[MUSIC] Brian, you wear many hats at Johns Hopkins. In your role as the Medical Director for Digital Health and Telemedicine, can you talk a bit about the early days when the campus shut down and you were setting up the Incident Command Center? What was that like? >> Yeah, it was a little bit crazy to be honest. And a lot of us wore many hats during the first few weeks of the pandemic. Certainly, as a practicing internist and pediatrician, and someone who practices in the ambulatory space, but also someone overseeing digital health and telemedicine. A lot of unique ambulatory operational as well as telemedicine operational questions, tasks, and problems that had to be solved. But fundamentally, we have 15,000 visits a day in our ambulatory space, 75,000 visits every single week. And overnight, nearly, we had to figure out how to transition most of those visits to some other way for patients to receive care. Somethings going to the lab, going to the radiology suite, getting an infusion, obviously had to still remain in person. But we were also tasked with trying to figure out the safest way for patients to navigate those visits. While at the same time taking people out of the clinic, when clinically safe and appropriate and getting them connected to their providers virtually in as fast a way as possible. It was complicated and often times the lower tech solutions are sometimes the best. We certainly relied on the use of the telephone, quite frequently, during the beginning parts of the crisis. But it unraveled with a few other aspects of what it means to change care quickly. So patient instructions that once said go to this office building now needed to overnight say don't do that. Wait for a phone call, click on this button, expect this link. So education and interacting with technology, when that was unanticipated, became as big of an issue as just the care delivery itself. Certainly was a very interesting and busy time to try to work with our colleagues across ambulatory operations, infectious disease and epidemiology, technology. Patient family and centered design to make sure we're always keeping the patient front and center to figure out all these problems in a really quick period of time. Make sure people didn't lose access to care that they needed. >> Yeah, Brian, you've really been making the rounds speaking to providers across the health system as a telemedicine champion. And I know that you even recently briefed Nancy Pelosi's staff. What have been some of the pain points for providers in adapting to these rapid roll outs. It's not just about getting used to a new technology, but like you said, the ways in which all of the workflows have to be adjusted to support virtual care delivery. Easier said than done? >> So absolutely, Ash, far more easier said than done. For every education point there is for a patient, there's probably a matching one for the provider. So if it was as easy as just handing a provider a schedule with a set number of administrative video conferences to do, we can handle that. A lot of us have learned how to handle that. But as anyone that's been to a doctors office knows and experiences, things don't stay on time. There's more than just getting into a video visit or a video room to make clinical care successful over a distance. Things that we learn as providers, from the beginning of medical school the first time we set foot in a clinic all the way through to when we leave training. we're trained over years on how to engage with the patient in a setting that feels comfortable, that we know, inside the clinical exam space. And we learn how that works, how we engage with patients, how the administrative aspects of clinical care flow. Even on the back end, how we document, what we document, and ultimately how we bill. So all of those are different pieces of education that really had to be fundamentally transformed and reimagined for our providers as much as they did for our patient. And so every aspect of the patient's journey had to be thought of what's the digital equivalent? What's the virtual equivalent? I'd get to a clinic, and I checked in the front desk. What's virtual registration look like? How do I convey my medications, my medical history? How do I confirm my pharmacy? How do I upload my insurance information? How do I tell the provider that the patient's there. I typically have a medical assistant or a nurse who's helping triage the patient, obtain vital signs. And then either electronically or in person come by and let me know that the patient's ready. However, replacing all of those steps so that our virtual care can mimic as much as possible in person care. Each of those different tasks and different steps had an education problem for both providers and not just physicians. This is not physician centric, physicians, nurses, medical staff, front desk staff. How is everyone going to engage differently in this new patient journey? Then everyone had a matching education problem for the patient as well. To make sure that at the end of the day we can figure out how to get the patient and the provider into the same room at the same time over a distance. And so we've learned as we've gone. One of the most important technical lessons, I think, comes out all the time in any technical workflow change. But consumers, and to be very clear, providers and patients were consumers in this transition, will take the path of least resistance. Simplicity is key in designing a technical solution. And didn't matter what we said you should do. What was done is what was easiest. And so ultimately, we learned from that. Learning from your customer and, in this case, again, we've got many customers across the clinical care spectrum was important. How do we understand? How do we break down the barriers in accessing something that is really accessed through a complex set of steps, logging into different things? Navigating through different screens having broadband Internet access, how do we boil that down to its most simple parts? And make sure that we're, at the end of the day, again, connecting patients to providers in the way that they need to do to ensure that we can deliver that care? I think we were pretty successful. Over half of the care at Johns Hopkins Madison was delivered virtually during the peak of the pandemic and May and June of 2020. That accounted so far this year to over 350,000 total virtual visits. We were up to 90 to 100,000 during those months of May and June. It was a lot of care that was happening virtually. And that was up from just a couple of day before the pandemic. So just a massive transition in how our patients and providers were interacting with each other online and virtually. >> Yeah, thanks for everything that you're doing, Brian, the dual hats you wear as a provider as well as your medical director role. It's been a lot. I will never forget early March, we were still on site. It was about the week before everything shut down. And I remember you saying to me, gosh, Ash, as a health system in a hospital we're focusing on which doors do we limit entry into. And how do we take care of that sick patient and mitigate risk once they've entered the door? But this thing is about the community spread and everything that's outside the walls of the hospital. And here we are now. It's really been a different perspective on population health management during COVID-19. >> It's absolutely right. I mean, certainly the technology was deployed in a variety of settings. And we did some neat stuff inside the hospital too. But the favorite phrase is physical or social distancing that was applicable to how we consumed, interacted with healthcare. And I think virtual care, certainly, has a lot of obvious connections into how we kept patient safe during the pandemic. And a lot of our feedback from patients has been really positive in this transition. We have had 36,000 patient surveys come back to us after our virtual visits. Our providers are getting ranked 95, 96 out of 100. Patients are happy with how they're engaging in the healthcare system because, quite frankly, we do it everywhere else in the economy. We engage virtually and digitally and on demand and convenient. And so this pandemic has really accelerated that transition to an emphasis on patient centered convenience, reaching patients where they are. And we're proud to have been able to play a part in that. [MUSIC]
