For two dermatologists from a small private suburban medical practice, COVID-19 has created a professional landscape that could not have been imagined six months ago. These doctors are not opposed to the idea of technology as an administrative tool but have steadfastly embraced a traditional model of patient care that feels comfortable and familiar to their mostly elderly patient base.
When the stay-at-home order was issued in their community in late March, appointment cancellations swept in like a tidal wave, with a handful of patients asking to email pictures of their skin concerns so they could get diagnoses from home. Without a digital EHR (electronic health records) system, and never having even contemplated telemedicine, the doctors had no idea how they could move forward and satisfy their patients’ needs. Yesterday’s problem of over-scheduling too many patients had, virtually overnight, become a question of practice survival.
Medical providers around the world are facing this immediate challenge of providing patient care at a time when we can no longer touch or be close. Add to this the loss of medical support staff who choose to quarantine, and the result feels like sudden death for private practices.
Our dermatologists started to research what it would cost to implement a new EHR system with the ability to provide remote care. This was no small consideration, as they quickly realized. They would need new computers, enhanced communication abilities, a new digital security system, and better internet access for starters. In short, it felt impossible.
Fortunately, these doctors turned to their operations consultant for guidance in keeping their practice afloat. They did not understand the finer points of the CARES Act that was signed into law in March, providing doctors and medical facilities with a myriad of ways to navigate the unpredictable territory of COVID-19. Within one week, their consultant helped them implement an entirely new operations model. They did not need to buy new equipment or expensive software, and they did not need to lay off any of their employees.
Changes were made to the documentation tools used in the office. Instead of paper, a checklist-style format was designed that could be used on the doctors’ touchscreen Chromebooks, which would require no support staff to maintain. The documentation still meets all local, state, and federal requirements, but is much easier and faster to use.
Two laptop computers were set up solely to be used for virtual face-to-face visits with patients. Using readily available online tools and their existing software security, the doctors and their nurse could now “see” patients and maintain patient care.
Three of their five employees have chosen to quarantine but are able to continue working as a result of the new business model. Using remote access software that they already had on their server, the work-from-home employees are now scheduling appointments and calling patients proactively to help educate them on the new approaches. For patients that wish to have telephone check-ins, and for those with serious conditions that require ongoing attention, the remote employees with clinical credentials are indispensable for the provision of continuing care.
Nearly four weeks later, our dermatologists are busy taking care of their patients and delivering the same quality care that they have been known for dispensing over the past twenty years. For the most part, their patients have adjusted happily to the changes. Of course, patients that have urgent surgical needs are still able to receive in-person care, but the traffic flow in this small practice has been reduced to a very safe and manageable level. At this time, their consultant has projected that the practice can remain comfortably viable throughout this unpredictable time.
All over the world, people are being forced to adjust to a scenario that most had never imagined, without the luxury of time to adjust. This small dermatology practice is an example of how quickly and adeptly changes can be made with a little help and a calm approach.