Columbia Doctors: Telehealth

Overview

Post-pandemic, ColumbiaDoctors established an organization-wide goal of increasing telehealth usage, ideally to achieve 20-25% patient visit volume. With appointment lead times of 30+ days in several specialties, ColumbiaDoctors worries about patient leakage to competing hospitals and patient dissatisfaction as these issues affect not only revenue, but also their reputation when it comes to providing top-level and timely care.

Objective

Our client representative, both a practicing physician and a digital health advocate on the leadership board, tasked us with developing actionable models to increase telehealth adoption among the >1,800 physicians affiliated with ColumbiaDoctors.

Approach

We conducted primary research by interviewing current employees of ColumbiaDoctors. We focused on two specialties, Gynecological Oncology and Vascular Surgery, and our interviewees spanned different roles within those practices, including practice managers, mid-level providers (such as nurse practitioners), front desk secretarial staff, and attending physicians. In our interviews, we sought to understand the current state of and attitudes towards telehealth, pain points currently inhibiting greater usage, and opinions on what methods would or would not work in each practice.

Problem

From our primary research we surfaced key obstacles preventing further adoption of telehealth at ColumbiaDoctors, from both the patient and provider perspective. However, to narrow the scope of the project, we decided to focus on provider pain points as we had direct access to physicians/staff that would allow us to easily trial and implement proposed changes given the short time period of this project. From the provider perspective, key barriers are:

● Lack of perceived benefit of telehealth by providers

● Lack of provider capacity on existing appointment templates

● Lack of standardized approach between physicians within a medical practice, but also between practice types

● Lack of adequate technology for telehealth

Solution

Through our primary research, we learned that each specialty has different needs, and on a granular level there is an extreme amount of variability between the needs of physicians even within the same specialty. We acknowledge that a one-size-fits-all model would not work in this scenario. Thus, we built five different models based on the four key pain points identified through our research:

1. Batched mid-level provider blocks
2. Batched attending blocks
3. Attending office hours
4. On-demand urgent care
5. Added telehealth-only resources

Furthermore, we pressed practitioners on what variables would make a given model work for their practice versus another and developed a framework outlining six key practice parameters and the directional value (low vs mid vs high) of each parameter best suited to each model (Figure 1):

Figure 1. Models and their characteristics

Our developed models are listed in the leftmost column, and parameter characteristics are listed in the top row. To see which model is recommended based on this framework, practitioners can use the Excel tool we developed (Figure 2) and select a dropdown value of low, mid, or high for each parameter. An example practice is illustrated in gray under “Vascular Surgery,” where volume of inbound requests is selected as “high” while mid-level provider availability is “low”. The tool then calculates a fit score for each model based on the overlap with the stated practice parameters, and the model with the highest fit is recommended.

Figure 2. Excel tool developed to help practitioners choose their best fit model

Conclusion

We developed a process framework inclusive of a decision making tool that is adaptable to many different practice types at ColumbiaDoctors. Our proof of concept endeavor has generated encouraging metric improvements in two different surgical practice types, as well as an organization-wide initiative to provide iPads to all practitioners lacking adequate video technology. From the feedback from our pilot studies, we are learning of the emerging barriers as well as successes from our recommendations and look forward to keeping in touch with our client to continue to hear of their progress. Continuing on, we hope ColumbiaDoctors will continue to use telehealth as a lever to increase patient access and healthcare equity, and ultimately look at a follow-up project addressing patient barriers, as those who could benefit the most from telehealth are often those who most lack the requisite technology and digital literacy required.