Telemedicine for cancer care: implementation across a multicenter community oncology practice.

ABSTRACT

PURPOSE: To describe onboarding and utilization of telemedicine across a large statewide community oncology practice and to evaluate trends, barriers, and opportunities in care delivery during the coronavirus disease 2019 pandemic. METHODS: We describe telemedicine onboarding and utilization across a statewide oncology practice, covering 221 sites of service and more than 650 practitioners. We describe qualitatively the onboarding process of a diverse set of administrative, technical, and clinical partners. We describe quantitatively utilization throughout the practice. We describe a survey conducted to enlighten barriers and opportunities for optimal utilization. RESULTS: Multistakeholder education was directed to clinical teams, administrative and technical support staff, and patients through webinars and team meetings. Utilization was high from April through October 2020, representing 15% to 20% of new-patient visits and 20% to 25% of established-patient visits. In a survey offered to all clinicians, 96% of respondents indicated they are using telemedicine, with 33% using it for more than 25% of patient encounters. Among respondents, 59% reported that the use of telemedicine helps expedite diagnosis and treatment more than seeing patients in person in the clinic, 55% of respondents managed urgent issues by telemedicine, 80% believed that patients benefited From urgent assessment by telemedicine, and 57% believed an emergency department visit or a hospitalization was avoided because of a telemedicine visit. Most clinicians reported that patients enjoy benefits of telemedicine because of decreased exposure risk, decreased transportation requirements, and ease of including caregivers in the visit with the treating clinician. The most common barriers to patients accessing telemedicine were technical challenges and broadband access. Despite this, less than 5% of respondents routinely use telephone-only communication, as most typically use bimodal audio/video communication. Many clinicians have expansion ideas on how telemedicine can further expand the longitudinal care delivery for our patient population. CONCLUSIONS: Telemedicine can be implemented successfully across a large statewide oncology practice and service a high volume of patients. Clinicians utilize telemedicine for new and established patients with minimal dysfunction. Clinicians believe patients benefit From telemedicine For new, established, and urgent care visits. Broadband access functionality should be explored to optimally serve our patient population.