Following the COVID-19 outbreak, telehealth EHR integration helped UPMC Pinnacle train thousands of staff members in a week.
The deadly spread of COVID-19 has forced health systems to adopt telehealth at a rapid rate. And for University of Pittsburgh Medical Center (UPMC) Pinnacle, telehealth EHR integration has been an asset in putting that telehealth delivery to scale.
The central Pennsylvania health system, which has over 160 clinics, has had telehealth capabilities since 2012. But, according to, Salim Saiyed, chief medical informatics officer at UPMC Pinnacle, said the health system needed to greatly accelerate its telehealth adoption to reduce patient, provider, and clinician exposure to the virus.
“We wanted to reduce exposure because COVID-19 is very contagious and we did not want our providers and nurses to enter the patient rooms,” Saiyed said in an interview with EHRIntelligence. “The telehealth solutions are automated, so an ER nurse can call in and it picks up automatically so the patient does not need to touch anything.”
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But introducing telehealth across a broad care continuum — and doing so quickly — can be challenging. Prior to COVID-19, not a lot of patients weren’t even using telehealth, and even some clinicians were reticent to adopt the tool.
The pandemic introduced a steep telehealth learning curve that was further complicated by the multiple tools needed to deliver patient care. Toggling between the telehealth platform and EHR technology could be burdensome for providers and patients alike, and was set to impede UPMC Pinnacle’s efforts.
“We wouldn’t have been able to move as rapidly if we hadn’t already had integrated workflows for providers, staff, and the patients,” Saiyed explained. “It allows the providers to be in their native EHR system. We just added a new visit type for telehealth, but overall, the EHR feels and looks the same.”
Saiyed said the familiarity made training much easier and it reduced burden across the board.
“The majority of EHR go-live training is done in person in a classroom with hours of training,” he said. “However, we did this all virtually within a week. We had to provide remote go-live support, but it helped our providers tremendously to have the integrated EHR workflow.”
UPMC Pinnacle patients having familiarity with the EHR patient portal also made it an easy transition.
“They were used to messaging providers to ask for refills and checking out their appointment times,” Saiyed said. “While this was a new workflow feature, it was within an existing patient portal that they’re used to. Existing patients didn’t have to go into a new portal, create a new account, or download a new app.”
And because the telehealth solution was integrated on the same EHR platform, Saiyed said it made documentation very easy for users.
“The user is still within the same EHR because there is a floating window of the video,” he explained. “The user can continue to document with the window open and he can toggle the floating window wherever he would like to place it. If they prefer, users can also utilize their iPhone for the video off to the side, while they document on the computer. Either way, it’s very convenient.”
Saiyed, who has completed over a dozen Epic EHR implementations across the country and a handful of go-lives, said he never seen such a quick and efficient EHR integration and training process throughout his career.
“All within a week, we trained over 750 providers and over 1,000 staff members on the ambulatory side,” he said. “This was all done virtually. On the inpatient side, we trained an additional 200 providers from hospitalists to residents that provide inpatient coverage, as well as in the COVID-19 patient rooms.”
“Our go-live, from the inception, design, planning, and launch, reached over 2,000 users within a week,” he continued. “It’s something I’ve never seen before in such a short time period. In terms of volume, we were doing a dozen on-demand, urgent care video visits a day, to now over 6,000 to 6,400 a week. It’s about a 1400 percent increase from what we were doing before.”
Even though both providers and existing patients were able to pick up the changes relatively quickly and efficiently, there were some operational challenges during the implementation and usage process.
“There’s always device issues and hardware issues,” he said. “Even though we trained everyone, we deployed thousands of cameras and microphones within our clinics, as well as our hospitals.”
“During this time, we had some providers that had to be quarantined or were too high risk to come to the clinic to deliver telehealth, so they were doing it at home,” Saiyed added.
“This meant we had to come up with creative solutions on how to engage a provider on their personal computer and walk them through the steps to get it set up.”
Prior to the coronavirus, UPMC Pinnacle had a mock training process called Application Dress Rehearsal (ADR), where the organization used a test patient and clinician to check the camera and microphone settings to ensure the end-to-end workflow was proficient.
However, with some clinicians unable to enter the facility, this process had to be done virtually.
“Our teams had to really adapt quickly to make the virtual ADR happen remotely,” he explained. “They had to make this happen very rapidly within a week with thousands of computers across our 10-county region.”
And it’s that quick pivot that has allowed UPMC to see a surge in successful telehealth use. Overall, UPMC Pinnacle has seen an uptick in telehealth visits across the board, and not from just COVID-19 patients. Saiyed said the future is bright for telehealth and it will still be heavily utilized once the number of coronavirus cases lowers.
“From a primary care standpoint, we’re seeing almost 80 percent of regular pre-COVID visits via telehealth,” he explained. “Some of the specialties, such as endocrinology and rheumatology, have seen close to 90 percent telehealth visits.”
During the last few weeks, UPMC Pinnacle has optimized its telehealth technology over a dozen times and its team wants to continue to make it easier for patients in the future. Saiyed said they are looking into adding closed captions for patients who are hearing impaired and for patients to read through the visit after it completes.
Improving the way providers engage will be crucial to telehealth advancement in the future.
“We now have thousands of patients who have experienced telehealth,” Saiyed concluded. “We’ve already received a lot of positive feedback and testimonials from patients who love the technology and are already scheduling their follow up via telehealth.”
“In the future, I think the tool itself is going to improve. I really believe telehealth is going to be more engaging and make life easier for both the patient and the provider.”
Source: EHR Intelligence