Early last year, Baptist Health, a health system based in Louisville, Kentucky, was taking note of the lessons staff had learned and the data gathered through the first year of the pandemic to reassess the organization's overall virtual care strategy and current digital health tools.

THE PROBLEM

Patient experience and access, along with provider efficiency, were areas Baptist wanted to improve – to ensure the virtual tools it had were helping to meet its overall goals around care delivery, and to ensure it was providing innovative quality care to meet community needs.

"Looking at our innovation and health IT project queue, we saw we had some capital needs and wanted to keep our margins steady despite greater costs associated with COVID-19," said Dr. Brett A. Oliver, chief medical information officer at Baptist Health. "My operations partners may not be aware of the type of available technology, but they knew there were access and efficiency issues.

"It's my job to have a strategy and priorities in place to look for the right tools to address all of these challenges," he added.

One of the biggest learnings from COVID-19 was that patient expectations had changed. From a digital health perspective, the floor of what Baptist offered had been raised significantly.

"We also learned that, as a system, we need to be ready for this cultural shift," Oliver said. "Before COVID, video visits had trouble gaining traction, and technical quality was lacking. However, the same folks back then who were saying, 'Hey, that wasn't so bad,' are the same ones who are really primed and helping move us along this cultural continuum.

"We also learned that to be successful a care option has to be simple and user-friendly," he added.

Baptist strives for new opportunities to improve patient access and equity, which is especially important for its population.

"We have more than 400 outpatient facilities and services in more than 80 Kentucky counties, plus counties in Illinois, southern Indiana and Tennessee," Oliver explained. "We need to reach patients in counties where transportation challenges are great.

"The other critical challenge we wanted to solve is one that every healthcare delivery organization faces right now – provider efficiency," he continued. "Far too many digital tools have disregarded interoperability and integration with EHRs, and have actually added to the administrative burdens and unnecessary work that frustrate providers – and keep them from practicing at the top of their license and building relationships with patients."

That was another key factor that led Baptist Health to telemedicine vendor Bright.md, he said.

"If you're not already addressing the patient experience and access for care, be aware many others are going to do it for you."

Dr. Brett A. Oliver, Baptist Health

PROPOSAL

Access to primary care has been an issue for Baptist for the last eight years, and that got Oliver thinking of other ways to become more efficient with workflows. Asynchronous telehealth really appealed to Oliver because of its 24/7 access, any time, with a low burden on clinicians.

"When I was looking at Bright.md, there just wasn't any company out there doing it like they were," he contended. "They are evidence-based, and a leader in asynchronous care. They have great patient and provider satisfaction because of the thoroughness and consistency of their clinical interviews, and the provider time required to deliver care to patients for low-acuity conditions was lower than anything we were doing already internally.

"Another key factor in choosing the platform was that it doesn't require the user to have broadband access. That's critical for us, too, as broadband is the biggest thing that threatens health equity for our communities that's outside of our control," he added.

Oliver and staff were particularly happy with the vendor's clinical content, which has since allowed the health system to expand its asynchronous telehealth offerings – Baptist calls them eVisits – from six common medical conditions to 25, including coughs, pink eye, sinus issues, urinary infections, and COVID-19 and flu screening.

"The resources required to build and roll out more than 25 eVisits in our Epic EHR and maintain them ourselves with the latest clinical guidelines was more than we wanted to permanently invest in," Oliver noted. "There also is a speed to market for us with Bright.md. Even if we could build out all the eVisits we wanted to – which we thought about – it would take a couple of years likely to design, vet and build 25 clinical conditions that the vendor can treat asynchronously."

In addition, when Baptist was considering how to drive efficiencies and meet changing patient expectations to keep them coming back for all of their care needs, the vendor exceeded expectations in terms of configurability, ease of use and the breadth of conditions covered.

Care Finder, Baptist's branding of the vendor's Navigate system, has proven critical to make sure the health system not only is getting more people access to care, but getting them to the right level of care to meet their needs as quickly as possible, Oliver said.

MARKETPLACE

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MEETING THE CHALLENGE

Implementation of the telemedicine technology was smooth. The vendor helped Baptist Health get set up, working closely with Baptist's IT team and helping with a marketing campaign to educate and engage patients. The staff has been pleased to see the response in terms of patient adoption and patient and provider satisfaction.

Baptist's medical director for urgent care vetted all of the vendor's clinical content that makes up all of their interviews across health conditions. Baptist makes modifications, if necessary.

"Once you go through the content and see what's there, there's a trust that develops," Oliver remarked. "It is a process, though, when it's an outside, third-party vendor. Building that trust with our clinicians has been a process, but it has been a relatively easy process.

"Integration with our Epic EHR also was absolutely critical, and Bright.md really impressed me and our IT team with its integration," he continued. "The information gathered in a patient's interview is relayed to clinicians in an easy-to-read SOAP note, along with evidence-based treatment options, and prescriptions are ordered directly – and it's all in a chart note that is automatically filed in a patient record in Epic."

