An Inside Look at Developing the Digital Health Playbook

The road to telehealth during the pandemic

As the pandemic swept across the world early this year, healthcare information was in constant flux. This made having trusted science-based information in one voice more important than ever. Leadership at Cleveland Clinic recognized the importance of bringing together our medical and scientific experts to communicate real-time knowledge on how to deliver patient care during the pandemic.

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Digital health resources that are searchable in a shared community contribution model became the ideal solution to offer providers everywhere with reliable information. Cleveland Clinic teams quickly harnessed the flow of the most current and accurate health information to meet the need amidst a tumultuous landscape to support medical providers and touch more patient lives.

Together, the teams created Cleveland Clinic’s COVID-19 Response, a Digital Health Playbook – one for inpatients and one for outpatients. Matt Stanton, Executive Director, Digital Health, says the playbooks were designed to give providers guidance on making patient care decisions when people were quarantined at home.

“Through long days working with multiple departments, Cleveland Clinic teams gathered information on our evolving, innovative practices,” Stanton says. “We developed numerous workflow diagrams in a self-serve model that focused on which telehealth options were successful to provide the best care for both patients and caregivers. For example, if a certain level of patient interaction is necessary, then the ideal options, platforms and documentation are provided in one set, but if clinicians determined the need for a different type of patient interaction, then they were guided to each appropriate solution set.”

Early on in the crisis, Stanton says, the natural inclination was for doctors to want to learn how to provide virtual visits, because that replicates patient care. But in reality, a lot of the care could be delivered through phone calls or e-Visits and other approaches and methods.

“The playbooks allowed us to provide information about digital tools that providers weren’t aware of,” says Stanton. “And so much of the work was driving people to the right platform for what they were trying to accomplish. For clinicians, it meant we could guide them down the path to choosing the right technology and show them how to access those platforms.”

To meet this need, it was imperative to create more frequent interaction across departments and institutes, leading teams to work smarter and with greater efficiency. As the disruption of the pandemic led to rapid growth and the need for adjustments to digital care delivery, this brought about the need to collaborate with numerous support teams, including the Legal team, Finance, Market Network Services and Marketing.

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There was a constant need to communicate with the specialists (not all physicians) already in demanding roles, to help prepare their teams to perform. Through their experience, the technology development teams understood the frequent changes brought about by late-breaking patient care decisions. For example, keeping apprised of evolving adjustments by insurance companies allowed providers to compliantly charge for services.

“A lot of demand for new telehealth approaches fell to primary care providers,” Stanton says. “This was the focus of our energy for the first six to eight weeks. As we were first learning what their needs were, we recognized the complexity of what lay ahead. They were on the frontlines responding to patients’ health demands.”

As federal, state and local legislative bodies and regulatory agencies adjusted to late-breaking changes brought about by the pandemic, critical communication to a diverse team across the enterprise ensured that Cleveland Clinic could continue to  provide optimal care across all healthcare services and departments.

Leading the charge around prioritizing an enterprise response – identifying which departments and institutes needed to be brought to priority next – became a demanding focus as the regulatory landscape was repeatedly changing.

Chris Piel, Administrator for Cleveland Clinic’s Dermatology & Plastic Surgery and Endocrinology & Metabolism institutes, who assisted with the team’s coordination, says, “All of these efforts benefited from multidisciplinary input and a diverse team of stakeholders and subject matter experts. For each clinical team, it was important to understand what telehealth solutions were in place and functioning appropriately and then provide education of alternatives when necessary.”

Throughout the long days and fast pace, communication with more than a dozen clinical institutes required daily calls dedicated to telehealth. The focus was on troubleshooting solutions that were overextended and quickly determining how to provide alternatives. As a result, there became a clearer understanding of current capabilities and  possibilities.

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Piel reports that today, with this new knowledge, the team is engaging across the enterprise on developing a strategic direction. As for the day-to-day work, agility and regulatory changes require staying fluid on responses. He adds, “Due to platform concerns, we initially needed to limit access to some of our primary telehealth solutions, but as regulatory changes allowed broader solutions, we were able to quickly educate caregivers on acceptable alternative pathways to provide care.”

The digital teams were diligent in complying with the rules of U.S. Department of Health and Human Services (HHS) law enforcement agency, the Office for Civil Rights (OCR), which protects the privacy, security and availability of individuals’ health information. In the state of a public health emergency declaration, HHS issued a temporary and limited Health Insurance Portability and Accountability Act (HIPAA) waiver for compliant hospitals.

Piel adds, “The Office of Civil Rights offered enforcement discretion of the HIPAA Privacy Rules to allow telehealth using nonpublic-facing communication products to provide good-faith care of patients during the pandemic. There was continual assessment of what we could and could not do, and our legal teams did a tremendous job in defining safe practice standards.”

The Cleveland Clinic COVID-19 Response, Digital Health Playbook is available from the Cleveland Clinic website. Please note that while many of the processes and information described in this document and the supporting materials may be broadly applicable, there are factors that will impact whether and how it can be adopted by other organizations or individuals. Factors that should be evaluated in implementation include: regulations in the state where the organization or individual is located; the electronic medical record used; and whether a particular clinician is hospital-based and/or employed by a hospital or healthcare system.

Read the Digital Health Playbook article for more details.

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