What happens when a federally qualified health center (FQHC) serving a vulnerable community faces the global COVID-19 pandemic, as it directly affects its operations? Needed innovation moves forward quickly, as has happened at the Los Angeles LGBT Center, located in downtown Los Angeles, and which serves the healthcare needs of the lesbian, gay, bisexual and transgender community of the LA area.
An organizational customer of the Chicago-based Allscripts, the Los Angeles LGBT Center saw approximately 8,900 patients during the 2019 calendar year. Its 13 core providers (eight physicians and five nurse practitioners), as well as its 42 mental health professionals, serve a broad range of patient care needs. It also operates an onsite pharmacy.
And the Los Angeles LGBT Center’s leaders moved quickly in March and April to transition the vast bulk of their patient visits to televisits, as the scope of the COVID-19 pandemic became apparent. Having signed an order with its clinical IT solutions provider, the Chicago-based Allscripts on March 5 for telehealth development, and begun the transition on March 10, by March 20, all medical providers had shifted to phone-based telehealth care delivery, and by March 23, all mental health providers had shifted to phone-based telehealth delivery.
Earlier this month, Gabriel Lopez, the organization’s director of health information systems, spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding the transition to telehealth, and the lessons learned from that process. Below are excerpts from that interview.
Can you share the story of your organization’s shift to a telehealth platform for most of your organization’s care delivery?
Basically, we anticipated that things would be happening, and reached out to Allscripts and said, we don’t currently do video visits, but we know that will happen. So on March 5, we signed an order to implement telehealth visits. That was a Thursday. We signed the order with them, and by Monday, March 9, we had a project manager to work with us, and by March 11, a Wednesday, we had everything set up and configured. And on March 13 we ordered additional licenses. And then over that weekend, our senior management staff all had to go into quarantine because we had a potential exposure.
And so on Monday, March 16, we decided that we needed to enact policies and procedures for our entire staff to set them up for telework and telehealth, so that week we started moving people away, to keep both staff and patients safe, and really going with a telehealth strategy, to reduce the people coming into the building, and also having it provider-driven, to determine who still needs to come onsite. So we worked over the next two weeks, and we prioritized our medical providers the week of March 20, to make sure we had a telehealth telephone visit protocol worked out, and moved everybody’s appointments over to telephone, got them set up to triage and check in patients, and let our patients know about the changes, keeping them aware of what was going on.
How many clinicians remain onsite physically?
We have two providers onsite, medical providers providing primary care. For STI testing, we stopped that altogether. We made sure to focus on primary care treatment services if they’re symptomatic. So we have people coming in only for essential services, if the provider deems it necessary. They’re both physicians.
What were the biggest challenges in pursuing the transition?
The biggest challenge was anxiety, making sure patients were still being seen. Per the stay-at-home order, we had to move people out of the building quickly, so there was some anxiety around that. Providing remote desktop access, VPNs, and hardware needs. Especially for 42 providers. So the anxiety around the new workflow, working from home, introducing the new technologies—and that learning curve involving doing something different and still seeing their patients—so, managing staff expectations and providing hardware and equipment, as well as managing morale.
What have been the biggest lessons learned in all this, so far?
Communication, just ensuring that staff feel like they are aware of what’s going on. That really helped. Our senior leadership has something called “Ask Dr. Bob.” Our senior medical director does a weekly Q&A with fellow staff. And our co-director, and senior team leader, they provide updates to let staff know what’s being communicated with patients, and to update them on what’s just happened and what is about to happen, so, keeping people engaged. So, making sure everybody’s on the same people. And we have a pretty robust health information systems team helping to support us, and we work pretty well with our IT team, to make sure we have a connection with our network. And the vendor connection with Allscripts has been great. As the press release noted, we got this up and running in three days. So it’s working well both internally and externally, and it’s really that human perspective on interoperability that has made this successful.
How big a team do you have?
There are two teams involved. I directly supervise health information systems, which manages our applications, and peripherals connected to software. That team includes myself, and an operations manager with three staff under him, as well as a business analytics manager and a performance improvement manager, who has two people under him; in other words, seven people including myself. We provide software support and some hardware support directly connected to software. And there’s an additional team, our IT department, for hardware and infrastructure. And that’s an additional five individuals.
How are things going to look for you in the next year?
I would say that we anticipate that this will be going on for the next year at least, looking to continue some level of telehealth and telework. So we’ll remain lean in terms of onsite visits. It will probably be a slow ramp-up. We realize now what our potential is as far as telework and telehealth; so that introduces more options around more ways to engage patients and provide services. A lot of that relates to the ability to bill for telehealth; but if the flexibility around that continues, that provides us the opportunity to continue forward in that way.
What’s been really great, too—I just got off the phone with our director of pharmacy services, and we’ve developed some very interesting new workflows. We’ve seen an uptick in the number of refill requests. They’ve seen a 10-percent increase in volume in the pharmacy over the past few weeks. And so we’ve continued to be able to serve those needs, which has been pretty awesome. That goes back to that interoperability piece—to continue to serve our patients and keep them engaged with us.