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Coronavirus panic has fueled the telehealth revolution in Colorado — and we won’t go back

“We’ve made three years of progress in about three weeks,” UCHealth’s medical director for virtual health says.

A virtual-health technician monitors patient vital signs at UCHealth's patient surveillance center in Aurora in a 2019 file photo. Medical teams use the center to monitor vital signs and assess frequent alarms for emergencies like sepsis, from hundreds of miles away. (Seth McConnell, Special to The Colorado Sun)
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Colorado patients visiting their doctors virtually through video links, phone calls or online chats are up more than 2,000% in some larger health systems during the COVID-19 crisis, easing life for consumers and promising permanent changes long after the virus is gone.

Turning a short-term necessity into a long-term virtue for consumers and providers, the state’s largest health systems are seeing video urgent care visits rise — one system jumped to 260 a day this week from 20 on a normal day. Systems that allow patients to email their doctors have seen volumes surge from 10,000 messages a day during a normal flu season to 16,000 a day at their COVID-19 peak.

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“Through March, it’s been absolutely exponential growth in demand for virtual visits,” said Dr. Chris Davis, medical director for Virtual Health in the UCHealth system, with a network of hospitals, primary and specialty care providers around the state.

While some systems, like Kaiser Permanente Colorado, already had nearly all their providers rotating into virtual care, by video, chat or phone calls, UCHealth had a smaller subset operating virtually before the pandemic hit. UCHealth had been expanding virtual care from its emphasis on primary visits into more specialties, but pandemic planning rapidly accelerated the timing, said Kathy Deanda, UCHealth’s senior director for ambulatory services and virtual health.

“So we spun off 600 virtual clinics across our system in a short period of time,” Deanda said.

There’s no going back, once both consumers and providers have tried and appreciated the speed and convenience of using virtual health for everything from evaluating the sniffles to consulting on chronic diabetes care, Davis said. Adaptations to COVID-19 have sped up UCHealth’s carefully plotted plans to an unimaginable degree, he said.

“We’ve made three years of progress in about three weeks,” Davis said.

It started with trying to comply with physical distancing rules

Nearly all health systems in Colorado have responded to crisis distancing rules by closing altogether to nonemergency or nonessential procedures, and by setting up separate facilities away from other services to handle suspected and full-blown coronavirus cases. Kaiser and UCHealth, among others, temporarily halted in-person non-COVID,  nonessential primary and specialist appointments. Hospitals and clinics retained ER and urgent care hours, but asked patients whose needs were not obvious to consider waiting or contacting an advice line.

At the Kaiser Permanente Arapahoe Medical office in Centennial on Feb. 29, signs told patients who had recently traveled to China to ask for a mask at the front desk. Soon after, Kaiser shut down all in-person medical appointments and asked people to check in with their doctors online. (Tamara Chuang, The Colorado Sun)

Kaiser and UCHealth, though, also told patients barred from normal in-person care to consider expanding their use of video, chat and phones for urgent care, primary consultation, and even specialty and chronic care. Kaiser, with 620,000 members in Colorado and a uniform, easily-accessed electronic patient record across all its facilities, was able to make a quick pivot.

“We did not create any new channels, we just flexed muscles already in place,” said Dr. Ari Melmed, Kaiser Permanente Colorado medical director of telehealth, who also continues to practice as an emergency physician for Kaiser. The moves did require some rescheduling, but not much retraining; Kaiser physicians already e-mail extensively with their patients, and are usually part of rotations to conduct video health, online chats and emergency phone calls.

While the transition went smoothly, the volume has still impressed Melmed and other Kaiser officials. Scheduled phone consultations were up six- to eight-fold at the peak, Melmed said. Video consultations in primary care tripled. Specialty consultations by video went from a handful a day to 400 a day.

Melmed estimates the peak traffic for Kaiser Permanente occurred on March 16 and 17, with a steady decrease since then. Next week, Kaiser will allow members to schedule video visits for themselves through the online portal or by phone, and he expects volume to leap again after that. In many cases, Melmed said, Kaiser is able to offer a video consult or scheduled phone appointment the same day the patient calls.

“In the near term we’ve been able to manage patients more rapidly by phone than before the pandemic,” he said.

TODAY’S UNDERWRITER

UCHealth needed to incorporate more introductory telehealth training with its COVID-19 plan, Deanda said, since most specialty clinics and some primary providers were not scheduled to join the system for some time. UCHealth also had to add computer server space to handle a big increase in digital traffic, all under HIPAA privacy compliance.

UCHealth added up to seven physicians to take video calls at its Virtual Urgent Care control center in a southeast metro office building, where before the virus, one physician would do. Some protocols make the home-based visit feel more like the real thing — for chronic disease patients used to taking their own blood pressure, oxygen level in their blood and temperature at home, a medical assistant first calls to “virtually room” the patient and take the vitals before the video-provider visit.

COVID patients will be added into the virtual mix by next week, UCHealth said. Recovering patients who are discharged will get a remote monitoring kit that automatically alerts the Virtual Health Center to disturbing changes in vital signs. Patients are usually happier, and hospital space is freed up for more acute cases.

The fast adoption of virtual visits by patients and providers will be one of the permanent societal changes coming out of the virus upheaval, health officials said.

“Now that everyone has had the experience because of this situation, we see that more and more physicians and patients are adopting it and are grateful for the convenience,” Deanda said. “This will be long term.”


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