New York City's NYU Langone Health had been investing in telemedicine for several years before the COVID-19 pandemic and had always been keenly aware of the important role technology would play in the future of healthcare.

The organization has offered services such as virtual urgent care, telepsychiatry and virtual post-op appointments for several years to meet the needs of patients. Telemedicine is not only cost-effective for both the patient and the hospital, it also can reduce the risk of exposure to disease for all parties, especially during a pandemic.

THE PROBLEM

Because NYU Langone already had a robust telemedicine infrastructure in place when COVID-19 hit New York, it was able to scale its technology to accommodate for the influx of patients, said Dr. Paul Testa, chief medical information officer at NYU Langone Health and assistant professor in the Ronald O. Perelman Department of Emergency Medicine at the NYU Grossman School of Medicine.

"However, we were still challenged to stay patient-centric at such a large scale and remain integrated across all of our campuses," Testa said. "Our NYU Langone Health app allows patients to access their health records, communicate with physicians and schedule virtual appointments across all NYU Langone facilities, streamlining their experience."

The organization also has invested in technology that enables physicians to virtually observe COVID-19 inpatients to reduce their exposure to the virus and reduce the use of valuable personal protective equipment (PPE).

PROPOSAL

When NYU Langone established its telemedicine program many years ago, it was not looking to solve an immediate problem; rather, it was thinking about what the future of care would look like.

"The landscape of medicine was beginning to shift, and it was clear that patients didn't want to travel far or wait hours to see a doctor for problems that could be addressed through a video visit," Testa explained. "We invested in our telemedicine solution – integrated into our enterprise electronic health record – to offer a convenient and cost-effective complement to in-person visits and streamline patient care."

The challenge was to provide those who seek care from the organization with the best digital patient experience – one that was intuitive and integrated, and valued their health information, he added.

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MEETING THE CHALLENGE

Early last year, NYU Langone converted conference rooms and operating theaters across all of its campuses (including on Long Island and in Brooklyn, as well as in Manhattan) into ICU facilities to treat COVID-19 patients.

"Working with Epic, Cisco and Apple as partners, we created clinician-to-clinician video capabilities for physicians to discuss patient care and share treatment suggestions," Testa recalled. "We also created mobile bedside video carts that allowed physicians to speak to patients virtually from a safe distance and document their symptoms in Epic's MyChart."

"Working with Epic, Cisco and Apple as partners, we created clinician-to-clinician video capabilities for physicians to discuss patient care and share treatment suggestions. We also created mobile bedside video carts that allowed physicians to speak to patients virtually from a safe distance and document their symptoms in Epic's MyChart."

Dr. Paul Testa, NYU Langone Health

Built into these devices was an automated pickup system that enabled physicians to dial into the rooms of patients who were intubated or otherwise unable to answer and monitor their condition virtually. Without the need to scrub in every time they entered the patient's room, NYU Langone physicians were able to use less PPE and check on patients more frequently.

RESULTS

Because NYU Langone had an existing telehealth infrastructure in place, it scaled its scheduling systems to accommodate the uptick in virtual appointments and ambulatory visits. Before COVID-19, the organization was conducting around 25 to 50 virtual visits a day; at the height of the pandemic, that rose to close to 8,000 virtual appointments in a single day.

"NYU Langone also was able to transform conference rooms and offices into ICU treatment facilities for COVID-19 patients," Testa noted. "This helped address the problem of bed scarcity and allowed physicians to monitor ICU patients from a safe distance, reducing their exposure and reserving PPE.

"Our organization also created more than 1,000 bedside tablets and telemedicine carts, which allowed for video and voice calls between patients and their physicians and families," he continued. "Clinicians could video chat with patients about their symptoms, access their test results on MyChart and take notes about their care on the HIPAA-compliant devices."

​In addition, and of tremendous importance, these tablets allowed patients to connect with their loved ones at the height of the pandemic, he added. And in some cases, it allowed them to use the technology to say goodbye to loved ones when they were suffering from severe cases of COVID-19 in the ICU and patients could not physically see their families.

USING FCC AWARD FUNDS

Last year, the FCC telehealth funding program awarded NYU Langone Health $983,772 to employ telehealth in operating rooms and conference room spaces that have been converted into ICUs so doctors and healthcare providers can carefully monitor ICU patients from separate floors, thus magnifying the finite number of available ICU specialists, reducing exposure to the coronavirus and maximizing the limited supply of personal protective equipment.

"NYU Langone used the FCC funds to rapidly expand, scale and enhance our foundational, existing, proven telemedicine services across all our campuses as well as more than 350 ambulatory locations," Testa said. "We rapidly cycled new programs through development to address the challenges COVID-19 wrought upon our patients and how we delivered care, bringing video to the bedside, exam room and patients' homes, and digitally connecting their families and caregivers."

In addition, the FCC support helped accelerate remote patient monitoring, also deeply integrated into the organization's EHR, supporting asynchronous data monitoring of patients, helping to accelerate safe discharges while remaining connected to patients.

"Foundationally, the FCC grant allowed us to rapidly mature the digital patient experience and telemedicine to build upon a new model of delivery that is integrated, convenient and of the highest quality," he concluded.