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Insourcing and scaling a telemedicine solution in under 2 weeks: Lessons for the digital transformation of health care.
Healthc (Amst). 2021 Jul 19; 9(3):100568.H

Abstract

The Covid-19 pandemic required rapid scale of telemedicine as well as other digital workflows to maintain access to care while reducing infection risk. Both patients and clinicians who hadn't used telemedicine before were suddenly faced with a multi-step setup process to log into a virtual meeting. Unlike in-person examination rooms, locking a virtual meeting room was more error-prone and posed a risk of multiple patients joining the same online session. There was administrative burden on the practice staff who were generating and manually sending links to patients, and educating patients on device set up was time-consuming and unsustainable. A solution had to be deployed rapidly system-wide, without the usual roll out across months. Our answer was to design and implement a novel EHR-integrated web application called the Switchboard, in just two weeks. The Switchboard leverages a commercial, cloud-based video meeting platform and facilitates an end-to-end virtual care encounter workflow, from pre-visit reminders to post-visit SMS text message-based measurement of patient experience, with tools to extend contact-less workflows to in-person appointments. Over the first 11 months of the pandemic, the in-house platform has been adopted across 6 hospitals and >200 practices, scaled to 8,800 clinicians who at their peak conducted an average of 30,000 telemedicine appointments/week, and enabled over 10,000-20,000 text messages/day to be exchanged through the platform. Furthermore, it enabled our organization to convert from an average of 75% of telehealth visits being conducted via telephone to 75% conducted via video within weeks.

Authors+Show Affiliations

University of Pennsylvania Health System, Penn Medicine Center for Health Care Innovation, 3400 Civic Center Blvd, 14(th) Floor South Pavilion, Philadelphia, PA, 19104, USA. Electronic address: katherine.choi@pennmedicine.upenn.edu.University of Pennsylvania Health System, Penn Medicine Center for Health Care Innovation, 3400 Civic Center Blvd, 14(th) Floor South Pavilion, Philadelphia, PA, 19104, USA; University of Pennsylvania Health System, Hospital Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address: Yevgeniy.Gitelman@pennmedicine.upenn.edu.University of Pennsylvania Health System, Penn Medicine Center for Health Care Innovation, 3400 Civic Center Blvd, 14(th) Floor South Pavilion, Philadelphia, PA, 19104, USA. Electronic address: Damien.Leri@pennmedicine.upenn.edu.University of Pennsylvania Health System, Office of the Chief Medical Information Officer, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address: Mary.Deleener@pennmedicine.upenn.edu.University of Pennsylvania Health System, Penn Medicine Center for Health Care Innovation, 3400 Civic Center Blvd, 14(th) Floor South Pavilion, Philadelphia, PA, 19104, USA. Electronic address: Lauren.Hahn@pennmedicine.upenn.edu.University of Pennsylvania Health System, Penn Medicine Center for Health Care Innovation, 3400 Civic Center Blvd, 14(th) Floor South Pavilion, Philadelphia, PA, 19104, USA. Electronic address: Christina.Omalley@Pennmedicine.upenn.edu.University of Pennsylvania Health System, Information Services, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address: Erik.Lang@pennmedicine.upenn.edu.University of Pennsylvania Health System, Office of the Chief Medical Information Officer, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA; University of Pennsylvania Health System, Internal Medicine, Division of General Internal Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address: Neha.Patel@pennmedicine.upenn.edu.University of Pennsylvania Health System, Information Services, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address: Timothy.Jones@pennmedicine.upenn.edu.University of Pennsylvania Health System, EHR Transformation, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address: Kert.Emperado@pennmedicine.upenn.edu.University of Pennsylvania Health System, EHR Transformation, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address: Christopher.Erickson@pennmedicine.upenn.edu.University of Pennsylvania Health System, Penn Medicine Center for Health Care Innovation, 3400 Civic Center Blvd, 14(th) Floor South Pavilion, Philadelphia, PA, 19104, USA. Electronic address: Roy.Rosin@pennmedicine.upenn.edu.University of Pennsylvania Health System, Penn Medicine Center for Health Care Innovation, 3400 Civic Center Blvd, 14(th) Floor South Pavilion, Philadelphia, PA, 19104, USA. Electronic address: asch@wharton.upenn.edu.University of Pennsylvania Health System, Office of the Chief Medical Information Officer, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA; University of Pennsylvania Health System, Anesthesia, Surgery and Internal Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address: William.Hanson@pennmedicine.upenn.edu.University of Pennsylvania Health System, Penn Medicine Center for Health Care Innovation, 3400 Civic Center Blvd, 14(th) Floor South Pavilion, Philadelphia, PA, 19104, USA; University of Pennsylvania Health System, Office of the Chief Medical Information Officer, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA; University of Pennsylvania Health System, Cardiology, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address: sri@pennmedicine.upenn.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34293616

