Kyle Knierim, MD; Brian S. Bacak, MD; Shandra M. Brown Levey, PhD; Heather Holmstrom, MD; Jodi Summers Holtrop, PhD, MCHES; Erik Seth Kramer, DO, MPH; Christina Palmer, MD; Rachel S. Rodriguez, MD; Alison Shmerling, MD, MPH; Peter Smith, MD; Elizabeth W. Staton, MSTC
Corresponding Author: Kyle Knierim, MD; University of Colorado School of Medicine. Email: Kyle.Knierim@cuanschutz.edu
Section: Family Medicine & The Health Care System
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Introduction: Our university hospital-based primary care practices transitioned a budding interest in telehealth to a largely telehealth-based approach in the face of the COVID-19 pandemic. We describe practical guidance for successful, rapid transition to telehealth in primary care. Initial Work: Initial implementation of telehealth began in 2017. Provider reluctance and inadequate reimbursement prevented widespread adoption at the time. The COVID-19 served as the catalyst to accelerate telehealth efforts. Implementation: COVID-19 resulted in the need for patient care with “social distancing.” Also due to the pandemic, the Centers for Medicare and Medicaid Services began expanded reimbursement for telehealth. Practice-based virtual visit champions rapidly developed strategies and training resources to transition to all providers to telehealth. More than 2000 providers received virtual health training in less than two weeks. These efforts contributed to a ready system environment for rapid adoption and upscaling of primary care telehealth. As a result, in March 2020, we provided 2376 virtual visits, and in April 5293, which was over 75 times the number provided in February; 73% of all visits in April were virtual (up from 0.5% in October, 2019). As COVID-19 cases receded in May, June, and July, patient demand for virtual visits decreased, but 28% of visits in July were still virtual. Lessons Learned: Several key lessons are important for future efforts regarding clinical implementation: 1) prepare for innovation, 2) cultivate an innovation mindset, 3) standardize (but not too much), 4) technological innovation is necessary but not sufficient, and 4) communicate widely and often.