Responding to a crisis: A call to action

Introduction

As coronavirus disease 2019 (COVID-19) escalated into a global pandemic, health system scrambled to prepare for surge conditions. Patient loads increased exponentially, and state governmental agencies advised hospitals to double their capacity while simultaneously reducing their non-COVID-19 patient populations. As an additional measure to free up bed capacity, nonemergent medical procedures were severely restricted. The pressure to prepare and the pressure to perform changed how health care was delivered during that time and, potentially, permanently.

I am the Senior Vice President of the Houston Methodist Physician Organization, which employs 800 physicians across 18 specialties in 170 clinics across a geography larger than the state of Connecticut. Our Houston Methodist Hospital system includes eight hospitals, an integrated academic institute, and Houston Methodist (HM) operates more than 2393 hospital beds and has approximately 25,000 employees. Some changes at Houston Methodist were consistent with preparations modeled around the world, but others offer case studies for the future. With the dedicated and coordinated efforts of our hospital employees, our academic and clinical staff, our government leaders, and our first responders, this pandemic will end. However, the effects on hospitals and how we deliver care in physician offices may forever be changed. In many ways, health care will never be the same—and that is a very good thing.

Virtual foundation

In the months leading up to COVID-19, Houston Methodist was celebrating a milestone of success as we had reached a pace of 1000 visits per month through our “on demand” virtual urgent care platform. HM physicians and advanced practice nurses were employed to be “at the ready” to treat specific common medical conditions through a mobile virtual interface. Our virtual urgent care platform was accessible in a number of online venues such as Walgreens and Zocdoc. We had seen a volume increase of 20% every month in patient visits, had outstanding patient satisfaction scores, and the platform was proving to offer a cost-effective way to treat common illness in the comfort of the patient’s own home. The data we collected from those seeking virtual urgent care showed that many individuals were using this form of care delivery to supplant primary care office visits or urgent care visit ( Fig. 1.1 ).

In our established physician practices, we were utilizing our EMR, EPIC, to deliver virtual care to our patients that needed specialty and primary care. Patient volume was low in this use case, as we were struggling to implement a new virtual care operational workflow in a traditional practice. There was not a “burning bridge” moment to spur our physicians to try virtual care. We found that often times, physicians would be very excited about the idea of virtual care and would want to pilot it in their clinics. However, when it came time to introduce the new workflow, the momentum of the traditional in-person style of visits would quickly suffocate any new process. In the end, adoption for virtual care in established physician practices was low. It was clear that although we had made tremendous strides in building the administrative and IT infrastructure to facilitate a virtual health platform, many physicians were skeptical or felt like the time for virtual care had not come—at least not yet.

It was clear that we were at the beginning of a very long journey. We had a clear strategic imperative to build new patient business, reduce facility overhead, be more consumer-centric, and maintain connectivity with our patient base by leveraging virtual medical care. In our most optimistic of moments, we would hope that we could get 50% physician adoption of virtual care in our established physician offices, and reach 2000 patient visits per month on our virtual urgent care platform in the next 3 years. We had no idea of the impending wave of adoption that would push our dreams of virtual care to the brink and serve as a foundation of stability that we would use as a base for our slow and steady recovery from the worst pandemic in 100 years.