Patients report positive experiences with telehealth appointments

Despite the fact that many patients and clinical providers were new to the idea of completing a medical appointment remotely – or by using telehealth, when Vanderbilt Health appointments were rapidly transitioned to telehealth due to social distancing precautions during the COVID-19 pandemic, patients overwhelmingly reported positive experiences with the approach.

“Some optimistic news that has come out of this situation is that once our patients tried a telehealth visit, which allowed them to remain safe at home but still receive the high-quality care they deserve, they realized the value of these encounters,” said Brian Carlson, vice president  of VUMC Patient Experience. “As we celebrate Patient Experience Week, April 27-May 1, we applaud everyone involved with these appointments – from the schedulers to those who help patients with technology questions as they prepare for telehealth visits to the clinical staff that provide stellar care to our patients no matter how many miles are in between. Our institution faced a formidable challenge and you all delivered outstanding service without missing a beat.”

When in-person visits were converted to telehealth appointments, the Press Ganey patient experience surveys that are sent to patients following appointments were automatically sent out, Carlson said. When it was found that those were actually telehealth appointments, the survey results were quickly analyzed for this new appointment category. What was seen is that these appointments overall have rated even higher than in-person appointments. Now, a telehealth-specific patient experience survey is being sent after these types of appointments.

Telehealth survey results since mid-March:

• 1,872 surveys were received for telehealth visits (as of 4/21)
• Comparing Vanderbilt Health against Press Ganey’s peer group of 1,228 other facilities, we are in the 99^th percentile for the overall roll up of all the questions on the survey.
• 91.4% marked “very good” on likelihood to recommend (98^th percentile)
• 92.6% marked “very good” on how well staff protected their safety (99^th percentile)
• 90.5% marked “very good” on our concern for patient privacy (99^th percentile)

Carlson pointed out that telehealth easily checks every single box of the Vanderbilt Patient and Family Promise, a guiding principle for how all employees behave that was created by patients and providers and adopted at VUMC in 2013. The promise includes a commitment to:

1. Include you as the most important member of your healthcare team
2. Respect your right to privacy
3. Work with you to coordinate your care
4. Personalize your care with a focus on your values and needs
5. Communicate clearly and regularly
6. Serve you and your family with kindness and respect

Sample of patient comments related to telehealth:

• Did appointment by the Zoom video service and loved it! I would love to be able to have all my follow up appointments this way. I was able to have my appointment and move on with my day quickly, and it was easy, and I just loved it!
• I did the virtual doc or teledoc and it was very easy. Generally a drive to Nashville takes a full day, but it was over in 15 minutes!
• Mendes has been my cardiologist for many years, but this was our first telehealth visit. it was easy and went very well! I hope this option will continue after we get past the COVID-19 crisis. It’s certainly more convenient for me and being a “high risk” patient, it keeps me from being exposed to others who are sick.
• Amazing Facetime with Dr. Eli Steigelfest. I am 91, and traveling an hour and a half during COVID-19 was dangerous.
• It was quick, easy and Dr. Womack was very thorough. I felt I received excellent care while remaining safe from exposure to any other illnesses, especially COVID-19
• The nurse went out of her way to help me set up a visit on my computer. When we couldn’t get that to work, she helped me get a Facetime visit on my phone with the doctor. She later called me about the prescription. She was fabulous!
• This appointment was AWESOME! Was via telehealth and it was SO easy and simple! No traffic to fight, no waiting in a waiting room or exam room. My appointment was at 7:50 am and Dr. Clarke was there on Zoom at 7:50am. Simple and convenient! Would do this again and again!
• Great experience. Virtual visit with Dr. Allison Adams. She was patient while I tried to make the camera work to show the back of my throat, and she is always empathetic and helpful. She spent the perfect amount of time with me – enough to build rapport, solve my problem, show empathy, and then we both logged off.
• I love video appointments! It’s the safest way to see Dr. Gore right now. I’m impressed with how quickly you all were able to get this set up!

Be prepared to address questions about security

In the patient comments received, a few individuals expressed concern about privacy during telehealth visits. There are many misconceptions about Zoom and security related to Zoom, many of which have been stirred up by media reports that tell only part of the story, according to Andrew Hutchinson, VUMC Chief Information Security Officer.

He provides these points to clarify the security of Vanderbilt Health’s telehealth visits:

1. There are multiple versions of the Zoom service. There is the “free” version of Zoom, the paid Enterprise version of Zoom, and Zoom for Telehealth. All of these have different feature sets.
2. For all Telehealth visits, we are using Zoom for Telehealth, which is integrated with Epic/My Health at Vanderbilt (MHAV). Zoom for Telehealth is a product specifically designed for telehealth and is a “medically focused application.” More telehealth is conducted in the U.S. using Zoom for Telehealth than any other platform.
3. Zoom for Telehealth meets all requirements for compliance with the HIPAA Privacy and Security rules.
4. Zoom for Telehealth through MHAV includes security mechanisms that are enabled but transparent to both providers and patients in order to maximize ease of use. For example, one of the significant issues with the “security” of Zoom is ZoomBombing (uninvited guests joining a Zoom call). This isn’t a security issue as much as a failure to enable available security controls. Anyone hosting Zoom meetings can enable a password, and can control the admission of participants through the use of a virtual “lobby.” This happens automatically behind the scenes when using Zoom through MHAV. There is a unique password for the meeting, but neither the provider nor the patient sees the password, as it’s embedded in the link in MHAV.
5. Only the provider and patient can join a meeting using Zoom for Telehealth. Additional participants are not permitted to join after the call is established.

Telehealth ‘best practice’ tips

• Pre-educate the patient to let them know what to expect from their video or phone appointment, including what (if any) technology will be used and how it will work.
• Explain to the patient how the telehealth appointment will compare to in-person care, and what you are doing to ensure the same level of care quality.
• Before you begin the appointment, check with your patient to ensure that they can see (when applicable) and hear you well. Make sure that you are centered in the camera’s field of view and remain close to the microphone.
• Throughout the appointment, pay attention to non-verbal and verbal cues from the patient such as facial expression and tone of voice.
• As always, be sure to ask your patient if they have any remaining questions before concluding the visit. A helpful way to prompt discussion is by asking “Is there anything else?” until the patient responds, “That’s everything.”