Apr 02 2020

Scaling Up Telehealth: What Providers Need to Know

Demand for virtual visits has increased by 2,000 percent at one California children’s hospital. Strong tools and collaboration helped ensure a successful pivot.

Telehealth isn’t new at Lucile Packard Children’s Hospital Stanford, but it has quickly become essential as staff adapt to increased demand during the COVID-19 pandemic. 

In a single week, the daily number of virtual outpatient visits soared from 20 to 400 — and surpassed 600 soon after, said Kadambari Beelwar, the California hospital’s telehealth manager. The spike has underscored the value of Lucile Packard’s ongoing virtual care expansion and a game plan to pivot quickly to meet public health needs.

“We had the very modest beginnings of telehealth technology,” said Beelwar, who talked about the effort as part of an online roundtable hosted by Cisco on March 25. “We realized, ‘We have to scale.’” 

Rapid workplace shifts due to coronavirus are affecting many industries. Cisco, which normally has about 25,000 remote employees, now has 140,000 at-home staff in nearly 100 countries, said CIO Jacqueline Guichelaar.

And the adaptation is shaking up notions about interpersonal communication and care delivery. “In the past, there was a belief we couldn’t do some of this virtually, and we’re learning that’s not true,” said Francine Katsoudas, Cisco’s chief people officer.

Cisco solutions support telehealth applications in approximately 17,000 organizations across nearly 120 countries, she said.

Staff Training for Telehealth Is a Critical First Step

Lucile Packard, located in Palo Alto, Calif., quickly had to rethink the limits of virtual care, and onboard many new people to deliver and receive it.

The first step: making sure users had the necessary tools to utilize the hospital’s Cisco collaboration platform. 

“We had one challenge of having desktops for providers and patients, so we had to quickly figure out how to enable them for telehealth by giving them cameras, speakers and microphones,” Beelwar said. 

Technology is just one part of a three-pronged approach that includes people and processes. Faced with big telehealth demand, “our processes were unsustainable,” Beelwar said.

An evaluate-and-adapt strategy was key, along with training staff and volunteers to coach providers and patients through the system and provide technical support.

The plan crosses departments and specialties: Some Lucile Packard virtual exchanges relate to COVID-19 concerns, with parents using a new, on-demand service to discuss the virus with providers. But most, Beelwar said, are normal office visits now converted to telehealth as parents seek to avoid potential exposure amid shelter-in-place orders. 

Ultimately, the arrangement could become a way of life. 

“After the whole storm dies down, I don’t think we will come back to our modest beginning,” Beelwar said. “We have introduced digital transformation, and we are changing the mindset of people, of providing healthcare by office visits. We are training providers and patients to work from home and be able to provide and get the care they need.”

READ MORE: Learn why telehealth solutions are vital in a disaster.

4 Tips to Speed Up Telehealth Rollouts for Outpatient Visits

As more providers increase telehealth services, the experience of Lucile Packard suggests four tips to scale quickly: 

  • Start with the right tech: Staffers ensured they had the proper tools in place before addressing people and processes, said Beelwar. After expanding the hospital’s telehealth infrastructure, they focused on making sure users knew what to do and had the right procedures to follow.
  • Educate your audience: A strong platform and a “white glove” approach — an employee contacts the provider and patient before the visit to ensure systems are ready — can simplify consultations and reduce hiccups. “Every patient has a different level of technology acuteness,” Beelwar said.
  • Practice solid documentation: The hospital had well-documented processes for deployment and management of its telehealth services. That made it easier to ramp up staff and volunteers quickly when faced with “unprecedented” demand, Beelwar said. 
  • Be cooperative and flexible: Scaling a service quickly will keep any team on its toes, Beelwar said, so being able to roll with the punches is critical. “It’s making us think every day of what we are doing right and what we are doing wrong, and because of that, there are a lot of last-minute changes on process that we are introducing.”
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