Story contributed by NYU Langone Health.
With the gradual growth of telemedicine in recent years, NYU Langone Health had been investing in building a telemedicine capacity anticipating a future in which it would become more ubiquitous. Both the need to reduce in-person contact during the pandemic and the need to divert patients from in-person care in efforts to prevent overwhelming emergency departments created compelling reasons for virtual alternatives.
Dramatic local, state, and federal regulatory changes quickly help facilitate patients’ access to virtual care. With these changes, telemedicine is being leveraged with enormous speed and scale, turning into the forward “front line” of the battle against the pandemic.
Substantial migration to telemedicine took place over a week in March 2020, complementing a decline of over 80% in in-person visits (Figure 1). Between March 2 and April 14 2020, telemedicine visits grew by 683% in urgent care after the system-wide expansion of virtual urgent care staff response to COVID-19. Of all virtual visits, 56.2% and 17.6% of urgent and non-urgent video doctor visits were COVID-19 related. The increase in telemedicine was enabled by a rapid increase in urgent care providers. A workforce of 40 emergency medicine providers, managing less than 100 virtual visits on an average day, grew to 289 “surge” providers from various specialties.
The increase in telemedicine urgent care was paralleled by a larger increase in ambulatory care video encounters. On March 19, NYU Langone Health expanded video doctor visits to all its ambulatory care settings, reaching more than 7,000 visits within 10 days and representing more than 70% of total ambulatory care volume during this time. Over an approximately six-week period, there were 144,940 virtual visits conducted involving 115,789 unique patients and 2,656 unique providers. Telemedicine usage was highest by patients aged 20-44 years, particularly for urgent care. However, patients of all ages were able to use the technology across NYU Langone’s telemedicine platform. Notwithstanding the rapid expansion of the program to thousands of new providers, patients’ satisfaction ratings with virtual visits remained positive.
The ongoing battle against COVID-19 in the United States is still ongoing, and will likely stay at the top of healthcare systems’ agenda in the coming months. Yet telemedicine has already proved to be an invaluable tool to not only divert an overwhelming volume of patients from the emergency rooms, but also transform the work practices of thousands of providers, across multiple specialties. As demonstrated by the experience at an academic healthcare system at an epicenter of the pandemic in the United States, well-integrated virtual health tools can reliably manage thousands of patients over a short period of time, and provide care at times of acute shortage in healthcare personnel. The impact of telemedicine on COVID-19 response is matched by a likely enduring impact of COVID-19 on telemedicine, and through it on healthcare delivery in general, with a new reality of a broad population of Americans and their providers who are getting a crash course in using telemedicine tools, experiencing their capabilities, and establishing comfort and expectations of their widespread availability.
Read the full methodology and further discussion in JAMIA.
Tiffany Martinez is a Project Associate at HiBRID Lab at NYU Langone Health; Devin Mann, MD, is NYU’s Associate Professor and Senior Director of Informatics Innovation; and Paul A. Testa, MD, JD, MPH, is the Chief Medical Information Officer.