Johns Hopkins Launches an EHR Tool to Improve Telehealth Adoption

One of the biggest challenges to telehealth adoption is digital literacy. Patients won’t embrace new technology if they don’t know how to use it.

Over the past few years, healthcare organizations have launched programs to address this barrier, connecting with patients to teach them how to use mHealth apps, devices and other tools. Many of these programs, however, spend as much time identifying those in need of training as they do actually training them.

Researchers at Johns Hopkins Medicine have developed a new process to measure digital literacy. And they’ve integrated that tool into the Baltimore-based health system’s Epic electronic health record to ensure that every patient in one of the health system’s many connected health programs is given access to help if they need it.

“Health systems leverage EHR data routinely to highlight which patients may need special attention during a visit (e.g., those who are due for vaccines or need an interpreter),” the researchers wrote in a recent column for Harvard Business Review. “Harnessing EHR data to identify patients likely to experience difficulties in accessing video visits is another important step in tapping the potential of these systems to provide a more individualized approach and make the best use of health care systems’ resources.”

The program is part of a growing trend in the healthcare industry to address barriers to care access, often called the social determinants of health. And while connected health is viewed as a means of addressing those barriers, it can also be a barrier for those who don’t understand the technology. That could imperil the success of a program, especially one that reaches out into underserved regions or communities.

The researchers – Helen Hughes, MD, associate medical director of the Office of Telemedicine; Rebecca Canino, the office’s administrative director; Stephen Sisson, MD, vice president of clinical operations at Johns Hopkins Physicians; and Brian Hasselfield, MD, medical director of digital health and telemedicine at Johns Hopkins Medicine – used surveys from patients and their families and interviews with clinical and front desk staff to determine how often someone needed help adapting to new technology. They learned that while phone calls were good for some people, others needed more guidance, and that support was hard to coordinate with staff who were busy handling in-person care, especially during a pandemic.

Working with colleagues in IT and ambulatory operations, the team came up with a “video visit technical risk score,” a color-coded rating system that would identify those in need of help. The score was based on factors such as familiarity with the health system’s online patient portal and past experiences with online services, even phone calls, all charted in the EHR.

To test the value of the rating system, the team launched a pilot project at three ambulatory clinics that had seen problems acclimating patient to video visits. Text messages were sent three time prior to a scheduled virtual visit to patients whose score indicated they could use help; in a second phase of the pilot, the last text message was replaced by a phone call.

While the pilot saw some success in helping patients understand the technology, it did create an easier method of identifying who might need help, and it helped health system staff improve their workflows for onboarding patients into a telehealth program. Researchers cited the challenges of connecting with patients ahead of their scheduled visit, and suggested creating processes that would help patients when they logged on rather than in advance.