Prior to the novel coronavirus (COVID-19) outbreak, providers at Stanford Children's Health conducted an average of 20 telehealth visits daily. Now, they do more than 700 per day. They're not alone—hospitals around the country are increasingly turning to telehealth to provide important medical services while minimizing person-to-person contact.
Children's Hospitals Today caught up with Natalie Pageler M.D., M.Ed., chief medical information officer, Stanford Children's Health and clinical professor of pediatric critical care, Stanford University, in Palo Alto, California, to discuss how the hospital handled the sudden influx of telehealth visits and what it might mean for the future.
How was Stanford Children's Health able to accommodate such a dramatic surge in telehealth usage?
One of the things that helped us early on was that our leadership quickly realized we were going to be living in a different way for a while, so they prioritized telehealth projects—putting a halt to nonessential projects so our staff could be redeployed toward the priorities. There was quite a bit of work that needed to be done to support this dramatic increase on a couple of fronts.
First, all our technology teams—technical, unified communications and those under our chief technology officer—have been phenomenal. They've ensured we have the network bandwidth to support increased telehealth and remote work as well as securing enough licenses for our virtual desktop.
From a process standpoint, we had already done training and rollout to some of our services and specialties, but not all of them. So, we had to quickly update our training process—creating online and video training materials—so we weren't dependent on in-person or in-class training.
We also redeployed more than 50 of our information services department staff to support telehealth. Some were assigned to the Patient Support Team to proactively call patients to make sure they were set up for telehealth in advance of their appointments. Others assisted the provider support pool that sets our providers up to do telehealth and answers any questions or issues they may encounter.
In addition to remote screening for COVID-19, what are some of the ways you're using telehealth to cut down on person-to-person contact?
We have implemented several different measures to reduce the number of people in the hospital and the number of people going into our isolation rooms.
For some of our providers whose consults are based on conversations—psychiatry, social work or case managers, for example—those have been turned over to telehealth inpatient consults.
We are also decreasing the number of family members allowed into the hospital. So, to continue to create connections between the patients in the hospital and their family members at home, we have enabled them to connect from the iPad in their room. Additionally, the providers or the ancillary services can either use the iPads in the room or our workstations on wheels to connect with a parent or a family member who may be at home to give them updates that they normally would give when that family member was in the hospital.
Again, all these things decrease how many people are coming in and out of the hospital and how much personal protective equipment (PPE) is used for the providers or family members going into those isolation rooms.
Are you finding any unintended benefits of the increased telehealth usage?
We are finding quite a few interesting benefits that people had not been aware of before.
For example, our developmental behavioral pediatricians are telling us about some cases where they are getting better information than they do during in-person visits because they're seeing the child in their home environment and doing their natural routine—information that they wouldn't normally get in a somewhat artificial clinic visit.
We also had one of our pulmonologists doing a telehealth visit for one of his obstructive sleep apnea patients who happened to be asleep at home, so he was able to see him sleeping.
Our providers are getting to see a whole different aspect of their patients that they don't normally see in a visit setting. In some ways, it's like bringing back the home visits—we're seeing a lot of surprise benefits from this massive rollout of digital health.
What does this mean for the future of telehealth?
I think we're absolutely going to be in a different place when this is all over. There are some places where we may be stretching the limits a bit now by doing telehealth in situations that might not be ideal because of the risk-to-benefit ratio of exposing people in this current pandemic. But for a large portion of these visits, it was just an activation barrier to getting people to try these. Now that both the patients and the providers are seeing the value and seeing how much they can get from these telehealth visits, I think we're going to have a large number of converts who will continue with telehealth visits after this is over.
Additionally, I think now that we're seeing what can be done, people are envisioning the next steps. We were already planning to upgrade our virtual visit platform and are now seeing with more urgency some of the functionalities we need to add—including increased ability to have multiple parties in telehealth visits and the ability to share screens and documents. We already enabled remote signup for our patient portal, so then we started getting into remote monitoring or remote equipment requests. Now that people are seeing what can be done from home, the ancillary tool requests will also go up with that.
I'm excited about the potential for digital health to transform the way children's health care is delivered—a silver lining to this COVID pandemic is that it has launched digital health forward.