Provider Perspectives Regarding Ambulatory Telemedicine at a Large Academic Health System During the COVID-19 Pandemic.

Purpose: To understand provider preferences regarding telemedicine across clinical departments and provider demographic groups. Methods: A cross-sectional online survey was distributed to providers at Johns Hopkins Medicine who had completed at least one outpatient telemedicine encounter. The survey included questions about clinical appropriateness and preferred use of telemedicine. Demographic data were obtained from institutional records. Descriptive statistics provided a profile of provider responses. Wilcoxon rank sum tests evaluated departmental and demographic differences. Results: A total of 1,342 of 3,576 providers responded (37.5%). Providers indicated that telemedicine was clinically appropriate for new patients a median of 31.5% of the time (Range: 20% in pediatrics, 80% in psychiatry/behavioral sciences). For existing patients, providers indicated that telemedicine was clinically appropriate a median of 70% of the time (Range: 50% in physical medicine, 90% in psychiatry/behavioral sciences). Providers desired a median of 30% of their schedule template be dedicated to telemedicine (Range: 20% in family medicine, 70% in psychiatry/behavioral sciences). Providers who were female, had fewer than 15 years in practice, or were psychiatrists/psychologists tended to find telemedicine more clinically appropriate (p < 0.05). Conclusions: A majority of providers across clinical departments felt that high-quality care could be delivered through telemedicine, although the amount of care varied widely based on department and patient type. Preferences for future telemedicine similarly showed wide variety across and within departments. These findings indicate that in this early adoption phase of widespread telemedicine integration, there is lack of consensus among providers about the amount of telemedicine appropriate for everyday practice.

A Process for Developing a Telehealth Equity Dashboard at a Large Academic Health System Serving Diverse Populations

Johns Hopkins Medicine (JHM) rapidly implemented telehealth system-wide as part of its COVID-19 pandemic response. In a four-month period (January–May, 2020), video visits across the system increased more than 1,000-fold (from approximately 80 to 80,000 per month). For vulnerable populations, telehealth may reduce or exacerbate disparities in access to and quality of care. To enhance equity in telehealth access, we must assess, in the moment, how system-wide digital health strategies affect vulnerable populations. In this commentary, we describe how we are developing a telehealth equity dashboard and our plans to apply the data for system-wide improvement in telehealth access. We describe key elements of this process including the composition of the team involved in dashboard creation, how a telehealth impact assessment tool can be used to determine which measures to track, and how dashboard data will inform action across the system to advance equity in telehealth.