Citation

Choi, Katherine, et al. "Insourcing and Scaling a Telemedicine Solution in Under 2 Weeks: Lessons for the Digital Transformation of Health Care." Healthcare (Amsterdam, Netherlands), vol. 9, no. 3, 2021, p. 100568.
Choi K, Gitelman Y, Leri D, et al. Insourcing and scaling a telemedicine solution in under 2 weeks: Lessons for the digital transformation of health care. Healthc (Amst). 2021;9(3):100568.
Choi, K., Gitelman, Y., Leri, D., Deleener, M. E., Hahn, L., O'Malley, C., Lang, E., Patel, N., Jones, T., Emperado, K., Erickson, C., Rosin, R., Asch, D., Hanson, C. W., & Adusumalli, S. (2021). Insourcing and scaling a telemedicine solution in under 2 weeks: Lessons for the digital transformation of health care. Healthcare (Amsterdam, Netherlands), 9(3), 100568. https://doi.org/10.1016/j.hjdsi.2021.100568
Choi K, et al. Insourcing and Scaling a Telemedicine Solution in Under 2 Weeks: Lessons for the Digital Transformation of Health Care. Healthc (Amst). 2021 Jul 19;9(3):100568. PubMed PMID: 34293616.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insourcing and scaling a telemedicine solution in under 2 weeks: Lessons for the digital transformation of health care. AU - Choi,Katherine, AU - Gitelman,Yevgeniy, AU - Leri,Damien, AU - Deleener,Mary Elisabeth, AU - Hahn,Lauren, AU - O'Malley,Christina, AU - Lang,Erik, AU - Patel,Neha, AU - Jones,Timothy, AU - Emperado,Kert, AU - Erickson,Christopher, AU - Rosin,Roy, AU - Asch,David, AU - Hanson,C William,3rd AU - Adusumalli,Srinath, Y1 - 2021/07/19/ PY - 2021/03/17/received PY - 2021/06/24/revised PY - 2021/07/10/accepted PY - 2021/7/23/pubmed PY - 2021/7/23/medline PY - 2021/7/22/entrez KW - Connected health KW - Digital transformation KW - Health IT KW - Informatics KW - Innovation KW - Telemedicine SP - 100568 EP - 100568 JF - Healthcare (Amsterdam, Netherlands) JO - Healthc (Amst) VL - 9 IS - 3 N2 - The Covid-19 pandemic required rapid scale of telemedicine as well as other digital workflows to maintain access to care while reducing infection risk. Both patients and clinicians who hadn't used telemedicine before were suddenly faced with a multi-step setup process to log into a virtual meeting. Unlike in-person examination rooms, locking a virtual meeting room was more error-prone and posed a risk of multiple patients joining the same online session. There was administrative burden on the practice staff who were generating and manually sending links to patients, and educating patients on device set up was time-consuming and unsustainable. A solution had to be deployed rapidly system-wide, without the usual roll out across months. Our answer was to design and implement a novel EHR-integrated web application called the Switchboard, in just two weeks. The Switchboard leverages a commercial, cloud-based video meeting platform and facilitates an end-to-end virtual care encounter workflow, from pre-visit reminders to post-visit SMS text message-based measurement of patient experience, with tools to extend contact-less workflows to in-person appointments. Over the first 11 months of the pandemic, the in-house platform has been adopted across 6 hospitals and >200 practices, scaled to 8,800 clinicians who at their peak conducted an average of 30,000 telemedicine appointments/week, and enabled over 10,000-20,000 text messages/day to be exchanged through the platform. Furthermore, it enabled our organization to convert from an average of 75% of telehealth visits being conducted via telephone to 75% conducted via video within weeks. SN - 2213-0772 UR - https://www.unboundmedicine.com/medline/citation/34293616/Insourcing_and_scaling_a_telemedicine_solution_in_under_2_weeks:_Lessons_for_the_digital_transformation_of_health_care. L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-0764(21)00051-8 DB - PRIME DP - Unbound Medicine ER -
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