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 eVisit, a patient-initiated, on-demand urgent care video visit, drove 15% of the volume with 15,531 visits.
  • 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.

New MedStar Health Human Factors Center Research Reinforces Critical Importance of EHR-Related Reporting and Collaboration

The MedStar Health National Center for Human Factors in Healthcare just announced the publication of two new studies in a press release titled, “New Research Reinforces Importance of Reporting and Collaboration to Prevent Patient Harm in Electronic Health Record Systems” (EHRs). This work contributes to the growing body of evidence—released by the MedStar Health Human Factors Center and beyond—underscoring the critical importance of making improvements to and further evaluating EHR systems to protect patient safety and clinician well-being. The Center is part of the MedStar Institute for Innovation and works in partnership with MedStar Health Research Institute and others throughout MedStar Health.

The latest Center study was published in the Dec. 17 issue of the Journal of the American Medical Association (JAMA) and is titled “Identifying Potential Patient Safety Issues from the Federal Electronic Health Record Surveillance Program.” The research analyzed more than 350 reports of EHR issues perceived to violate the federal certification program, as defined by the U.S. Department of Health and Human Services—finding that many of these reports pose potential safety issues. The study reinforces that there is a real possibility for EHR platforms to cause patient harm—making it increasingly important for EHR vendors, providers, policymakers, and patients to collaborate to improve this essential health information technology. 

Center authors include Raj Ratwani, PhD, Center director and associate professor at the Georgetown University School of Medicine, and Aaron (Zach) Hettinger, MD, Center medical director and director of cognitive informatics. The study’s first author, Thomas Pacheco, conducted this research as a fellow supported under the Frank S. Pellegrini, M.D. Medical Student Research Scholarship, a prestigious opportunity given to select Georgetown University Medical School students to perform research under the auspices of the MedStar Health Research Institute within the MedStar Health system.

Another Center study was published in JAMA Network Open on Dec. 13 and is titled “Evaluating Improvements and Shortcomings in Clinician Satisfaction With Electronic Health Record Usability.” It analyzed the System Usability Scale (SUS) data for 27 of 70 widely-used EHR vendor platforms and found that there was no statistical improvement in EHR satisfaction SUS scores between recently certified products, despite past research finding that poor EHR usability relates to both clinician burnout and patient harm. This MedStar Health study is particularly noteworthy when considered with other recent external research showing that SUS scores of implemented products are even lower. This points to a gap between usability satisfaction as measured during the time of product certification and the reality of satisfaction with implemented products.

Dr. Ratwani authored the JAMA Network Open study with first author Kylie M. Gomes, who conducted the research as a University of Virginia doctoral student. 

Both studies were supported with research grant funding from the Agency for Healthcare Research and Quality

Read more in the related MedStar Health press release, which includes expert perspectives on this research and its calls to action.

MedStar Health Receives Cool Idea Award From Protolabs for NICU Feeding Device Invented by MedStar Franklin Square Nurse with MedStar Inventor Services

Tiffany Morris, RN, BSN, a MedStar Franklin Square Medical Center NICU nurse, holding her award-winning invention: MedStar Health’s gravity feed syringe holder.

 

MedStar Health is proud to announce that a new device, invented by Tiffany Morris, RN, BSN, a MedStar Franklin Square Medical Center nurse, received the Cool Idea Award: Healthcare Grant from digital manufacturing leader, Protolabs. This news, shared in a press release by Protolabs, is a celebration of the “innovative ideas our MedStar Health associates have to treat people and advance health,” said Stephen Kinsey, director of MedStar Inventor Services at MedStar Institute for Innovation, which partnered with Tiffany in the development of the device. 

MedStar Health’s gravity feed syringe holder offers a new alternative to what can be a time and labor intensive process of feeding newborns in the neonatal intensive care unit (NICU). Currently, a nurse must hold a syringe above an incubator by hand while milk or liquid formula drains into the baby via a stomach tube. The device illustrated the premise that simple, elegant solutions can have a substantial impact on patient care. With the use of the compact device, a gravity feed syringe can be suspended from the top of the incubator, freeing the nurse to manage other duties while still attending to the baby during feeding.

The Protolabs grant, which provides in-kind manufacturing services to support development of medical products, was used to iterate and advance Tiffany’s design. Now with added elements to ensure safety and ease of use, the holder design has also been adjusted to accommodate a variety of syringe sizes and to attach to an IV pole, expanding its potential use beyond the NICU.  

