke, and other cardiovascular diseases over time using easy-to-read graphics. This assessment will help doctors recommend lifestyle choices to improve patients’ heart health, a topic that is top of mind each February during American Heart Month.

Kristen Miller, DrPH, Scientific Director, MedStar Health National Center for Human Factors in Healthcare

This innovation was developed by the MedStar Health National Center for Human Factors in Healthcare, which is part of the MedStar Institute for Innovation. The Center’s work was made possible by nearly $2 million in combined cooperative agreement funding the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator (ONC) for Health Information Technology awarded two winners in November 2018 as part of the Leading Edge Acceleration Projects (LEAP) in Health IT opportunity. The team worked with Centra Health, CareJourney, Asymmetrik, MedStar Health’s EHR vendor, a patient advocate, and many within the MedStar Health system to make the tool possible.

The calculator has the potential to transform the delivery of heart risk checks nationwide. It supports quicker clinical decision-making while striving to help reduce technology burnout for providers through its fully embedded, integrated display and automatically populated patient data. The project demonstrates the MedStar Health Human Factors Center’s growing capabilities in informatics and SMART on FHIR app development, which are complemented by the team’s foundation in human factors and commitment to designing tools for and with end users.

“As researchers and innovators, we’re always looking for ways to use technology and design to improve the well-being of both patients and clinicians—this time by advancing knowledge at the point of care,” said Kristen Miller, DrPH, scientific director at the MedStar Health National Center for Human Factors in Healthcare. “We’re proud the team has reached such a significant milestone in this work—one that now brings innovation, research, and education to the bedside and beyond.”

Learn more in the MedStar Health press release, “MedStar Health launches new interactive heart risk calculator in patient electronic health record,” and our new Featured Project page. 

Heart Risk Calculation: This initial, prominent view of the heart risk calculator EHR application enables the physician to quickly see and convey a patient’s 10-year cardiovascular event risk, calculated automatically from data already in the patient’s EHR.