Cleveland Clinic’s digital transformation is a startling representation of the overnight shift health care as an industry has made in response to COVID-19.
“We were doing less than 2 percent of patient care virtually and we needed to scale that up extremely quickly. Over the course of a week or two, 75 percent of the care we were providing was being done virtually,” says Steven Shook, MD, a neurologist and the COVID-19 Distance Health Transformation, Clinical Team Lead, at Cleveland Clinic.
Across the country, health care providers are encountering similar circumstances. NYU Langone, for instance, has experienced a 683 percent increase in urgent virtual visits and an unprecedented 4,345 percent rise in non-urgent virtual sessions. Approximately 90 percent of physicians are seeing patients remotely, according to one study.
“If you didn’t have a single digital project going on at your health care organization, overnight you have the ability to go fully digital. That’s what we’re seeing. People are requesting, ‘How quickly can you implement?’ That wasn’t always the request from existing health systems and payers,” says Glen Tullman, executive chairman of Livongo.
Making a rapid transition to digital health is hard enough for the Cleveland Clinic or NYU Langone, and even more difficult for organizations that aren’t in the same league as large urban-based health systems with considerable resources.
“Embracing a digital strategy is critical for business survival during the COVID-19 crisis. Many times, it is an overlooked fact that health care practitioners are often small business owners struggling to stay afloat—regardless of this crisis. Many practices are now asking non-essential employees to stay home and are limiting or eliminating face-to-face encounters—not only with patients but also with business partners, such as health plans,” says Tom Langan, CEO of Veradigm, a Chicago-based health IT company.
For those providers and health care organizations struggling to make this rapid transition work, Cleveland Clinic has created a digital health playbook based on its experiences. Shook expanded on a few important aspects of the playbook with Health Evolution.
Elements of a digital health playbook
Expansion of telehealth privileges: As Shook notes, Cleveland Clinic had to quickly reorganize and retrain its workforce, which had focused primarily on in-person care. One of the first things in its rapid transition plan was to work with government relations and legal team members to understand the scope in which the system could work virtually. With Congress and the federal government quickly changing the rules to expand virtual visits, there was a lot to learn. “We were able to meet the needs of patients virtually in a way we were never able to do before,” says Shook. The playbook made it clear what could and could not be done, what would be reimbursed fully and what wouldn’t, which platforms could and could not be used.
Expand digital platforms: Speaking of platforms, coming into COVID-19, Cleveland Clinic had a virtual care service called “Express Care Online.” However, that was used for approximately 2% of care being done in Cleveland Clinic. Transitioning close to 4,000 physicians, an army of advanced practice providers, 19 clinical institutes to a virtual environment meant the IT department had to ramp up additional platforms by which providers and patients can interact remotely. “We committed early to using a couple of platforms to make it simple for our providers and move things along very quickly,” Shook says. The playbook included workflows and guidance for platforms such as Apple FaceTime, Google Duo, and Doximity Dialer.
Steven Shook, MD, Cleveland Clinic
Workforce training: Despite being one of the most innovative health care organizations in the country, most providers at the Cleveland Clinic had never done care virtually. The Clinic developed a number of quick reference guides very quickly. Not only did these reference guides and training templates include information on how to use the virtual care platforms, but also how to document, schedule, bill and code for these remote visits. “We needed this information so we could follow the rules of the playground that was rapidly changing,” Shook says. The playbook also provides training and information on expressing empathy in virtual visits.
Communication: The organization has “tiered huddles,” every day to talk about pressing problems with virtual care, COVID-19 or other issues. They also have frequent webcasts, asynchronous communications through its intranet, and an internal social media structure. Shook says this helped inform the development of the playbook. “Having that structure with shared communication was really the key to moving quickly and getting done what we got done so well,” he says.
Infrastructure and providers
The digital health playbook is constantly updated and reviewed daily. Cleveland Clinic, Shook says, is shifting from a short-term strategy to how these tools can be leveraged in the long term and a post-COVID era. The system is looking at how to maintain momentum of digital health adoption once patients are able to return with face-to-face care.
Shook says infrastructure is important in successfully transition to a digital environment, although thanks to the advancement in technology, a remote environment now requires just a cell phone and Wi-Fi. “The infrastructure is not nearly as much of a barrier as it once was. You need to have that though and an EHR that supports that,” he says.
Another important factor in transitioning to digital successfully is getting providers on board with the change. One silver lining to COVID-19 is that a lot of providers who may have been on the fence about virtual care were quickly won over.
“The provider barrier has started to come down. So now we’re looking at use cases of patients that would benefit from this type of care,” he says. “You need to listen to your providers. Make sure you’re providing them with the training and support they need. The different institutes, the types of patients and problems they’re dealing with are different so we’re going to need to innovate around that. We need to listen to patients. We need to innovate around what they’re looking for and what can provide the highest quality care.”