Primary Care’s Transition from Office Visits to Virtual Visits

As the COVID-19 pandemic began to surge in South Carolina, MUSC Health Primary Care providers faced a challenge: How do we continue to meet the Lowcountry's everyday health needs? While many news outlets focused on the statistics around the declining number of people in the emergency room for conditions like heart attacks and stroke, primary care offices noted a concerning decline in visits for managing chronic diseases and treating common illnesses.

To address this decline, MUSC Health Primary Care quickly transitioned to online video visits on the doxy.me platform, which allows for a secure audio and video connection with a patient. In less than one month, MUSC Health Primary Care was able to train staff, update schedules, set up home offices and begin to see patients through this online platform.

Marty Player, M.D., a family medicine physician, professor, and codirector of Primary Care Telemedicine, explained that MUSC Health Primary Care was able to move so efficiently because "MUSC has been building and working in telemedicine for many years now." Player noted that MUSC houses the South Carolina Telehealth Alliance and highlighted MUSC's continued investment in developing and expanding telemedicine options.

"We already had telehealth services in place on a smaller scale well before the pandemic. When the first shutdown came, we had people at every level of operations in place with knowledge and experience using this technology. It was a matter of scaling that up, which took a good deal of effort but happened quickly, I believe, because we had the basic knowledge and resources in place." 

One example was a remote patient monitoring (RPM) program for patients with diabetes and heart failure that was in progress. Player said, "The full program had not started, but the protocol and build were well underway. We placed that on hold and turned it into an RPM program to monitor COVID-19-positive patients from home. If they showed signs of worsening, we could intervene faster. That happened very quickly because of the work we had already done."

Patients and primary care providers reacted positively to the transition. Video visits are typically more convenient for patients because they allow for increased appointment availability and because patients can use their phones or computers to talk to their doctor from any location with an internet connection. A video visit can address most medical concerns, and if a provider uncovers an issue, the patient can be routed to the correct point of care, such as an in-person appointment, a follow-up call or an emergency room visit.

Player said, "We know from our research and from other institutions that telemedicine can provide just as high-quality care as an in-person visit for many acute-type visits when designed and targeted correctly. However, the care has evolved. With the novel coronavirus pandemic, we are doing a lot more care for chronic conditions like diabetes, hypertension and depression. We have been able to rely on patients checking their own weight, blood pressure and blood sugar so we can continue to treat these conditions.”

Physicians also learned that some physical exam elements can still occur by video; for example, doctors can still look at a rash or have patients perform joint movements over video.

"There is also value with videos that I believe improved care. Often family members appeared on camera with patients, and I could speak with them. These same people may not have been available to come to an in-person visit. I've had patients gather all their medication bottles and go through them in the video visit. Very often, patients do not remember to bring in all their medications to the office."

"Of course, there are challenges, too," said Player. “In the short term, a poor internet connection limits a visit's usefulness, and some issues need in-person evaluations and lab work. As the use of telemedicine grows, this question remains: Who is unable to access virtual care? Despite all we had in place to make it as easy as possible, we may have missed some patients due to lower health and technology literacy, limited access to internet connections, lack of trust in technology, and so forth. These are all areas we will need to continue to investigate and improve, as I believe broader uses of telemedicine are here to stay."

Thanks to the entire team’s rapid transition to telehealth, MUSC Health Primary Care improved patients' access while maintaining safety and continuing to provide high-quality, patient-centered care throughout the pandemic.

Player concluded, "This has been a tough year for many of us personally and for our colleagues, patients and families. I'm sorry we've seen so many pass from this virus. Two or three weeks in early spring are a blur to me. It was a massive undertaking to get our large academic medical system, which is vital to our state and region, transitioned over to virtual care. The work, dedication and collaboration of so many is heartening. At a time that was scary, confusing and uncertain, we were able to identify the problem before us and quickly implement a solution for the good of our state, our institution and, most importantly, our patients. It's not surprising, but in these times it is remarkable."