Article

3-minute case study: Enabling pediatric practice and patient health during COVID-19

By Carley Thornell | April 2, 2020

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Across the athenahealth network and beyond, healthcare organizations are designing and implementing simple interventions with outsized impact on outcomes, satisfaction, and success. Here's another.

The problem

Thankfully, children are not at high risk to fall severely ill from the coronavirus. But a shortage of personal protection equipment for medical staff and parents concerned about exposure at medical offices threatened to disrupt “business as usual” for ESD Pediatric Group after the onset of the COVID-19 pandemic. Wellness visits and immunizations are core contributors to pediatric practice profitability, and this two-office private practice in Cincinnati, Ohio, is no different. Dr. Jeff Drasnin and his colleagues knew they had to get creative quickly with how they schedule, examine, and treat patients.  

The solution

ESD was able to quickly adopt Doxy.me as their telehealth solution, and appointments are created in the athenahealth EHR. Providers have their telehealth platform open on a screen side-by-side with the child’s athenaClincals records. This also opened up new unfulfilled opportunities for online behavioral health visits, requests for which can spike during times of crisis. Previously, these services were only offered in-person.

But beyond ESD’s technological solutions, they came up with myriad creative physical workarounds. While telehealth screens gave physicians the opportunity to evaluate children feeling ill — which in large part keeps these sick children away from others outside of their homes — they were able to schedule these patients in person if needed at no additional cost for parents. By splitting their two offices — one in Cincinnati’s Hyde Park neighborhood, the other in Milford — into separate camps for well and ill patients, respectively, ESD was able to continue scheduling wellness visits. The timing of such visits is imperative for children under the age of 2 especially, as vaccinations and newborn exams must be conducted in-person. Such visits are the key to sustainability, too. “Well visits are the financial lifeline of a pediatric practice and if they are not maintained, the office will struggle,” said Dr. Drasnin. “We want our patients to keep well checks, and we want to keep them to safe.”

In order to enable best practices for social distancing, the Hyde Park location has adopted several other measures. Waiting rooms are closed, and parents are instructed to send a text message to the front office when arriving. Families are asked that just one parent attend their child’s visit, and whoever attends is met at the door so both family members can have their temperatures taken by a nurse. Anyone measuring over 100.5 degrees is not admitted.

He explains that the Milford “ill” location only sees a small number of low-risk patients due to effectiveness of the telehealth pre-screenings. ESD has been able to preserve a limited supply of personal protection equipment and provide all staff with N95 masks since they aren’t being used at the “well office.” The Milford location also has a novel approach to testing: if the telemedicine visit determines the need, drive-up procedures can be conducted for mononucleosis, influenza, and streptococcal pharyngitis (strep throat). Nurses have PPE to perform tests in the car, and parents are later phoned with the results.

The outcome

Adopting new methodology in a time of crisis opened up new opportunities for ESD providers and their patients. It’s oftentimes more convenient to conduct behavioral health visits online, especially since parents may have to take time off from work to drive a child. Doctors can also potentially increase the number of patients they examine. Now, each ESD provider can see 18 to 20 patients comfortably per day using their telehealth solution complementing athenahealth services.

Dr. Drasnin admits that while tests performed in parents’ vehicles may be a temporary COVID-19 workaround, “sometimes perfect medicine is not the most practical thing.” ESD’s creative caretaking goes beyond baby steps, so that the practice is still able to encourage older kids to come in for regular exams and ensure practice sustainability — and reduce stress for patients and providers alike.