A rapid increase in virtual visits during the 2019 coronavirus disease (COVID-19) pandemic could transform the way physicians provide care in the United States going forward, according to a new study led by researchers from NYU Grossman School of Medicine.

The findings, published online recently in the Journal of the American Informatics Association, captures the largest experience to date of the speed, scale, and rapid expansion of video-enabled visits by patients and providers in varied and diverse settings. Specifically, between March 2 and April 14, 2020, Virtual Urgent Care visits at NYU Langone Health grew by 683 percent and non-urgent video doctor visits grew by an unprecedented 4,345 percent in response to COVID-19, in daily averages.

Also participating in the study were researchers from NYU Tandon School of Engineering and NYU School of Global Public Health.

“The pandemic created an urgent need to divert patients from inpatient care and prevent the flooding of our emergency rooms beyond capacity,” says Devin Mann, MD, associate professor in the Departments of Population Health and Medicine, senior director for informatics innovation and the information technology team at NYU Langone, and the study’s lead author. “Through telemedicine, we pushed the front lines to locations far from our hospitals and doctor’s offices. And because NYU Langone invested early in this technology, we quickly leveraged it to help hundreds of thousands of patients.”

In recent years, telemedicine’s growth has been incremental, utilized by only 8 percent of Americans in 2019, according to the researchers. Outside of rural medicine and before COVID-19, there were few compelling reasons to replace in-person care. In order to facilitate the rapid expansion in telemedicine captured in this study, U.S. insurers expanded coverage to include all telemedicine visit types, including from home, and states relaxed licensing requirements so that care can be delivered across state lines. Additionally, the U.S. Department of Health and Human Services allowed the use of consumer audio and video communication for telemedicine visits.

Responding to a Pandemic: Study Findings

Using NYU Langone’s enterprise electronic health record system Epic, the researchers captured COVID-19–related visits using diagnostic codes containing relevant respiratory issues and matched them with keywords describing symptoms including fever, shortness of breath, cough, and more.

Over a six-week period, the investigators found the following:

• There were 144,940 virtual visits conducted involving 115,789 unique patients and 2,656 unique providers.
• Of all virtual visits, 56.2 percent of Virtual Urgent Care and 17.6 percent of non-urgent video doctor visits were COVID-19–related.
• The increase in Virtual Urgent Care was enabled by a rapid increase in urgent care providers. A pool of 40 emergency medicine providers, managing less than 100 visits on a typical day, grew to 289 “surge” providers from multiple specialties.
• On March 19, NYU Langone expanded video doctor visits to all of its ambulatory care settings, reaching more than 7,000 visits within 10 days and representing more than 70 percent of total ambulatory care volume during this time.
• Telemedicine usage was highest by patients aged 20 to 44 years, particularly for urgent care. However, patients of all ages were able to use the technology across NYU Langone’s telemedicine platform.
• Patients’ satisfaction ratings with virtual visits remained positive, despite the rapid expansion of the program to thousands of new providers.

“Through this massive expansion, the numbers of providers and patients who experienced telemedicine for the first time increased dramatically, facilitating transformation of technologies and work practices across multiple medical specialties,” says Oded Nov, PhD, professor and chair of the Department of Technology Management and Innovation at NYU Tandon School of Engineering and the study’s senior author. “An important question going forward is how much this will continue beyond the COVID-19 pandemic. While we expect patients and providers who got a crash course in telemedicine to continue using it long term, regulators’ and insurers’ decisions will have a major impact."

Virtual Healthcare at NYU Langone

Anticipating that the future of medicine would include virtual delivery of care, NYU Langone was uniquely positioned to expand services with tools that had already been successfully integrated across the health system. As a centralized virtual health ecosystem, all technology is built into NYU Langone’s website and the NYU Langone Health app, where patients have a central point of access for all their healthcare needs by logging in with their NYU Langone Health MyChart account.

At the forefront of this strategy is ensuring a seamless and positive patient experience, whether an appointment is in person or via video visit. Through the app, patients are easily able to make appointments for Virtual Urgent Care, as well as other types of doctor appointment either through video visits or in person.

In addition, providers can see patients with COVID-19 remotely at the hospital in intensive care units (ICUs) through tablets, which helps save on personal protective equipment and limits exposure. The use of clinical mobile companions also allows providers to communicate with each other using digital health tools.

“Our ability to scale and expand telehealth quickly has allowed us to battle overcrowding and human spread of the disease,” says Paul A. Testa, MD, assistant professor in the Ronald O. Perelman Department of Emergency Medicine, chief medical information officer at NYU Langone, and a study co-author. “It also pushes our ability to care for patients beyond any physical boundary, which you can only do digitally.”

To further expand the reach of telemedicine services both inside of our hospitals and in patient homes via remote patient monitoring and other technologies, NYU Langone and NYU Grossman School of Medicine were each recently awarded grants from the Federal Communications Commission’s COVID-19 Telehealth Program.

In addition to Dr. Mann, Dr. Nov, and Dr. Testa, co-authors are Ji Chen, MS, NYU Grossman School of Medicine; and Rumi Chunara, PhD, NYU Tandon School of Engineering and NYU School of Global Public Health. Funding for the study was provided by the National Science Foundation.

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