On an early March day in Georgia, clinical and IT leaders at Augusta University (AU) Health, an academic health center that manages the clinical operations associated with Augusta University, began to realize that things were about to change very quickly. The patient care organization, which includes a 478-bed adult care facility and a 154-bed children’s hospital, was set to roll out a direct-to-consumer telehealth platform in partnership with Amwell later that month. But then as the COVID-19 outbreak began hitting the region during the first week of March, the health system decided that it needed to pivot, turning the platform into a COVID-19 virtual screening tool.
In just a matter of days, that conversion was complete, and the process included a number of key details, such as changing marketing tactics, changing the tool’s intake questions that aligned with CDC and Georgia Department of Public Health (DPH) COVID-19 guidelines, as well as training ED faculty and residents over a course of just two days, explains Lauren Williams, the director of population health at AU Health.
During this same time, AU Health also stood up COVID-19 hotline that patients could call with disease-related questions. Once the screening tool was set up, patients who called the hotline were directed over to the screening tool, notes Williams. Via the screening tool, patients could select from a list of available providers, and the chosen physician from Augusta University Health ExpressCare—the organization’s virtual care arm—reviews the patient’s history and symptoms before examining and treating him or her. From there, AU Health worked closely with the county’s local health department to open up what was at the time the region’s first drive-through clinic for COVID-19 testing, available for those patients who received a positive screening through the virtual screening app.
In just a week, AU Health conducted more than 1,500 virtual care screenings throughout the Augusta region, and the medical center’s leaders began to recognize that there was an opportunity to expand the program with the state more broadly, Williams recounts. The local DPH coordinated with state DPH officials to let them know the progress that was being made in Augusta, and the first step in that process was to partner with the Georgia National Guard and state DPH, with hundreds of National Guard members assisting state public health officials in testing tens of thousands Georgians statewide.
“When our physicians screened a patient, if it was determined that a [COVID] test was needed, the [doctor] would complete a form online that sent the patient to the appropriate testing site depending on where he or she lived. And we embedded that within our [Amwell] workflow,” says Williams. “It worked very well, and we also had a collaboration with our College of Nursing [at Augusta University] to provide a result notification back to patients in a timely manner once we received them.”
The core message, notes Williams, was to partner with local providers in the health system’s 14 country Central Savannah River Area (CSRA) region, and outreach them to say, “let us help you.” She adds, “We have this COVID screening tool [available], so send us your patients for a screening and let us help you screen them prior to coming in. That took the extra burden off small rural clinics or hospitals that may not have had PPE available.”
What’s more, AU Health also had a testing algorithm that walked through a series of steps aligned with CDC and DPH guidelines, meaning that providers were testing patients who only truly needed to be tested at that time. “The criteria changed from [asking] if you traveled outside of Georgia in the last 14 days, to if you traveled within Georgia, to no travel questions at all. We developed and [frequently] revised the testing algorithm. We’re on version 22, and by having that algorithm internally developed by our chief medical officer and chief of infectious disease, we were able to have nimbleness in [being able] to change the algorithm to align with the needs of the community,” says Williams.
From a hundred telehealth visits a month to thousands
From a telehealth perspective more broadly, AU Health has had experience in offering patients virtual care services. Its REACH Health service is a nationally recognized telehealth service that makes neurological consults more available to patients in rural areas. The program lets neurologists at AU Health diagnose and treat stroke patients at member hospitals through a standard computer, webcam and broadband internet connection, according to health system officials.
Williams, who took over the organization’s virtual care department in May 2019, says AU Health “has been relatively successful” with the tele-stroke program, while admitting that other telehealth services the health system offers have mostly been in isolated clusters. In 2018, though, the U.S. Department of Agriculture awarded a Distance Learning and Telemedicine Grant, worth $368,000, for Augusta University Research Institute to implement an emergency telehealth network in rural Georgia. According to Williams, the organization partnered with five rural hospitals in the state, and launched the tele-ED service last October with each of the facilities.
And prior to COVID-19, the aforementioned direct-to-consumer telehealth platform was about ready to launch, at which point health system leaders knew they’d have to turn non-essential in-person visits to virtual ones. “The genie came out of the bottle very quickly, and we don’t think we’ll be putting it back in anytime soon,” says Williams, noting that in the midst of the pandemic, AU Health also rolled out its ambulatory care clinics onto the Amwell telehealth platform.
Williams reports there are now more than 35 ambulatory clinics live on the telehealth platform, with over 400 providers using it. “We have done 8,000 telehealth visits for ambulatory care since March 23. That compares to less than 100 ambulatory telehealth visits a month before [COVID-19],” she attests. “Today, our focus has [tuned to] how we can continue using telemedicine; in which areas will it benefit your practice? And the overwhelming response from our community, as well as from our patients and staff, has been great. We have seen a complete turnaround in the culture and mindset of what telehealth can do for a healthcare system.”
