With the onset of COVID-19, healthcare delivery organizations around the world were collectively faced with one primary challenge: How to effectively deliver quality healthcare to all patients, regardless of the entry point into the system, while protecting the well-being of non-COVID-19 patients and the healthcare workforce.

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Retaining Healthcare Quality During COVID-19 and Future of
Care Delivery.
By.Dr.Mahboob Khan
With the onset of COVID-19, healthcare delivery organizations around the
world were collectively faced with one primary challenge: How to
effectively deliver quality healthcare to all patients, regardless of the entry
point into the system, while protecting the well-being of non-COVID-19
patients and the healthcare workforce.
As health systems navigate challenges created through risk of exposure for
patients and caregivers, rapidly changing regulatory paradigms and
significant financial burden, digital medicine and virtual care are
becoming critical tools for maintaining and improving quality healthcare
while mitigating those barriers. As organizations become more adept at
navigating the pitfalls associated with treating COVID-19 in a digital
environment, the lessons learned now by healthcare providers will drive
the adoption of digital strategies for managing chronic disease, health
maintenance and wellness.
Governance for Quick-Turn
Transformation
Effective digital transformation starts with governance. Organizations with
structured, collaborative governance for IT adoption were more timely
and nimble in responding to the challenges associated with delivering
quality healthcare in a pandemic. Merely developing an enterprise-wide
response plan and delivery model requires significant expansion of many
health systems’ teleconferencing and digital communication capacities.
In order to facilitate social distancing, healthcare providers made
significant investments in video conferencing and remote Wi-Fi capacity
to ensure the appropriate collaboration between subject matter experts,

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front-line caregivers, information and technology staff, and C-Suite
leadership can take place to create the framework for using technology to
meet the standard of care in the new care environment. To be prepared to
deliver quality healthcare in the face of future disruptive pandemics, health
systems and providers will face the challenge of retaining the increased
telehealth capacity during financial contraction.
Technology for Innovative Care
Approaches
Most health systems determined that they needed to establish multiple
virtual entry points for receiving COVID-19 screening data. Leveraging
web questionnaires, chatbots and telehealth visits for patients, health
systems could conduct risk stratified screenings to develop orders for
patients at highest risk. Dually, these virtual entry points facilitated the
allocation of limited testing supplies to the highest risk patients, while
protecting clinicians and patients from large crowds gathering in
emergency departments and testing sites.
In order to facilitate the huge transition of patient volume from face-to-
face encounters to the virtual environment, organizations needed to
significantly scale up virtual visit capacity. Organizations will also need to
coordinate with their care partners in long-term and post-acute care to
accommodate increases in virtual encounters. These non-acute care
settings should expect to play an increasingly important role in facilitating
and coordinating these interactions for their residents and adjusting their
staffing, training, workflows and infrastructure to accommodate this new
modality.
With as much as a 300% increase in virtual encounters at some
organizations, and with clinical staffing impacted by the spread of
COVID-19, virtual screening tools could be operated by non-traditional
healthcare workers (school nurses, paramedics, etc.) provided those
workers have a templated care workflow which ensures the same

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interventions are triggered, as if the patient was being screened by a
physician or nurse practitioner. Adherence to a care plan or pathway which
has structured fields guiding the provider through every step of care and
documentation ensures that quality healthcare standards are met,
regardless of the entry point into the system.
Telehealth for Non-COVID-19 Care
Once organizations successfully applied virtual screening capacity, they
need to continue treatment of chronic disease and other ambulatory
patients. Screening for COVID-19 validated that digital medicine was an
effective method for monitoring wellness maintenance and managing
chronic disease. Following the lead of organizations like HIMSS Davies
Award of Excellence recipient Ochsner Health, who launched chronic
disease and pre-natal care digital medicine programs several years ago,
healthcare organizations transitioned much of their outpatient care to a
digital environment.
The U.S. Centers for Disease Control and Prevention’s rule changes
allowed interventions taking place in digital environments to count toward
quality reporting metrics. And equal reimbursement for digital encounters
helped drive the transition to digital medicine methodologies for wellness
and chronic disease management.
In the European Union, COVID-19 has driven a significant increase in
demand for digital health services and teleconsultations. Readiness,
much like in the United States, varies significantly between member
countries. In countries where regulatory oversight ensures effective
information governance, privacy, and security, where full public
reimbursement for digital health services existed before COVID-19, the
foundation is in place for significant expansion of digital medicine in other
areas. In countries where public reimbursement and a mature regulatory
framework for information governance and security is still a work in
progress, it will be more challenging to continue the transition into

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utilizing digital medicine for chronic disease management and health
wellness.
Chronic disease management registries were a commonly utilized tool
across the United States health ecosystem prior to the onset of COVID.
The transition to digital environments for managing chronic disease
requires the backbone of a chronic disease registry to facilitate risk
adjustment, monitor care plan adherence, and intervene when appropriate.
The risk adjustment algorithms in many of these registry tools factor social
determinants like housing, access to healthy food, and other risk factors.
Tools then “visualize” the highest risk patients in dashboard interfaces
with care coordinators and provides customized templated care plans
based on the standard of care and risk.
Once the registry tool is in place, and an organization leverages the tool
with the strong governance to ensure that care coordinators use the tool to
effectively identify candidates for virtual care, organizations can then start
to leverage the virtual platforms for care management that proved
successful for screening and treating patients during COVID-19.
Telehealth and digital communications platforms facilitate a patient
encounter. Decision support-driven template care plans are utilized during
these digital encounters to ensure that the standard of care for the disease
state is being met regardless of the entry point into the system. Care
coordinators can then use templated care plans to monitor and engage
patients to ensure that the patient is following the prescribed care plan.
Through the use of home monitoring technology, clinical data can be
uploaded to the provider to monitor the patient’s disease state.
Interoperable transfer of patient generated data from these devices can be
interpreted through analytics interfaces which visualize potential patient
deterioration. The clinician can then trigger a face-to-face encounter or a
hospitalization to intervene.

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Telehealth and the Patient Experience
With many patients experiencing a telehealth visit for the first time,
some were confused while others found the visits a relief from travel and
parking challenges at medical centers. Providers hit an accelerated
learning curve on this technology and the patient experience suffered in
some cases. However, especially for those who are immune compromised,
telehealth provided the safety and comfort of care from home.
Now that telehealth has become a more routine part of care, some, such as
Adrienne Boissy, MD, the chief experience officer at Cleveland Clinic, are
training providers in this new mode of care. “New technologies, processes,
and metrics are needed to enable us to deliver on both our timeless
patient-centered promises, and actual caring.”
Patient preference for care via telehealth, now that many have had some
experience, will make it a standard modality. While some may prefer face-
to-face encounters in the future or require it for special tests and
procedures, many, particularly younger patients, will demand virtual care
as their first option. Those receiving ongoing care in long-term or senior
care settings will also see a shift toward providing more services virtually.
For these populations virtual visits, remote monitoring and virtual triaging
will become common.
Sorting out what is missing from in-person visits will continue to evolve,
but some solutions, such as remote monitoring devices, will enable more
care including chronic care to be done virtually. Governance of these
models and quality measures will need to be in place along with new
forms of patient experience measures. Patient surveys after telehealth
visits will be essential to get feedback on these programs to improve the
digital experience.
Finally, mental health services via telehealth has been broadly adopted.
Patients adopted to it quickly and providers learned how to show empathy

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over video. While studies of outcomes of telepsychaitry show promising
results, particularly in the use of cognitive behavioral therapy, more
research is needed on which diagnoses and techniques are most effective.