Using virtual care to support patients during COVID

The coronavirus disease 2019 (COVID-19) pandemic has accelerated the widespread adoption of collaboration and communication software to enable medical care at a distance1 and reduce the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between patients and Microsoft Teams healthcare providers from gathering together in hospitals, offices, or clinics. Most virtual care solutions have been implemented to ensure adequate physical distancing between patients and health-care providers, while ensuring that patients without COVID-19 can still access ambulatory care for acute or chronic medical conditions. Although previous efforts to expand virtual care offerings have been met with resistance, the COVID-19 pandemic has highlighted the tremendous value of care delivery at a distance to prevent contagion, but also to provide access to care under these extraordinary circumstances. As a culture, we have learned that many of the patients or providers we had previously deemed too uncomfortable or inept at using technology have actually become quite proficient with videoconferencing for shopping, exercise, socialising, and learning.For the past two decades, our academic medical centre and others have been building capability in ambulatory virtual visits in specialty care, virtual urgent care for minor complaints, and interfacility emergency virtual consults for time-sensitive conditions like acute stroke.

These efforts have been rudimentary at most institutions due to complex technology integration, substantial regulatory barriers, and a lack of reimbursement. One of the greatest criticisms of virtual care in the past has been its depersonalisation of the patient–provider experience, which is too distant for the intimate connection required for good care.6 Ironically, this attribute of care delivery at a distance is now virtual care’s greatest asset. Providers are scrambling to provide options that ensure safe, effective, and equitable access to care for patients in the setting of relaxed regulations and broader reimbursement. Here we describe two innovations in virtual care delivery that have been developed and deployed across our organisation, virtual rounds and a virtual intercom communication system, and give suggestions for how these innovations might be implemented at other institutions.Maintaining an adequate supply of health-care workers is vital to reducing mortality due to COVID-19. Many health-care systems have struggled to preserve members of the workforce after community spread has begun. At our hospital (Massachusetts General Hospital, Boston, MA, USA) at the start of the epidemic, health-care workers who were exposed to COVID-19 were removed from patient contact until they were asymptomatic or had tested negative. After learning that in one morning (March 16, 2020) 60 health-care workers at our hospital had potential exposures to COVID-19 that required them to be confined to home isolation for several days pending test results, we realised that traditional medical rounds were a communal activity with large numbers of health-care workers frequently huddled together around a computer screen or test results, discussing clinical management, reviewing abnormal findings on radiological images, or discussing findings from examinations. To implement physical distancing among our health-care workers, who often gathered in multidisciplinary groups of eight to ten individuals, we created virtual rounds as a means of so-called medical distancing. In this model, one or two health-care workers are physically present on the ward, while all others join remotely via collaboration software (Microsoft Teams, Microsoft Corporation, Redmond, WA, USA) from home or other locations in the hospital (figure 1). This approach creates a digital replica of normal medical rounds, preserving the intimacy of group work, social supports, task management (eg, order entry, note writing, consulting colleagues), and image sharing while avoiding the dense clustering of individuals. Also, no longer constrained by physical space, members of the virtual rounds can invite others to join in with daily work, such as pharmacists, allied health professionals, coordinators, quality staff, and case management staff. Scribes to support documentation and other support staff can easily be incorporated into virtual rounds. This approach also allows providers in self-isolation to continue to contribute meaningfully and support their teammates. Virtual teams might experience less psychological trauma caused by physical distancing and wearing personal protective equipment (PPE), and enable otherwise non-essential personnel and student trainees (who have been frequently removed from hospital settings during the pandemic) to re-join the workforce, thereby creating a scalable platform for knowledge sharing and collaborative teams between facilities to help with load balancing as needed across health systems.


Related: Microsoft Teams Healthcare

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