JHM Telemedicine: Data Review and Equity Dashboard

June 28th, 2021

Brian Hasselfeld, MD – Medical Director, Digital Health and Telemedicine

2Telemedicine Visit Volume TrendsMonthly Comparison

15,349

70,540 75,619

72,589

59,494

50,177 48,409 48,798 46,484

54,218 51,457 52,421 52,365

47,132

39,523 9,534

18,909

18,377

19,065

14,338

11,205 10,207 9,672

8,857

9,601

9,142 9,264 9,293

8,299

6,651

52 64 65 73 55 74 86 70

24,883

89,449

93,996 91,654

73,832

61,382 58,616 58,470

55,341

63,819

60,599 61,685 61,658

55,431

46,174

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May

Video Phone

Total COVID Volume: 956,989

Total FY'20 Pre-COVID Volume: 539

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

2-Mar-20 2-Apr-20 2-May-20 2-Jun-20 2-Jul-20 2-Aug-20 2-Sep-20 2-Oct-20 2-Nov-20 2-Dec-20 2-Jan-21 2-Feb-21 2-Mar-21 2-Apr-21

Telemedicine In-Person Pre-COVID FY Daily Volume Average

3Telemedicine Visits vs. In-Person VisitsTotal Ambulatory Volume Major snow

events▪ Telemedicine

volume peaked in April / May

▪ Stabilized over last 6 months

▪ Total volume remains around pre-COVID projected volume (to date, telemedicine substitute and not additive)

*Note: Orange (in-person) and blue (Telemedicine, including both video and audio-only visits) are stacked (not overlapping)

4Telemedicine vs. In-Person VisitsAmbulatory Volume

▪ When excluding “telemedicine insensitive” areas (i.e., Lab, Radiology), telemedicine visits have been approximately 28% of “telemedicine sensitive” ambulatory care so far in CY 2021

▪ Care remains distributed across multiple primary care and subspecialty verticals

% telemedicine (1/1-3/15/21)

*Note: Excludes “telemedicine insensitive” visits, such as lab, radiology.

86.1%

79.7%

59.6% 58.0%55.3%

49.4% 48.9%

29.6% 29.5% 28.2%23.8% 23.7% 23.2% 22.9%

17.3% 15.3% 15.3%

9.8% 8.7% 7.5% 7.2%

0.4%

5Out of State Continuity of Care and Telemedicine

• Telemedicine encounters to states other than MD, FL, DC*: 68,449

• Represents ~9% of total completed telemedicine encounters through Feb’21

• Out of state Telemedicine encounters in 4 border states (85% of total OOS):• VA: 27,693 (40%)• PA: 20,140 (29%)• DE: 6,198 (9%)• WV: 4,086 (6%)*Note: As of February 2021

6

Patient and Provider Expectations

7

Satisfaction with Provider?

Recommend to Friends / Family?*

Important to Have Video Visit Options?*

✓ Rating JHM providers 94/100 in nearly 72,000 surveys in the last 12 months

✓ Median response 9/10 (where 10/10 = Extremely Likely)

✓ 88% stated would be moderately, very, or extremely important

Patient Satisfaction with Telemedicine

*Based on 674 responses from 1,935 surveyed patients

8Provider Expectations around Telemedicine

▪ Provider telemedicine survey sent to ~3,600 providers who have completed a telemedicine visit in last 12 months

▪ After 2 weeks “in the field”, 1,342 responses (37.5% response rate)

▪ How often do you feel you can provide clinically appropriate, high-quality care via telemedicine in comparison to in-person visits?

▪ New patients: Mean 41%, Median 31% ▪ Established patients: Mean 60%, Median 70%

▪ What percentage of your schedule template would you like to have open for telemedicinevisits?

▪ Mean: 40%▪ Median: 30%

9Provider Expectations around Telemedicine (cont’d)

Assuming you had the necessary equipment, where would you prefer to conduct most of your telemedicine visits after the COVID-19 pandemic? (multiple responses permitted)

67%

50%

41%

Your home Your clinicallocation on campus

A non-clinicallocation on campus

(e.g., office)

What statement best describes how you would prefer to conduct telemedicine visits after the COVID-19 pandemic?

44%

31%

26%

Dedicated telemedicine/ virtual only

Mixed - with restrictions(i.e., only beginning or

end)

Mixed - no restrictions(i.e., can alternate, etc)

10Provider Expectations around Telemedicine (cont’d)

What barriers have prevented you or your patients from using the Cisco platform? (multiple responses permitted)

25%

28%

39%

46%

58%

61%

63%

66%

Cisco missing functionality (e.g. chat, screen share limitations)

Patient preference for other video technology

Patient preference for telephone

Patient had trouble completing the MyChart eCheck-in process

Patient does not have a MyChart account activated

Cisco audio connection issues

Cisco video connection issues

Patient internet connectivity issue

11

Telemedicine Equity

12Telemedicine Equity Working Group

1. Identify populations experiencing telemedicine access disparities?2. Develop and implement plans to promote more equitable delivery?3. Measure impact on equity and outcomes?

• Use telehealth equity impact assessment framework/toolkit

• Develop and Review Telemedicine Equity Dashboard

• Develop 1-2 target populations/SMART aims

• Present aims to quarterly telemedicine equity leadership steering committee

• Track implementation/progress

• Discuss scholarship opportunities

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14

15

16

JHU 21st Centuries Cities Initiative

21213 – Bel Air Edison 2,898 visits in the past 3 months

38% by Telephone

17

Institutional average 18% phone

21213 - Bel Air Edison37% phone

21216 – Mondawmin36% phone

21205 – North East of JHH35% phone

21222 – Dundalk33% phone

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