Health Care from Home
As COVID-19 took hold, SLU鈥檚 physician practice found a new way to treat patients.
Dr. Matthew Zimmie came to Saint Louis University in January 2020, joining the staff as an assistant vice president in Information Technology Services and the chief medical information officer for SLUCare, SLU鈥檚 academic medical practice. Little did he know what he would face just mere months later.
By March, Zimmie was pivoting SLUCare online as the novel coronavirus, COVID-19, forced the closure of SLUCare doctor鈥檚 offices and the cancellation of elective medical procedures at SSM Health Saint Louis University Hospital, SSM Health St. Mary鈥檚 Hospital and SSM Health Cardinal Glennon Children鈥檚 Hospital.
In a matter of weeks, SLUCare transformed most areas of the practice, transitioning to telehealth appointments.
鈥淢edicine is a little bit behind the times on this,鈥 Zimmie said. 鈥淭here was always the question of reimbursement from the CMS (Centers for Medicare and Medicaid Services), which sets the federal rate. You add in very busy physicians, with very busy practices, and it wasn鈥檛 a priority before this to learn how to hold telehealth appointments.鈥
Zimmie said the federal government moving to pay practitioners the same rate for in-person or virtual visits incentivized a move forward with telehealth.
鈥淧eople saw how serious this was,鈥 Zimmie said. 鈥淲ith COVID-19, we now had the time to learn the technology, the need to keep patients and practitioners safe, and the government and insurance companies moving forward to make telehealth work.鈥
Zimmie said while the health care industry ramped up to make telehealth work, patients were wondering why it hadn鈥檛 happened sooner.
鈥淚f you pivot and look at this from a patient perspective, you think why didn鈥檛 we do this sooner,鈥 Zimmie said. 鈥淲e do so much online anyway. You could already go online and schedule an appointment or communicate with your doctor. This was the natural next step.鈥
SLUCare was aided in its transition by the University鈥檚 move to online learning. SLU announced in March that students would finish the semester online. To accommodate classes and virtual meetings, the University contracted with cloud-based video conferencing service Zoom.
鈥淭o the credit of SLU鈥檚 CFO David Heimburger and President Dr. Fred Pestello, they recognized quickly that we were going to have to do things in a very different way, and they invested the money in a system that would do what we needed it to do,鈥 Zimmie said. 鈥淚t has worked out so splendidly.鈥
Zimmie said SLU鈥檚 priority, putting its people first, came through as leadership navigated the rapidly changing landscape. SLU鈥檚 information technology professionals readied the University to operate virtually within a matter of days.
鈥淪ince we knew we had to do something from the academic side, that gave us a head start for SLUCare,鈥 Zimmie said. 鈥淲e stood up Zoom for academics in a week. Something that normally might take a year to roll out, we did in five days.鈥
After getting the campus ready to learn remotely, Zimmie and ITS moved to securing a HIPAA (Health Insurance Portability and Accountability Act) compliant version for the medical practice.
鈥淭here were a lot of conversations with legal and compliance to make sure we had everything we needed. These are things that usually take a bit of time,鈥 Zimmie said. 鈥淲e were working on the fly 鈥 it was like changing a tire on a car while still trying to drive down the road.鈥
How It Works
SLUCare patients making a virtual visit access their care just like they normally would. Appointments are scheduled through the MyChart online system.
鈥淚t is really integrated,鈥 Zimmie said. 鈥淭hey schedule in MyChart, and patients receive an email notification. They log into the appointment the same way 鈥 there is no Zoom login information needed.鈥
A patient will enter the virtual exam room a few minutes before the appointment is scheduled to start. A nurse or medical assistant will do an initial workup before the physician enters the virtual meeting.
鈥淭he nurses and assistants have really taken on the troubleshooting because they are the first person to engage with the patient,鈥 Zimmie said. 鈥淭hey have made sure the microphones and video are working.鈥
Once the appointment starts, physicians have access to all their electronic health information through EPIC, so they can share X-rays or lab results with a patient as they talk. If other specialists are needed for a consult, they can join the appointment. Students in the School of Medicine can continue their rotations as well, sitting in on the appointments.
鈥淥ne of the most incredible pieces of this story is how patient and understanding everyone has been 鈥 from the students, faculty, providers, patients 鈥 all the way through,鈥 Zimmie said. 鈥淧eople understand the mechanics of sheltering in place or working from home. People understand if you hear dogs barking or kids in the background. We are all working like this.鈥
Health care providers working in their offices had access to iPads for the visits.
Zimmie, who started his career as a family physician, said virtual visits are more difficult for some specialties.
鈥淲e can take care of chronic issues and check-ins fairly easily. A broken bone or an intricate eye exam cannot be done virtually,鈥 he said.
Adjusting to the New Normal
Zimmie said several physicians expressed concern at the outset about how a virtual visit would change how they interacted with patients.
鈥淲e doctors are creatures of habit, and we tend to like to be in control,鈥 Zimmie
said. 鈥淲e had no control here, but we remained committed to taking good care of our
patients. The pandemic offered us the unplanned
opportunity to expose clinicians who wouldn鈥檛 have tried telehealth before.
鈥淲e鈥檝e had incredible success stories,鈥 he added. 鈥淓veryone has taken to it like a champion.鈥
SLUCare doctors, medical personnel and office staff were trained on Zoom.
鈥淲e used technology to teach technology,鈥 Zimmie said. Once the technology was in place, SLUCare staff began the monumental task of working through postponed appointments and upcoming visits to determine who could be seen virtually.
As SLUCare offices and other medical facilities begin to reopen, Zimmie said that virtual doctor visits will stick around in some form or fashion.
鈥淔rom a patient perspective, the convenience factor for moving a regular provider appointment online where you don鈥檛 have to take off work or find someone to watch your kids is fantastic,鈥 he said. 鈥淭hese appointments are running really smoothly.鈥
For the providers, holding a virtual visit means less work turning over exam rooms after each visit.
鈥淢aybe it won鈥檛 be at a level that it is now,鈥 Zimmie said. 鈥淲e hope the federal government and insurance payers are thoughtful about how we use telehealth going forward. But I see patient demand and satisfaction continuing.鈥
Telehealth Hubs
On June 1, SLUCare opened the Neighborhood Virtual Visit program, which is designed to connect those without smartphones or home internet to SLUCare medical providers from participating area churches. The program aims to open access to health care, which has been limited due to the coronavirus pandemic.
鈥淲hen we think about the social determinants of health, access to health care services is one of the things we are looking at,鈥 said Dr. Daniel Blash, chief diversity officer for the School of Medicine. 鈥淚t is important that SLUCare is investing in going to people and removing one of the barriers between the sick person and health care.鈥
鈥 By Maggie Rotermund
Saint Louis University is a Catholic, Jesuit institution that values academic excellence, life-changing research, compassionate health care, and a strong commitment to faith and service. Founded in 1818, the University fosters the intellectual and character development of more than 13,000 students on campuses in St. Louis and Madrid, Spain. Building on a legacy of now more than 200 years, Saint Louis University continues to move forward with an unwavering commitment to a higher purpose, a greater good.