Expanding Telehealth for the COVID-19 World: An Interview with Courtney Stevens, Director of Virtual Care, Henry Ford Health System

During the current COVID-19 pandemic, scores of health systems and medical groups have struggled to ramp up their telehealth capabilities. However, the more progressive and organized health systems in the country were already well prepared to supply virtual care. One of the most successful in that regard is Henry Ford Health System (HFHS), an integrated, non-profit health system in Michigan. HFHS’s successful deployment of virtual health during the ongoing COVID-19 crisis provides a working model for other organizations to maximize their telehealth/telemedicine programs.

In this exclusive interview, Courtney Stevens, director of Virtual Care at HFHS, provides insights into how her organization was able to quickly position virtual care to support potential COVID-19 patients and others during this time.

Courtney, please tell us about yourself and your organization.

Henry Ford Health System is a comprehensive, integrated, non-profit healthcare system serving Southeast and Central Michigan.  We provide care to thousands of patients a year and have more than 30,000 employees at hospitals and medical centers throughout our region.

I have been with HFHS for more than 13 years and I helped to develop our organization’s Virtual Care Program and strategy, also known as telehealth and telemedicine.  Our programs encompass inpatient, outpatient, home, and ER as well as synchronous (real-time) and asynchronous (emails, online messaging, images and questionnaires transmitted through patient portals) programs. My background is in industrial engineering, so I bring a “let’s solve this problem” approach to our organization’s virtual-care capabilities.

What is the overarching goal of HFHS’s Virtual Care program?

Our mission is to evolve innovative care delivery to enhance health and wellness through accessible technology that drives connection and collaboration — when, where, and how it is needed most. HFHS’s virtual healthcare programs began more than 10 years ago and have been rapidly deployed through most of the the organization’s specialties and subspecialties. Over 45 specialties are now active. While the early emphasis was primary care and behavioral health, use of virtual-care capabilities has spread to the entire care continuum, including medical and surgical specialties.

How has COVID-19 impacted your program?

The onset of COVID-19 led HFHS to deploy video visits — allowing the patient to connect using our EMR patient portal from their personal device at home — across an even broader range of specialties to promote social distancing and reduce exposure for patients and staff. Some of these expansions included surgical specialties such as cardiac surgery, neurosurgery, orthopedics, plastic surgery, vascular surgery, etc. and medical specialties such as allergy, cardiology, dermatology, endocrinology, pulmonary, rheumatology, women’s health, etc.  While some elective surgeries can be postponed, there are thousands of patients throughout the state that still need health care services. We had to create a virtual service option for them to protect them from infection and to help facilitate appointments.  Our virtual-care strategy includes features that enabled video connections and getting information through the patient portal, providing the ability for clinicians and patients to connect virtually. We were able to expand the scope of virtual care further due to the loosening of telehealth regulations through public health emergency waivers by state and federal regulators, especially with regard to telehealth approved services, expanding approved originating sites, and HIPAA.

What are some of the challenges you are facing?

Regulations remain uncertain and frequently change, requiring constant review and incorporation of new guidance.  One of the key concerns of regulators was to ensure the privacy of communications with patients. As HFHS had already developed and used its HIPAA compliant and secure communication platform before the pandemic, we’ve been better able to ensure the security of all communications.

How much has the Virtual Care program grown?

In 2019, prior to the COVID-19, HFHS providers conducted over 17,000 virtual visits (synchronous and asynchronous), about 65 per day. Once the COVID-19 pandemic hit Detroit, Michigan (around March 16th), that number skyrocketed to more than 1,500 a day. Adapting to that rapid level of change can’t be done overnight. It requires a mature system and policies, as well as the technology and hardware to enable these connections to already be in place. However, the experience of HFHS can show that any organization — no matter where they are in the virtual health technology adoption process — can effectively and efficiently build and deploy telehealth and telemedicine programs.

What are some concrete steps and tips you can offer to other organizations that wish to build out their virtual health programs?

While there are several, here are my top ten that, when deployed, can ensure a more efficient expansion of virtual-health programs.

  1. Recognize there are still barriers to adoption — some physicians and patients require education and support, in various mediums and communication methods, to increase comfort level with the technology.
  2. Understand the need to study and interpret regulations frequently — there are still inconsistencies in coverage among insurance payers — it changes often — don’t be caught unaware and ensure you understand the impact in your organization’s ecosystem.
  3. Make sure your billing policies don’t end up creating unnecessary costs for patients.
  4. Ensure all communications platforms are HIPAA compliant and/or non-public facing. Per HHS OCR HIPAA waiver, FaceTime, Skype and Google Hangout are acceptable as they have encrypted sign-in procedures; Tik Tok and Facebook Live are not. But all efforts should be made to ensure the security and privacy of these virtual encounters.
  5. Remember to keep up with all documentation and billing requirements necessary for telehealth services. While regulations have been relaxed, the fundamental provisions for telehealth remain the same.
  6. Check state Medicaid and Medicare regulations carefully.  While the originating sites for patients and some services have expanded, approved distant providers allowed under the programs have not.
  7. Be sure to follow all Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes regarding codes allowed and eligible providers (e.g., MD, DO, NP, PA, etc.).  Also, adhere to the documentation requirements for these services.
  8. Remain vigilant about where patients are located. Under the PHE temporary telehealth guidelines, states have the right to waive medical licensure — but it is up to state boards to authorize out-of-state providers and there is still variability.
  9. Pay attention to virtual behavioral health programs as they are sorely needed during the current crisis. Virtual behavioral health can be linked to clinics, ERs, and urgent care locations for use when needed.

My last tip for larger organizations is to look for as many ways as possible to connect your organization to hospitals and physicians in rural areas.  Many small towns are also hurting and are especially burdened by a lack of facilities and providers who can diagnose and treat. Virtual health programs expand access, ensure engagement with the leading clinicians in a state, minimize the need to travel, and will save lives.

Is there anything else you’d like to say about virtual health in today’s COVID-19 environment?

The value of having a scalable virtual health system in place is immense for a crisis like this. Now that many clinicians and patients have tried it, they won’t go back to the old way but will expect the convenience of remote care as the status quo. We have made an enormous leap forward in the way health care is delivered in the U.S.

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