Optimization of telemedicine in advanced practice provider (APP) led oncology/hematology remote-only clinic.

Abstract

523 Background: To continue quality timely patient care telemedicine usage increased during the COVID-19 pandemic. A systematic review of the literature supports the use of telemedicine beyond the pandemic. The goal of this quality improvement (QI) project sought to identify barriers and promoters to sustain telemedicine visits for adult oncology/hematology patients seen in the Virtual Advanced Practice Provider (VAPP) clinic. A Telemedicine Toolkit (TT) was developed for providers to enhance and improve the provider/patient experience. Methods: Retrospectivedata retrieved from EMR/VAPP included details from 1,985 patient visits for March-August 2022 to investigate how to optimize the specialty care visit. Over a 10-day period, staff completed pre/posttest surveys to assess engagement and satisfaction with TT. Results: The data points from the statewide EMR and VSee platforms showed the patient median age was 62; age range seen 19-95. More females were seen at 65% (1290) than males at 35% (695); predominant race/ethnicity was white at 47.5% (943). The main diagnosis seen was breast at 28.86% (573), then lung at 7% (127), followed by colon at 6.90% (137). Visit type from high to low: the teaching visit at 44.5% (884), standard follow-up visit (toxicity checks and hospital follow-ups) at 32.9% (645), new genetics visits at 11.5% (228) and follow-up genetic visits at 7% (138), Advance care planning visits (ACP) at 3% (58), urgent care follow-up visit at 1% (24) and the high-risk/preventive care at 0.4% (8). Nearly 250 locations were served predominantly in central Texas. Patient devices used included iPhone/IOS at 48%, Windows OS at 27.5%, Android at 20.5%, and Mac OS at 4%. Conclusions: The VAPP clinic with a robust infrastructure, is now serving the entire state of Texas. The staff noted the TT to be intuitive and helpful. Sustainability of the TT through updates and continued staff education is essential. This project did not find a significant problem with Wi-Fi services and the most common reason for an aborted/canceled visit was the patient did not remember their Apple ID/Google password to be able to download the VSee application. Patient education prior to visits regarding Vsee needs would potentially reduce canceled/aborted visits.