MedStar eVisit

Background

In 2015, MedStar eVisit was launched to provide patient-initiated, on-demand urgent care by video. Available 24 hours a day, seven days a week, 365 days a year, MedStar eVisit offers consultation, diagnosis, treatment, and even prescriptions (when appropriate) for a variety of conditions including colds, flu-like symptoms, fever, rash, stomach ache, sinusitis, pink eye, ear infection, migraines—and, now, COVID-19 screening. Amwell serves as the technology partner that helps make this possible.

In February 2020, the MedStar eVisit platform supported an average of seven visits per day. While some patients were seen by the eight MedStar Health clinicians trained on the platform, most were seen by Amwell providers.

In mid-March 2020, however, MedStar eVisit volume increased dramatically when COVID-19 struck, climbing to more than 530 visits in a day at peak—a higher daily volume than our busiest emergency departments. With a limited number of MedStar Health clinicians staffing the platform given past volume—and with Amwell seeing a national surge in requests—patients seeking urgent care by video for COVID-19-related symptoms or other concerns began experiencing longer wait times. Within days, MedStar Health prioritized rapidly scaling its own MedStar eVisit staffing and other support measures to best serve its surrounding communities, expediting a transition that was already on its MedStar eVisit roadmap to help patients best navigate to in-person care or testing at MedStar Health as needed, among other benefits.

Idea

The MedStar Telehealth Innovation Center (MTIC) quickly recruited and trained urgent care, emergency medicine, primary care, and speciality providers across MedStar Health to deliver care via MedStar eVisit, including determining whether and what level of in-person care was needed during the initial telehealth interaction.

To quickly onboard more than 230 MedStar Health providers in the first month of the effort, the team created a training that was initially facilitated in-person and then remotely via learning modules created by the MedStar Simulation Training & Education Lab (SiTEL) team. The training included not only an overview and demonstration of the platform but also the opportunity to conduct test calls with redeployed MedStar Health associates standing in as test patients. These test calls allowed providers to try out the technology, adjust their sound and lighting, and strengthen their “webside” manner. Additionally, MedStar eVisit leadership sent its growing MedStar Health provider list daily updates regarding process, COVID-19 testing information, and more, supplementing the technology training with timely information that would further strengthen team operations overall.

As more MedStar Health providers were onboarded to the platform, MTIC also built out a provisioning and scheduling infrastructure to ensure adequate coverage and to support rapid response to surges throughout the day. This was made possible by the teamwork of providers, associates, and telehealth leaders across the system, many of whom had never met in person.

The rapid scaling of MedStar eVisit was also supported by Georgetown University medical students who served as volunteer medical coordinators, among other roles. Working in tandem with MedStar Health providers, the students helped manage the referral process which, if necessary, directed MedStar eVisit patients to the Emergency Department, MedStar Health Urgent Care, or one of many MedStar Health COVID-19 testing tents. “We went from close to zero to more than 100 miles an hour in a very short amount of time,” said Ethan Booker, MD, medical director of MTIC and MedStar eVisit. “Being able to tap into the clinical skill set, adaptability, and enthusiasm of our medical students was really exciting for us.” Nearly 200 Georgetown University medical students had volunteered to support MedStar Health with its COVID-19 telehealth response by the end of May, including with MedStar eVisit and much more.

Impact

Prior to COVID-19, only 30% of MedStar eVisits were conducted by MedStar Health providers, with the remainder of patients being seen by Amwell providers. Within weeks of the pandemic response, 100% of MedStar eVisits were being conducted by MedStar Health providers, first working to get wait times under 45 minutes and then under 20 minutes on average, which was a significant accomplishment compared with national trends at that time. By Oct. 17, 2020, 281 MedStar Health providers had staffed the platform at some point during the pandemic, and 41,059 MedStar eVisits had supported patients. The median patient wait time during the pandemic was less than 15 minutes and patients had shared around 20,400 provider and platform ratings—resulting in near perfect overall scores.

Additionally, to further respond to specific areas of community need, the team worked to make MedStar eVisit more accessible to patients who are Spanish-speaking and to patients who are hard of hearing or deaf through a variety of translation solutions.

Serving as a critical part of MedStar Health’s COVID-19 response, MedStar eVisit helps protect patients, providers, and communities from coronavirus exposure by serving as a productive and low-barrier approach to screening patients for COVID-19 (read related research), in addition to safely delivering other urgent care. Its increased utilization also further elevated awareness of MedStar Health’s telehealth services overall among the communities we serve, which also include scheduled video visits, inpatient telehealth, remote patient monitoring, and more—together resulting in more than 475,000+ telehealth sessions during the COVID-19 pandemic as of mid-October 2020. As MedStar eVisit volumes begin to stabilize following the mid-March peak to around 114 average visits per day in mid-October, this service continues to present an incredibly important access point for care. MedStar eVisit lead clinician Allyson Gordon, PA-C, sees the service as the virtual “front door to MedStar Health”—an entry point she believes will remain essential for years to come.

July 2021 Update

As we begin fiscal year 2022, MedStar eVisit remains essential to our mix of innovative care delivery options for our patients. It is estimated that 67,350+ MedStar eVisit sessions were delivered in the first year of the system’s COVID-19 response, with 290 providers supporting the platform. MedStar eVisit also continued to earn excellent patient experience ratings, with more than 30,000 responses received for the supporting platform and providers and average star ratings at 4.8 out of 5.0 or higher.

Additionally, in late April 2021, MedStar Health received a Positive Impact award for MedStar eVisit’s “proven success using telehealth to improve population needs and close inequities in care” from Amwell, our telehealth technology provider for this service. Through this awards program, Amwell highlighted MedStar Health’s decision to waive all fees for our MedStar eVisit service during the height of MedStar Health’s pandemic response to help manage the threat of COVID-19 and further care for our community. Amwell also noted that the exponential increase in MedStar eVisit volumes described here importantly included some of the most vulnerable, low-income areas in Washington, D.C., where access to in-person care is limited. The recognition was part of Amwell’s annual Client Awards Program, which this year honored 10 organizations nationally that “exemplified telehealth excellence and led the way in providing and expanding safe access to quality care.”