Across the nation, hospitals and health systems are reshaping virtual care programs to be more accessible, affordable and responsive to patients, clinicians and care teams. The challenge is: How do you capture best practices of in-person visits and evidence-based medicine while adapting to the unique setting of virtual care?
Four leaders of clinical transformation, innovation and marketing from The University of Texas MD Anderson Cancer Center (MDACC) and Texas A&M University’s Mays Business School recently shared a blueprint in the Harvard Business Review.
The so-called “DIBS” framework — documentation, integration, best practices and support — offers benefits for all virtual care stakeholders. The report provides insights drawn from implementing a suite of virtual care services at MDACC and operating procedures and virtual care guidelines at other institutions, including the University of Pittsburgh Medical Center (UPMC) and Jefferson Health.
Building Your Virtual Care Framework
1 | Document your implementation strategy.
Include all unique activities of health care staff for a typical virtual care encounter. Compare and contrast in-person and virtual care contexts based on the patient’s reason for the visit. This comparison can help uncover process complexities that may arise unexpectedly when transitioning from in-person to virtual care. Categorize care-related activities before, during and after the visit and guide the technical assistance process for patients who have specific visual, auditory, language, technology literacy or technology infrastructure needs.
2 | Integrate all program components.
This will make the overall patient-clinician experience as seamless as possible. Focus on ways to:
- Prepare patients and clinicians to use required technology.
- Educate them on how to look at the camera during conversations, and choose appropriate lighting and audio equipment.
- Find a secluded space with minimal distractions.
- Streamline all ancillary logistics that complement a virtual visit, including making future appointments, ordering prescription refills and incorporating personal health information captured on in-home devices.
- To gain trust and buy-in, prepare patients and caregivers for self-monitoring and self-care with educational materials (e.g., tip sheets and links to training videos) and ensure that all communication is culturally and linguistically competent and clear.
3 | Follow best practices.
Use evidence-based decision criteria to guide appropriate use of remote care (e.g., for lower-complexity and lower-emotion visits).
- Encourage clinicians to review patient information and records (including, when possible, notes from other treating physicians) before virtual encounters.
- Involve the entire care team (e.g., nurses, medical assistants, etc.) in preparing for the virtual visit, gathering records and prepping the virtual room, connecting during the visit and scheduling appointments as the visit ends.
- Prioritize best practices that enable clinicians to adopt and sustain virtual care. Clinician benefits include greater efficiency, improved outcomes and patient experience scores.
- To preserve these benefits, codify virtual care workflows where feasible and refine them as new service line-specific needs arise.
4 | Provide support.
Timely support for virtual visits and the surrounding infrastructure is essential. Invest in ready-to-serve tech assistance for patients, clinicians and clinical teams. Ensure adequate supply chain redundancy to solve potential device or connectivity issues.
Explore using artificial intelligence (chatbots, virtual nursing assistants, clinical support algorithms) to aid patients and clinicians as they seek evidence-based guidance. And minimize the digital divide and access to care disparities by possibly installing a telehealth center with private cubicles in low-income housing complexes, community centers or other locations.
Delivering Optimal Virtual Care Consistently
In rural South Central Texas, consumers can use a telemedicine station at the Milam County Sheriff’s Office to get immediate help when clinics aren’t open, potentially saving them a 35-minute trip to the nearest hospital.
Once inside the booth, patients can check their vital signs, access a dispensary with common medications and have an on-demand video visit with a nurse practitioner. The station is a collaboration between Texas A&M Health Science Center and OnMed, which manufactures a self-contained virtual medical unit that connects patients with licensed clinicians and pharmacists.
MDACC, meanwhile, offers a remote-monitoring program for patients undergoing immunotherapy. This effort has significantly reduced emergency department visits and led to greater patient satisfaction.
Elsewhere, UPMC health plan members can use digital onboarding for a range of integrated virtual services, including primary care, behavioral health, wellness checks and urgent care with no co-pays.