Scalability of Telemedicine Services in a Large Integrated Multispecialty Health Care System During COVID-19

Introduction

The novel coronavirus (COVID-19) pandemic presents a major challenge to the delivery of health care. ¹ However, with today's digital health solutions and the easing of legislative, regulatory, licensing, payment, and administrative barriers, we have a very unique time-sensitive opportunity to capitalize on the circumstances and accelerate the adoption of existing digital tools by patients, health consumers, and health providers. Health systems that have already heavily invested in telemedicine are well positioned to test scalability of digital health care, to preserve health care delivery during the pandemic, although virtual, and advance telemedicine science. ² The 6,900 physicians and surgeons of Mayo Clinic campuses in Rochester Minnesota, across the Mayo Clinic Health System in Minnesota, Wisconsin, and Iowa, and campuses in Jacksonville Florida, and Phoenix and Scottsdale Arizona collectively care for 1.2 million people annually. As soon as The World Health Organization declared COVID-19 a pandemic on March 11, 2020, Mayo Clinic Center for Connected Care anticipated the increased demand for digital care solutions and rapidly scaled up its existing services for the entire Mayo Clinic organization.

Figure 1 depicts the number of physician and advanced practice provider (APP) to patient interactions per day early in the pandemic interval from March 11 to July 15, 2020, across a variety of digital health care services. Although in-person clinical encounters declined by 78% during the interval from March 11 to April 20, (depicted in Figure 1), Mayo Clinic witnessed 30% increase in Express Care Online interactions, 30% increase in outpatient e-consults, 60% increase in hospital e-consults, 890% increase in acute care video consults (ambulance, critical care, stroke, neonatology, emergency medicine, and on-demand multispecialty medical and surgical video consults in hospital), 10,880% increase in video appointments to home, and 13,650% increase in telephone appointments to home (depicted most clearly in Figure 2). A COVID-19 self-assessment tool reflecting the latest recommendations of infection prevention and control guidelines was created and added to Patient Online Services web portal and Mayo Clinic app to help patients assess symptoms and direct them to the appropriate care.

OPEN IN VIEWER

Fig. 1.

How Mayo Clinic Daily Utilization of In-Person Visits and Digital Patient Connections Changed in the COVID-19 Pandemic during the early interval from March 11 to July 15, 2020. COVID-19, novel coronavirus 2019.

OPEN IN VIEWER

Fig. 2.

How Mayo Clinic Daily Utilization of Digital Patient Connections Changed in the COVID-19 Pandemic During the Early Interval from March 11 to July 15, 2020. COVID-19, novel coronavirus 2019.

Two new remote patient monitoring programs were developed to support adult patients with COVID-19, enrolling 100 patients in fewer than 3 weeks. Immediately prior to the pandemic, 300 enterprise Mayo Clinic physicians and APPs had performed a minimum of one video telemedicine consult. By July 15, 2020, the number of Mayo Clinic providers performing video telemedicine consults had risen to over 6,500 reflecting a 2,000% increase. By July 15, 2020, there were also over 10,000 Mayo Clinic provider users of acute video telemedicine in emergency departments, in-patient hospital units, acute care on-demand, and in skilled nursing facilities. Through this pandemic, we have witnessed unprecedented growth in telemedicine utilization. The existing telemedicine system has proven to be scalable, even in the period following the peak of digital activity April 20 to July 15, 2020. The relatively unimpeded growth in telemedicine during this interval presents an opportunity for engagement in digital health care delivery outcomes research in order to help ensure that key regulatory and policy gains are not rescinded, postpandemic. ^3,4