Implementation of Telemedicine in a Tertiary Hospital–Based Ambulatory Practice in Detroit During the COVID-19 Pandemic: Observational Study

Abstract

Background The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital–based outpatient clinic in one of the worst-hit areas in the world. Objective Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. Methods We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. Results During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. Conclusions There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice.

Emergency physician perspectives on using telehealth with older adults during COVID‐19: A qualitative study

“…Similar to other studies, physicians in our sample were essential in providing COVID‐19 triage, 18 , 37 , 38 , 39 information and management via virtual outpatient clinics, and post‐discharge care. 40 Much like the experiences of physicians at a rural acute care hospital, many of our physicians reported that the physician‐patient relationship was not harmed by telehealth, 41 although physicians in other studies described experiencing discomfort with the lack of hands‐on assessments. 42 , 43 Participants’ desires to see telehealth as a supplement to care within the ED beyond the pandemic align with other research findings.…”

The reliability and validity of the Turkish version of the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) and Telemedicine Patient Questionnaire (TPQ) in individuals with multiple sclerosis

“…The importance of telemedicine in terms of providing care and increasing accessibility in patients with MS during the COVID-19 period has been emphasized in a recent study [ 32 ]. In addition, it has been stated that telemedicine has vital importance in pandemic situations due to possible limited staff, limited outpatient working hours, and increasing outpatient needs [ 33 ]. In this study, psychometric properties of TSUQ and TPQ were analyzed in individuals who had been undergoing a telerehabilitation program for 4 years, but more intensively for the last 6 months, by the neurology outpatient clinic.…”

“It Takes Some Empathy, Sympathy, and Listening”: Telephone Outreach to Older Detroiters in a Pandemic as a Modality to Gain an Understanding of Challenges and Resiliency

“…Research studies illustrate that telephone surveys have been used to measure health outcomes of older adults [ 11 , 30 , 31 ]. Consequently, telephone outreach methods have been incorporated to assess the effectiveness of telemedicine [ 12 ]. In addition to assessments, health services such as cognitive behavioral therapy, peer support, and physical health evaluations have been positively received by older participants who were unable to access in-person services [ 12 , 13 ].…”

“…Consequently, telephone outreach methods have been incorporated to assess the effectiveness of telemedicine [ 12 ]. In addition to assessments, health services such as cognitive behavioral therapy, peer support, and physical health evaluations have been positively received by older participants who were unable to access in-person services [ 12 , 13 ]. Thus, the telephone as a modality has many possibilities to support the health and social needs of older adults.…”