Ensuring Care Continuity Through an EHR-Integrated Telehealth Platform

After investing heavily in virtual care over the course of the COVID-19 pandemic, health systems must now determine how best to integrate telehealth with existing digital tools to create a seamless care journey for patients.

In the rush to respond to the massive spike in telehealth demand after the pandemic hit, healthcare providers quickly stood up or expanded virtual care options.

As telehealth use leveled off and in-person care returned, some providers were left with a fragmented set of digital care pathways and tools, according to Amanda Reed, director of virtual health operations at BHSH System's Spectrum Health West Michigan Division.

"When it comes to all of the virtual and digital care and expansion that we're experiencing more and more of, because of the high use and the high frequency and the adaption that we've experienced over the last couple years, we're seeing more and more now the fragmentation that can occur," she said in a phone interview. "It's not developed and grown in a way that is integrated with a system."

For Spectrum Health West Michigan Division, the key to ensuring continuity in care and enhancing patient experience lay in a virtual platform integrated within its Epic EHR.

Though the implementation of the platform came with certain challenges, such as legal scrutiny related to contracting, Reed believes that it has provided the system with a competitive edge.

A TELEHEALTH PLATFORM INTEGRATED INTO THE EPIC EHR

Spectrum Health West Michigan Division implemented KeyCare's virtual care platform in mid-July. KeyCare recently raised $24 million in a series A funding round that included Spectrum Health Ventures, the corporate venture capital arm of Spectrum Health.

The platform is accessible through the Epic MyChart patient portal, where patients can schedule virtual care appointments with providers across the country. The appointments are completed within the Epic system.

The health system aims to provide access to virtual care within 10 minutes of a request for all patients, even those outside the state. Currently, patients can only access virtual urgent care services through the platform.

"So, if they're traveling and don't have the access to urgent care, they're visiting actual physical urgent care [locations], or emergency rooms or not getting the care they need," Reed said. "[Now they have the ability] to utilize the service…when they're not currently physically within the state of Michigan at the time of requesting an appointment."

KeyCare providers conduct the virtual care appointments, but patients' established providers at Spectrum Health gain access to all clinic notes afterward. These include the after-visit summary, recommended treatments, and prescriptions provided, Reed said.

If after a telehealth appointment it is determined that the patient requires in-person care, the KeyCare provider makes a recommendation in the notes that Spectrum clinicians follow-up on, she added. 

IMPLEMENTATION BENEFITS AND CHALLENGES

Spectrum Health West Michigan Division added KeyCare's platform to its Epic system through the latter's 'Telehealth Anywhere' capability.

Having the virtual care platform integrated into the EHR has provided several benefits to the health system, according to Reed.

First, it has enabled Spectrum Health to provide a more seamless care journey for patients, allowing them to receive virtual care wherever they may be while also providing Spectrum Health clinicians visibility into that care.  

"Being integrated with the EHR gives us the ability to have the continuity of care for patients and really keep a single digital front door for our patients and members since we are an integrated health system and have a payer side as well," she said.

The platform has also helped the health system safeguard its clinicians from breaking state licensure rules while keeping access open. Once Spectrum Health determined the types of providers it required with the service, KeyCare ensured they had those providers across all states with the appropriate licenses to fulfill urgent care needs.

"They handle the licensure and credentialing, which is a huge benefit because we don't have the capacity or resources to do that in a way that we could cover [care] nationally," Reed said.

But implementation of the platform came with its own set of challenges, namely with regard to contracting.

It "took some unique eyes and unique perspectives" to build a contract that was scalable and worked for all parties, Reed said.

At this point, contracts between health systems and national telehealth vendors are fairly standard. But with KeyCare, which is offering an integrated service within Epic and has its own processes for credentialing and licensing, there was no standard contract to turn to.

"That was one of the toughest parts, I would say, in the beginning, just because we're navigating new technology and new approaches, and that comes with extra legal scrutiny," Reed said.

However, once that contract was locked down and the platform installed, Reed believes the patient care benefits of having an EHR-integrated virtual care platform became increasingly apparent. The benefits included cutting the cost of care and increasing access.

With the platform, Spectrum Health patients can avoid going to an urgent care center or emergency department in areas where healthcare services may be more expensive, Reed said. They are also able to avoid long wait times.  

According to Reed, one provider said that a patient used the service twice while in D.C. because there was an 18-hour wait in the emergency room. Experiences like this bolstered providers' acceptance of the new platform.

"We expected there to be some apprehension from our providers, but there wasn't," she said. "It was really well received by our primary care providers because they could, in fact, give their patients an option and weren't left with saying, 'Well, call me when you're back in the state.'" 

The response has been positive on the patient side as well. Since July, virtual care providers have seen patients in over half of US states, Reed noted. And this was before the health system had started marketing efforts.

"What that's shown us is that there is a true need and a demand," she said. "And without even advertising it, patients are able to find it."

Further, the platform has enabled the health system to gather valuable information on healthcare utilization trends among its patient population — some of which ran contrary to what they had previously thought.

For example, there was an assumption among providers that out-of-state virtual care utilization would be highest in states surrounding Michigan, like Indiana, Illinois, Ohio, and Florida,

"[But] we're seeing it really widespread across the entire country without patterns representing those states specifically," Reed said. "So, it's proving and disproving some of our theories on where our patients are flying. But it's also the summer — we'll see if that continues."

Spectrum Health West Michigan Division has several plans to expand the virtual care program. These include providing after-hours access to urgent care and offering virtual specialty care, starting with behavioral health.

The digitization of healthcare delivery is well underway. For health systems like Spectrum Health West Michigan Division, partnerships that enable EHR-integrated telehealth capabilities help them compete in a quickly evolving virtual care landscape, Reed noted.