Abstract:

The influence and success of Health Information Technology (HIT) in delivering virtual clinical care, depends on Technology Readiness (TR) of the care providers. Health systems all over the world are being recently challenged during the COVID-19 pandemic to offer alternative delivery systems of care. Expeditious integration of clinical applications in existing Electronic Health Record (EHR) using the ISO/IEC 9126 criteria was used to scale up the use of multiple telemedicine (TM) modalities and supporting technologies. In our safety net systems, rapid introduction, education, and training of academic clinical faculty and efficient utilization of these technologies, helped underserved patients get access to virtual care, compelling an investigation into the proclivity and influencers of the switch from zero to thousands of TM visits in a single month. The purpose of our study was to examine the engagement of academic clinical faculty in using these modalities, assess the quality of virtual care provided from the user standpoint (patient satisfaction), and determine the TR of the faculty to integrate ongoing utilization of telemedicine in future practice.

Methods:
The central database of our health system reported the use of modalities by 200 Faculty from two medical schools, staffing 25 community clinics in the SW area of United States. Using Feb 2020 visits as baseline, the data was studied for the first 90 days of the pandemic. Patient satisfaction data during this period was collected by a third party NRC Health using a 16 item questionnaire to determine the quality of virtual care. One the other hand, The Technology Readiness Index 2.0 was used to guide the development of a faculty survey to determine a) Attitudes and b) Utilization. The areas assessed were 1) Perceived ease of use of modality 2) Efficacy of modality in replacing or augmenting in-person visits 3) Utilization of modality and HIT tools 4) Overall self-assessment of efficiency with EHR. The faculty also rated the value of the educational series placed for their training. SPSS software analysis of this data was planned.

Results:
81.801 in-person visits at baseline with zero virtual care were converted to 37,095 virtual visits within 30 days increasing to 45,419 at the end of 90 days with 43,124 telephonic and 2295 video visits. At the end of the period, these TM visits outnumbered the 34,937 in-person visits. In summary, there was minimal interruption in care during the pandemic related lockdown due to TM. Third party patient satisfaction data for the same period reflected a 3.49% rise in patient satisfaction with the operations and 5.5% reported increase in patient education with these encounters. The modified TR survey of the faculty was sent to the 100/200 faculty in the first phase and ratings of the educational training sessions results are being analyzed.

Discussion:
TM is a valuable and sometimes indispensable delivery method for clinical care. The increased efforts of health systems to offer TM options for its patients rest on the technology readiness of its faculty and interactive educational training sessions. Additionally, the option of multiple modalities elevates the message of health equity. Telephonic visits are the preferred mode of virtual care in underserved populations. The educational component of clinical care in virtual visits is perceived to be equal to in-person visits.

Keywords:

Health information technology, telemedicine, academic faculty, technology readiness, patient satisfaction, patient education.