The Cool Idea Award: Healthcare Grant is an extension of Protolabs’ signature Cool Idea Award. It is open to members of the Cleveland Clinic Healthcare Innovations Alliance—a network of healthcare organizations focused on innovation that includes MedStar Health as a founding partner.

To learn more about the award and early-stage device, read the full press release here. For more on how MedStar Inventor Services is transforming the innovative ideas of MedStar Health associates from concept to reality, read about our work here, which includes the team’s MInnovations program that helped identify and advance this innovation and many others from MedStar nurses. 

MedStar Health Human Factors Center to Work with Virginia Tech on NIH R01 Grant Award to Better Leverage Unstructured Patient Safety Report Data to Advance Care

Virginia Tech has announced that its team will collaborate with the MedStar Health National Center for Human Factors in Healthcare on a newly-awarded, multi-year Research Project Grant (R01) from the National Institutes of Health (NIH) to advance care by developing novel statistical methods to analyze unstructured text in patient safety event reports and to identify temporal trends and patterns in the data.

Raj Ratwani, PhD, director of the MedStar Health Human Factors Center and associate professor at Georgetown University School of Medicine, and Allan Fong, research scientist with the Center, will serve as principal investigators (PI), along with project lead and PI Srijan Sengupta, assistant professor of statistics in the College of Science and a faculty member at the Discovery Analytics Center at Virginia Tech.

The Center is contributing its expertise in machine learning, natural language processing, patient safety, reporting databases that can be used to identify safety trends and patterns, and translating resources like those established through this grant into healthcare environments to improve patient safety.

“This research is critical to identifying patterns in the reported data and turning data into knowledge that the healthcare provider can then use to assess the safety of their technologies and processes and develop actions and interventions to prevent patients from being harmed by recognized hazards,” said Ratwani.

R01 awards from the U.S. Department of Health and Human Services are among the most prestigious grant mechanisms. The Center is proud that this marks its fifth active multi-year R01 award, among its other large, high-impact research efforts that are advancing health care. In addition to this award, the Center’s top leaders are the PIs on three Agency for Healthcare Research and Quality (AHRQ)-funded R01s that focus on improving the safety of electronic medication administration records, usability and safety guidelines for health information technology, and technology to support emergency department communication, as well as another NIH National Library of Medicine-funded R01 on developing effective clinical decision support.

Read more about the Center’s latest R01 award in the Virginia Tech press release here, and on the NIH’s website here. Read the overview of all Center R01 awards and other high-impact research grants here.

AHRQ’s New Health IT Research Year in Review Report Features MedStar Health Human Factors Research and Outcomes

This October, the Agency for Healthcare Research and Quality (AHRQ) released its Health Information Technology Research 2018 Year in Review, including overviews and outcomes of AHRQ-funded work awarded to MedStar Health Research Institute (MHRI) and led by the MedStar Health National Center for Human Factors in Healthcare (Center). The Center is part of the MedStar Institute for Innovation and regularly partners with MHRI. Click here to read more and download the AHRQ report

AHRQ investments detailed throughout the report aim to improve the quality and safety of health care via health information technology (health IT). The report has been released for years, typically annually and dating back to 2008. It supports AHRQ stakeholders, including patients, clinicians, researchers, and policymakers, with learning about the research, goals, and progress; emerging technologies; and how to access related information and products to support knowledge transfer and replicate successes. 

Six Active Center Research Projects Featured

The report recognizes the following MHRI-awarded, Center-led AHRQ research that was active in 2018 (Note: Page numbers refer to the online PDF pages): 

