Stories from health care’s front lines: A virtual explosion of virtual care

By Walter Neary

Six weeks ago or so, MultiCare’s Retail Health Virtual Care team thought it was a busy day when they “saw” 60 patients online. Patients who logged in to use the service were seen by the core team of two nurse practitioners, backed up by Retail Health leaders and a few others. As they moved into 2020, the team was ready to tackle their major business goal for the year: to raise virtual visits 30 percent, from 5,000 total visits in 2019 to 6,500 in 2020.

And then came COVID-19.

“It’s keeping us on our toes, for sure,” says Stephanie Cowan, DNP, ARNP, Clinical Care Director for Virtual Health.

The morning of Monday, March 2, the Retail Health Virtual Care patient queue exploded with patients, and the team scrambled to get the virtual care questionnaire they use to screen patients adjusted to incorporate questions about COVID-19.

As COVID-19’s spread in Washington increased, there was a lot of concern about people who might be sick with the virus showing up at clinics and in EDs. And so, in the earliest days of the COVID-19 outbreak, the Retail Health team proposed making COVID-19-related visits free, an idea supported wholeheartedly by leadership in the organization.

“We felt this was a way to keep people out of the EDs and the Urgent Cares, and not expose our staff to anything or getting exposed themselves,” Cowan says. “And for some people, $25 can be a big thing. We wanted to serve the entire community.”

The decision to offer free care won thanks from people on social media, politicians and the media. And word of this offer went around quickly. The core Virtual Care team knew they were going to need more than two people to start taking calls.

“We knew we were going to need a small army,” says Ben Chao, Program Director for Virtual Health.

The call for help went out. The first new recruits were other members of the Retail Health team. Two clinical care directors, Shane Brooks, DO, who leads several brick-and-mortar urgent cares in King County, and Hillary Arnold-MacLeod, DO, responsible for several clinics in East Pierce and Thurston Counties, offered to help because both had been pondering doing virtual visits.

“The numbers were daunting,” says Dr. Brooks of the number of visits being requested of the on-demand, online service. “There were hundreds and hundreds of patients. We’d never seen anything like it.”

That’s not an exaggeration. During their busiest week in March 2020, it was common for the team to have to manage 800 to 900 visits a day. From March 1 to March 17 alone, they served 7,700 patients.

Once trained, the pair quickly helped to train others. Through calls, email and a Microsoft Teams network, a lot of people learned how to provide care through the Retail Health virtual care platform. People were supporting each other, and right away.

“It was the old medical school saying come to life,” Dr. Brooks says. “See one, do one, teach one.”

Today, more than 60 people from all parts of MultiCare are trained and helping with Retail Health’s Virtual Care service.

New members of the Virtual Care provider team are nurse practitioners and physicians from both the Inland Northwest and Puget Sound regions, representing primary care, the service excellence team, OB/GYNs and a handful of pediatricians, including James Wu, MD, who normally practices at Mary Bridge Children’s.

“I wanted to prevent unnecessary Mary Bridge ED visits to decrease unnecessary exposures to patient and staff — as well as decrease patient load in the ED,” Dr. Wu says “I also wanted to experience a new way to practice medicine.”

So far in 2020, the team has helped nearly 16,000 patients. Volumes now seem to have “normalized” at several hundred calls a day, but the team is ready for anything, including any surge.

“I’m grateful for how many people who have trained to contribute to the platform,” Cowan says. “I hope we don’t have to utilize this many people again, but we’re much more ready if we do. Being prepared is important.”

“Having this program running pre-COVID has put us at the frontline for being prepared to use it during COVID. Not just to screen but to continue to take care of all our patients across the carelines,’ says Dani Henderson, DO, an OB/GYN who was part of the group who rallied to help. “It helps us to do what we can to flatten the curve.”

Virtual health at MultiCare

Virtual visits at MultiCare are now available throughout our system, from e-visits through our Retail Health Virtual Care service, to online appointments with your regular doctor. Read more about Virtual Health options at MultiCare.