The telemedicine vendor automates a lot of the documentation for Baptist providers, who trust the quality of the diagnosis because of the thorough, evidence-based interview – meaning it doesn't require much time for them to review and approve or change the treatment plan the technology offers, he added.

"From a user perspective, there's this old wives' tale that older folks won't use virtual health," Oliver said. "Personally, I've found that with our health services, once they understand it, they're some of the highest users. Of course, part of that is educating our providers so they're helping all patients understand what asynchronous care is, when they should use it and how to get started when they do need it.

"But what I tell our providers is not to write anyone off because of their age," he continued. "And we're seeing we have a broad spread of our patient population using Bright.md. Nearly 7% of our patients who have used it in our initial months live are 65 or older, and then we see a fairly even spread of users across all age groups – which reinforces that the convenience and ease of use resonates with folks across our population."

RESULTS

Right now, with capacity constraints across Baptist Health's primary and urgent care venues, ensuring that the asynchronous telemedicine technology is helping to reduce strain on providers and create more efficiencies is a top priority.

"We've seen a big surge in use during this most recent omicron surge in our region," Oliver said. "I've been really pleased with the amount of time it takes our team to deliver care for low-acuity conditions using the technology – less than five minutes on average.

"That is significantly less than what we've seen with other virtual care platforms, and such a drastic reduction in time our providers are spending on things like ear infections or UTIs – meaning they can spend more time with patients who need that face-to-face care," he said. "It also means providers don't have to spend as much time in Epic because Bright.md automates much of the documentation, billing and prescribing, and it's integrated into their existing workflows."

Oliver said he is not sure Baptist would see such low numbers without the evidence-based technology and the quality of clinical content, which means the technology can determine the right diagnoses and treatment plans to recommend to providers. This lays the foundation for providers to trust the technology, which is critical, he stressed.

"We've been pleased with the number of asynchronous visits completed by our patients, which shows we're expanding access to care, as well as the patient satisfaction: Ninety-six percent of Baptist patients say they like the experience of using it," Oliver reported.

"We see from patient feedback they really value the convenience of being able to get the same quality care they trust from Baptist Health providers without having to leave their home – and when you have a bad cold or an ear infection and are just feeling awful, you don't want to have to get on a video visit or even talk to someone," he said.

The time until patients receive care also has proven critical to Baptist Health's telemedicine success.

"The whole concept of a waiting room is changing, not just due to COVID-19, but because everyone now really expects quick, easy options," Oliver noted. "Healthcare is slow to catch up to other consumer industries, but it's important for us and our patients to keep that wait time to a minimum.

"Even while the omicron surge has been particularly challenging for our already strained urgent care teams, we've been able to keep the time for patients to get their diagnosis, treatment plan and any prescriptions ordered to their pharmacy of choice from their provider through Bright.md in less than 25 minutes on average," he reported.

Baptist Health asks patients who use the telehealth technology where they would have gone for care for their condition had they not had access to the asynchronous telehealth. Thirty-two percent of people say they would have gone outside Baptist Health to get care from a retail clinic or direct-to-consumer option.

About 22% would have come to a Baptist urgent care or ED – where they likely would have seen longer wait times because those venues have been strained due to COVID-19.

"Our data shows us that the top conditions our patients use the technology for are colds and respiratory infections, UTIs and yeast infections, ear infections, and anxiety or depression – all of which are conditions that are effectively treated through asynchronous care," Oliver said.

"We did an audit of 100 charts and found that 87% of patients did not need to seek additional care for the same problem after their eVisit," he continued. "That is reassuring that this is not 'add-on' care."

Further, nearly 90% of people who have come to BaptistHealth.com and used the Navigate system have been successfully guided to care through the platform, Oliver reported.

"And what we're seeing is that it takes patients less than one minute to go through Navigate, enter their symptoms or chief complaint, and get to their recommended care option," he said. "This is so efficient for patients – especially when you compare with a typical call center or a self-guided online search that may lead to frustration and added costs later if you don't find the right care option the first time for your needs."

ADVICE FOR OTHERS

"If you're not already addressing the patient experience and access for care, be aware many others are going to do it for you," Oliver advised. "From venture capital-backed point solutions to other organizations, patients will expect this level of care moving forward. There will always be a place for 'who' is delivering the care, but the time has come to recognize 'how' it is delivered is front and center."

Patient expectations have shifted, and health systems must meet their communities where they are at, he added.

"Today there are so many threats out there, and I think that's why asynchronous care is gaining traction," he said. "The reality is that many direct-to-consumer options don't want our complex, multi-problem patients. They want the low-hanging fruit – these common conditions asynchronous care treats so effectively and efficiently, that then lead to downstream revenue.

"And what I often tell other healthcare executives is that you have to be careful with letting these competitors have that low-hanging fruit," he cautioned. "We know our patients first turn to Baptist Health because we have a reputation for quality care, and if we don't provide asynchronous care and other innovative options, patients will keep looking – especially when they want convenient, online care for things like an ear infection or a UTI."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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