  • Developing Evidence-Based, User-Centered Design and Implementation Guidelines to Improve Health Information Technology Usability (page 53). This R01 grant is among AHRQ’s health services research projects and is led by principal investigator Raj Ratwani, PhD.
  • Improving Patient Safety and Clinician Cognitive Support Through eMAR [Electronic Medication Administration Records] Redesign (page 53). This R01 grant is also among AHRQ’s health services research projects and is led by principal investigator Raj Ratwani, PhD.
  • Context is Critical: Understanding When and Why Electronic Health Record Related Safety Hazards Happen (page 61). This R21 grant is among AHRQ’s exploratory and developmental grants to improve healthcare quality through health IT and is led by principal investigator Aaron Zachary Hettinger, MD.
  • Cognitive Engineering for Complex Decisionmaking & Problem Solving in Acute Care (page 70). This R01 grant advances AHRQ’s work to understand clinical information needs and healthcare decision-making processes in the context of health IT and is led by principal investigator Aaron Zachary Hettinger, MD.
  • Quantifying Efficiencies Gained through Shareable Clinical Decision Support Resources (page 78). This AHRQ contract is led by principal investigators Kristen Miller, DrPH, and Aaron Zachary Hettinger, MD.
  • Advancing the Collection and Use of Patient-Reported Outcomes through Health Information Technology (page 79). This AHRQ contract is led by principal investigators Deliya Wesley and Raj Ratwani, PhD.

Feature Stories Sharing More Information 

Additionally, two MedStar-led efforts were highlighted among stories about AHRQ’s emerging and innovative newly-funded 2018 research, which strives to ensure health IT is designed and implemented in ways that improve quality and safety without placing excessive burden patients, physicians, and other users.

  • Leveraging Clinical Decision Support (CDS) to Advance Research Evidence into Clinical Practice (page 24): This work compares CDS tools developed in isolation with those developed using resources available on CDS Connect, an AHRQ-funded project to translate evidence-based care into clinical practice with interoperable CDS. It includes four healthcare systems and two EHR vendors to allow for analytic comparisons within and across sites to identify efficiencies when using shareable and interoperable CDS resources. 
  • Supporting AHRQ Step Up App Challenge to Encourage Use of Patient-Reported Outcomes (PRO) to Improve Patient Care (page 25): The challenge encouraged participants to create apps that advanced the collection of standardized PRO data in ambulatory care settings both within and across different providers. MedStar Health is modifying and pilot testing an application that incorporated the draft technical specifications to enable broader PRO data sharing for clinical and research purposes, as well as the winning app from the Step Up App Challenge.  

In one of three patient safety Health IT research spotlights, the report also details how AHRQ health IT safety investigator and Center director Raj Ratwani, PhD, and team are using health IT research and advocacy to make a real difference in improving patient safety.

  • Improving Electronic Health Record (EHR) Design and Usability to Increase Patient Safety, Especially for Children (pages 31-32). Leveraging a novel natural language processing algorithm, the team analyzed medication-related patient safety report data from three health institutions and identified and categorized those related to EHR issues and possible patient harm in children. They found pervasive problems through this work and ultimately aim to establish clear guidelines for both EHR vendors and healthcare providers that will lead to usability improvements and avoid harm to patients.
  • Representing AHRQ Health IT-Funded Research in Health Affairs Patient Safety Issue and Event (page 45). The November 2018 issue of Health Affairs, as well as a related event, included a comprehensive look at the best and latest patient safety research, including the aforementioned AHRQ research by Dr. Ratwani. These efforts raised awareness about emerging issues in patient safety and explored ways to close gaps in research, policy, and implementation to reduce patient harm. 

Explore the full AHRQ report for more information about this research and related resources, as well as other AHRQ-funded initiatives taking place beyond MedStar Health to advance health IT research, quality, and safety. Follow the Center on Twitter, Facebook, and its main website for regular updates about its AHRQ-funded work and other important initiatives.

Becker’s Hospital Review Lists MedStar Institute for Innovation Among Innovation Centers to Know

The MedStar Institute for Innovation (MI2) is included in Becker’s Hospital Review’s 2019 list of more than 40 hospitals and health systems with great innovation programs.

Becker’s Healthcare recognized the organizations on this list for their commitment to staying on the forefront of change in health care.

The recognition also includes a brief profile of MI2’s work that helped earn this recognition as an innovation center to know in 2019. The article highlights MI2’s efforts to co-host challenges featuring innovative ideas from within MedStar Health, and work within the MedStar Health National Center for Human Factors in Healthcare, MedStar Health Simulation Training & Education Lab, MedStar Telehealth Innovation Center, and MedStar Pharmacogenomics Initiative—all among other important contributions from talented MI2 colleagues.

Read Becker’s Hospital Review’s full list here and its profile on MI2 here.

Congratulations to all organizations featured for sharing a commitment to catalyzing innovation that advances health.