Big sprawling urban hospitals built on a foundation of red tape, rules, regulations and reams of clinicians, administrators and support staff on hand to enforce it all, aren’t typically known as change agents.
But at NewYork-Presbyterian Health System, one of the nation’s largest public health systems with six major hospitals including NewYork-Presbyterian/Columbia University Irving Medical Center, NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian/Allen Hospital, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, NewYork-Presbyterian/Westchester Division and NewYork-Presbyterian/Lower Manhattan Hospital, change is coming rapidly for digital healthcare.
NewYork-Presbyterian, a health system with annual revenue of $5.2 billion and a staff of 4,974 attending physicians treating more than 2.2 million patients each year, only fully implemented a full-scale telehealth program—NYP OnDemand—in July of 2016.
But as soon as next year, NewYork-Presbyterian has ambitious plans to convert as many as 20% of all patients visits—potentially as many as 200,000 visits or encounters—to telehealth from about 6,000 annual telehealth visits today, says NewYork-Presbyterian senior vice president and chief transformation officer Dr. Peter Fleischut.
To achieve that goal, NewYork-Presbyterian is expanding NYP OnDemand to include a wider range of healthcare conditions and services including for pediatric care and treating stroke victims. “We are making telehealth mainstream,” Fleischut says.
NewYork-Presbyterian launched NYPOnDemand in July 2016 as a telehealth initiative that enables patients, doctors and other healthcare providers to perform a broad range of web-based healthcare transactions.
Those transactions include using NYPOnDemand to schedule a second opinion within the NewYork-Presbyterian system, inter-hospital consults between patients and doctors within different departments, scheduling follow-up appointments and emergency room consultations.
In July NewYork-Presbyterian Komansky Children’s Hospital launched Pediatric Urgent Care, a new online service from NYPOnDemand.
Available seven days a week from 6:00 p.m. to midnight on both NYP.org and the NewYork-Presbyterian mobile app, parents and caregivers can see and speak directly with a board-certified pediatric emergency physician via video-conference. After assessing the child the doctor may provide advice, treatment and medication or determine that the patient requires an in-person evaluation.
“Nothing is more difficult than when your child is sick or injured,” says Dr. Shari Platt, chief of Pediatric Emergency Medicine at NewYork-Presbyterian/Weill Cornell Medical Center and an associate professor of clinical pediatrics at Weill Cornell Medicine. “Our goal is to deliver immediate guidance and advice to a concerned parent, and to provide children with the best possible medical care. This new pediatric urgent care telehealth service is a convenient and fast way to diagnose and provide a treatment plan for common conditions such as fever, cough, vomiting, pink eye and skin rashes.”
The service covers patients located in New York, though the health system plans to expand coverage in the coming months to New Jersey, Connecticut and Florida. All patient information and virtual visits with a doctor are private, secure and HIPAA-compliant, says NewYork-Presbyterian.
“NewYork-Presbyterian is always looking for new ways to make our care more easily accessible to families,” says Dr. Rahul Sharma, emergency physician-in-chief, NewYork Presbyterian/Weill Cornell Medical Center and chief of the division of emergency medicine at Weill Cornell Medicine. “With the launch of Pediatric Urgent Care, families can now see a trained and experienced pediatric emergency physician from the comfort of their home.”
NewYork-Presbyterian also is using telehealth as the cornerstone of a new mobile healthcare program to expedite emergency room visits and deliver faster treatment for behavioral healthcare such as for mental health issues. In June NewYork-Presbyterian introduced its Express Care program at NewYork-Presbyterian/Weill Cornell Medicine to reduce emergency department wait times. The Express Care program is limited to assisting patients with minor injuries or complaints and for routine procedures like suture removals and wound checks. But expanding telehealth to cover at least some basic emergency room visits has reduced the average patient wait time to between 35 to 40 minutes from an average wait of 2 to 2.5 hours, Fleischut says.
Each year NewYork-Presbyterian conducts about 250,000 emergency room visits.
NewYork-Presbyterian isn’t saying what it is currently spending to launch and now expand telehealth. The health system also has yet to put out detailed metrics on its return on spending on digital healthcare and telehealth including how much money telehealth may save NewYork-Presbyterian annually.
But digital healthcare expansion is now a top priority across the health system, Fleischut says. “NYPOnDemand has become one of NewYork-Presbyterian’s core service offerings,” he says. “We are committed to having 20% of our patient encounters occur virtually by the end of 2018.”
For a sprawling healthcare system, NewYork-Presbyterian is able to expand digital healthcare and telehealth on a faster and wider basis because the organization spent two full years prior to the launch of NYPOnDemand building and planning the information technology budgets, technology needs, procedures and workflow process to incorporate the diverse needs of multiple departments.
Over the course of a year, Fleischut put together a working group of executives that represented 12 major departments that ranged from nursing care and information technology to legal and compliance. The group spent the year writing a business plan for the system wide digital healthcare program that outlined goals, objectives as well as troubleshooting potential problems. Once the business metrics were outlined the group next set about working with NewYork-Presbyterians information technology staff on a litany of issues dealing with budgets, systems integration and an implementation time frame.
With a year-long planning process and implementation plan in place, NewYork-Presbyterian was able to roll out a robust and multifaceted digital and mobile health plan in about two months. For example, because NewYork-Presbyterian had a standing digital healthcare committee that represented the health system’s core departments, it took only 30 days to interview nearly three dozen telehealth vendors and narrow the selection down to a pair of companies including Avizia, which provides the technology for NYPOnDemand.
NewYork-Presbyterian through its NYP Ventures investment program also was the lead investor in $6 million in total new investor funding raised by Aviza in November, although NewYork-Presbyterian didn’t release the amount of its specific commitment.
Being versatile and including diversity is how a big urban healthcare system such as NewYork-Presbyterian can expedite digital healthcare, Fleischut says.
In 2015 NewYork-Presbyterian created an Innovation Center to implement an enterprise wide digital healthcare system. Beginning in 2013 NewYork-Presbyterian met with employees across the system, Weill Cornell Medical College and Columbia University College of Physicians and Surgeons to identify opportunities and challenges associated with implementing a telehealth program.
In an article published in July in the New England Journal of Medicine NewYork-Presbyterian also outlined other due diligence moves and plans made to introduce widespread digital healthcare including:
- Researching the current state of state and federal legislation and regulation on telehealth.
- Speaking with several leaders in using telehealth, ranging from other academic health centers to the Veterans Health Administration.
- Reviewed 35 telehealth vendors that had been identified in the research process.
- Establish a core steering committee
- Speaking with consumer-oriented companies such as cell phone manufacturers and pharmacies about leveraging their distribution platforms to broaden the reach of NYPOnDemand.
As a result of detailed planning and the ability to implement digital healthcare quickly, NYP OnDemand has now diversified to include six major elements for its telehealth program including for urgent care visits, second opinions and in some cases faster trips in and out of the emergency room.
The health system also has expanded Fleischut’s role. In May he was promoted from chief innovation officer to his new role as chief transformation officer. Fleischut now oversees enterprise integration, clinical operations transformation, innovations initiatives, logistics and pharmacy. He also will oversee the implementation of clinical technology operations for the David H. Koch Center at NewYork-Presbyterian/Weil Cornell Medical Center, which will open next year.
“All we are doing in telehealth and digital healthcare is with the patient in mind,” Fleischut says.