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TELEMEDICINE

Multiple lessons were learned during UT Health San clearly communicated to all faculty and staff. Updated process maps
Antonio’s telemedicine implementation that are rel- were sent out if needed. These meetings ensured all stakeholders
evant for any organization, small or large. were able to not only give input to developing telemedicine work-
Start with a small pilot, then implement iteratively. This first flows but ensured questions and feedback were funneled to the ap-
primary care practice to implement video visits, with the support propriate decision-makers.
of IT and clinical operations, included only 2 scheduled visits in its
first day of operations. With a fail-fast mentality and an eye towards
continuous improvement, the lead physician and team assessed the
clinician and patient experiences after each visit. The first few visits
went smoothly, and lessons learned from this pilot phase were
quickly integrated into the implementation process at other primary
care practices as well as the rest of the UT Health San Antonio. Uti-
lizing a constant feedback loop between physicians, staff, patients,
operations, and Health IT, the team was able to continue to improve
multiple processes, including virtual patient “rooming,” adjusting
templates for both in-person and telemedicine appointments, and
identification of inappropriate telemedicine visit chief complaints
which would require in-person appointments instead.
Educate all stakeholders so the focus can remain on deliv-
ering medical care to patients. While the entire organization was
learning how to effectively utilize telemedicine, the expectation to
deliver the best care possible to patients remained. Physicians en-
hanced history-taking workflows and adjusted reliance on physical
exams. Staff helped contribute to new scheduling, follow-up, and COVID-19 continues to require us to innovate. In a normal en-
communication workflows. Patients acclimated to speaking with vironment, ensuring timely access to care is extremely crucial to
their primary care physician from their phone or computer. We were high-value care. Challenging this is the fact that the COVID-19
all learning. The Health IT team developed telemedicine training public health emergency has made patients more hesitant to leave
5,6
materials to teach physicians, staff, and patients. At the same time, home for medical concerns. To improve patients’ access to med-
marketing updated patient-facing education on current and new ical care, we started offering On-Demand Urgent Care video visits
websites. This education was important because, while technological in June 2020. Patients access this service through the UT Health
concerns and barriers were certainly front-and-center, the focus San Antonio Epic patient portal; the service is staffed by primary
needed to be on the medical needs of our patients. An educated care clinicians.
workforce and patient-base ensured that, when virtual visits oc- The lessons learned from our telemedicine implementation
curred between patients and clinicians, the technology did not over- helped inform the implementation of On-Demand Urgent Care
shadow the medicine. video visits. We utilized a “soft opening” without any marketing to
Do not forget to communicate regularly. During times of pilot the new care delivery process. We utilized feedback from our
volatility, uncertainty, complexity, and ambiguity, as physician leaders Primary Care Patient and Family Advisory Council to help inform
we should respond with agility, information, restructuring, and ex- our marketing team about On-Demand Urgent Care video visits.
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perimentation. The implementation of telemedicine required clin- After seeking further input from our primary care team, we trained
ical, operational, and technological adjustments, which meant all primary care clinicians on the new processes and workflows, in-
communication needed to be constant. UT Health Physicians pri- cluding how to utilize a “virtual” On-Demand clinical supervisor
mary care leadership implemented nightly “debrief” meetings to as- to assist with patient communication and IT issues. Lastly, we im-
sess the constantly changing environment in order to make plemented weekly debrief meetings to collect clinician feedback on
proactive decisions for the following day. During these meetings, and update workflows. We also personally outreach to every patient
input from physician and operations leaders were aggregated and who utilizes On-Demand Urgent Care video visits in order seek
processes were updated for the next day. Morning clinical team hud- feedback so that we can constantly improve.
dles ensured the changes agreed upon the evening before were On-Demand Urgent Care video visits are primary care focused,
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