Leveraging Health System Telehealth and Informatics Infrastructure to Create a Continuum of Services for COVID-19 Screening, Testing, and Treatment: A Learning Health System Approach

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic reached the US with little warning, and thus caught both public health and medical care delivery systems inadequately prepared to cope with the pandemic. Effectively screening, testing and treating the population for this dangerous virus became an unprecedented challenge for healthcare systems which were in parallel suffering enormous economic challenges in maintaining normal patient care. Most health systems have disaster plans, but the plans are focused on short-term events, such as mass casualties or hurricanes. The Medical University of South Carolina (MUSC) had a well-developed and tested disaster plan normally implemented to respond to disruptions due to hurricanes. An important facet of the plan is free Virtual Urgent Care (VUC) visits hosted by the MUSC Center for Telehealth. Through collaboration across multidisciplinary teams and strategic planning, four telehealth programs with corresponding informatics systems were deployed in the initial weeks of the pandemic: VUC screening, remote patient monitoring for COVID-19 positive patients, continuous virtual monitoring to reduce workforce risk and utilization of personal protective equipment, and the transition of outpatient care to telehealth. However, the speed, diverse needs, and high volume of services were unprecedented and thus these changes require extensive evaluation to better prepare for future challenges. This proposal aims to inform these choices through examining the effects of these four telehealth programs and corresponding informatics innovations as initial responses to the COVID-19 pandemic. Special attention will be paid to the ability of these innovations to address patient and healthcare worker safety and the provision of high-quality care. Additionally, continued surveillance of the consequences of these programs, including any unintentional exacerbation of healthcare disparities, will be examined along with the steps taken to mitigate these effects and close gaps in care for socially vulnerable populations. Our Specific Aims are to: AIM 1: Describe characteristics of programmatic interventions in screening, testing, and treatment and how the urgent COVID-19 requirements modified the standard telehealth or health systems processes; AIM 2: Measure and compare the health systems COVID-19 adjustments with regards to: overall patient volume, service uptake, delivery learning curves, and safety/quality indicators as they changed over time, with emphasis on differences observed for underserved and high-risk populations; and AIM 3: Assess population health outcomes, value, and cost from the perspectives of patients and providers with special attention to changes in access to acute care, emerging gaps in preventive care, unintended consequences of COVID-19 responses, differential effect on underserved and high-risk populations, and specific issues emerging in rural locations and in broadband "digital deserts". Study findings will provide evidence needed to transform care post-COVID to: improve quality of care, optimize value, support changes in payment regulations, and mitigate effects of racial, geographic, digital access, and economic disparities present in our current healthcare delivery systems.