Virtual care at Michigan Medicine explodes amid COVID-19 pandemic

This past winter, Headlines published a series of articles highlighting Michigan Medicine’s five Virtual Care initiatives — Remote Patient Monitoring, Video Visits, E-Consults, Telespecialty consults, and E-Visits.

The objective was simple — to inform faculty and staff of the virtual options available, present them as a viable patient care option and encourage adoption of the tools. A phased rollout was planned, with a July 1 implementation date set for a system-wide rollout over all service lines. But everything changed when the COVID-19 pandemic made its way to Michigan in early March.

On March 9, Michigan Medicine treated its first COVID-19 patient, one of two in the state, prompting Michigan Gov. Gretchen Whitmer to mandate that non-essential workers “Stay Home and Stay Safe.” To Michigan Medicine ambulatory care clinics, this meant deferring all in-person, non-critical appointments and elective surgeries, creating a backlog of appointments that pushed virtual care to the forefront.

In the ensuing weeks, the use of virtual visits exploded.

Impact of COVID-19 on virtual visits

“During the month of February, Michigan Medicine conducted 444 video visits,” said Jessie DeVito, associate director of virtual care operations for the U-M Medical Group. “In March, we completed over 6,800.”

These impressive numbers continue to trend upward, with 26,907 video visits completed in April.  The rise only represents video visits conducted through MiChart, but DeVito said that patients have also reached out to providers via other platforms, further increasing the number of actual visits.

Like video visits, E-Visit usage has skyrocketed as well. E-visits involve a patient filling out a condition-specific questionnaire within the patient portal and then receiving a written treatment plan from a Michigan Medicine provider. This E-Visit surge has been propelled by the recently introduced ability for this patient/provider messaging exchange in MiChart to address and triage COVID-19 related symptoms. 

“By keeping patients and providers at home, we’re able to provide the care people need while flattening the curve and preventing the health care system from getting overwhelmed,” DeVito said.

Indeed, those perks are encouraging thousands of patients to seek out virtual care options.

“Although it’s not unusual to see a spike in non-emergency virtual care usage during times like flu season when patients want to minimize potential exposure, the current environment has resulted in patients that may have normally opted for an in-person appointment to try other things,” DeVito said.

The need to quickly adapt

The rapidly-growing demand for virtual care delivery spurred by the pandemic quickly uncovered the need to streamline operations. Considerable behind-the-scenes work was implemented to make this dramatic uptick in virtual visits possible — and successful.

The team worked with many partners, including HITS, scheduling, call center and individual service line leadership to improve the virtual processes for both patients and providers, including:

• MiChart: The creation of a self-triage module for COVID-19 symptoms to help direct patients to the appropriate virtual mode of care (e-visit, video visit, self-care at home, etc.).
• Call center: Partnering with Michigan Medicine’s COVID-19 Hotline to guide patients with COVID-19 symptoms to virtual services in lieu of in-person appointments.
• Video visits: Opening a new patient self-scheduled video visit service for those with COVID-19 symptoms, available to all adult patients seen at MM in the last two years.
• Employee symptoms: Directing COVID-19 symptomatic employees to the OHS call center for risk assessments, guiding them to quicker resolution.
• Provider training: Implementing a more vigorous plan to train providers and prepare them for virtual care delivery. Over 1,400 providers have been trained to date, and training sessions continue to occur daily.
• Scheduling: Continuing to monitor virtual activity and providing recommendations on how to best space out appointments and avoid overloading systems.

The future of virtual visits

Moving forward, Michigan Medicine is committed to maximizing virtual care. All clinical service lines are slated to adopt a virtual-first practice model, which will be the standard going forward.

Although the bulk of virtual visits conducted thus far have been internal medicine-related, psychiatry, surgery and pediatrics have also seen significant surges in volume.

“Nearly every service line offers some type of virtual or video option,” DeVito said. “These visits will serve as the first-line of care for our patients in the future.”

“The current climate may have inspired people to adopt these options faster than they may have otherwise, but we believe that our patients will see the advantages of virtual care and video visits,” said Margaret Punch, M.D., associate medical director for Virtual Care. “We’re able to offer more patients more access to treatment, and we look forward to continuing to improve and expand their options.”

Many Virtual care resources are available to help faculty and staff navigate and understand E-Visits, video visits and the other modes of virtual delivery. These include tip sheets, Q&As, weekly webinars and more. Please visit the Virtual Care internal website for more information.