Implementation of Telemedicine in a Tertiary Hospital-Based Ambulatory Practice in Detroit During the COVID-19 Pandemic
BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome-coronavirus-2 (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 busy university hospital-based outpatient clinic in one of the worst-hit areas in the world. OBJECTIVE: Our goal was to assess the adoption of telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also wanted 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 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 video visit converted to 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 (e.g activity suggested through diagnosis or procedural code) which were addressed remotely by the physicians. RESULTS: During the study period, we had 110 telemedicine visits scheduled, of which 94 visits (85.4%) were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 patients (25.54%) were recently discharged from hospital, and 70 patients (74.46 %) were seen for urgent care needs. There was 50 % increase from the baseline in the number of clinical tasks which were addressed by the physicians during the pandemic. CONCLUSIONS: There was 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.