All over the globe, health care systems have witnessed drastic changes over the past few months following the COVID-19 outbreak. While coping with the situation and accommodating those who were infected with the disease, there was a realization that continuity of care for non-urgent cases should be not be neglected. As a response to these unique requirements, there was increased adoption of virtual care and the shift in attitude towards it becoming the “new normal” to enhance patients’ experience through virtual clinics.
The Ministry of Health and Prevention (MOHAP) UAE with its patient-centric focus were very quick to embrace this change. While defining the “new normal” for their population, MOHAP devised a well-thought plan for continuity of care through virtual visits. This functionality would ensure that patients would keep on receiving their required care while minimizing their exposure during social distancing times.
Being one of MOHAP’s strategic partners, the Cerner team extended its support to establish all the required workflows and tools for making virtual visits possible. Cerner’s PowerChart® and PharmNet® tools are designed to deliver quality care while minimizing risks of exposure for patients and caregivers through telehealth and other digital technologies.
Experience from other healthcare systems shows that there are three important factors to consider when transitioning to virtual care are: First, ensuring that quality of care and adherence to standard practices are not compromised. Second, the maximizing of caregivers’ operational efficiency, especially where resources are extremely stretched. And third, ways to create a positive patient experience.
In response to the need of the hour, the Ministry, in partnership with Cerner, created virtual clinics and equipped its caregivers with all the required tools and workflows to manage patient care virtually. This adoption of telehealth strategies involved modifying patient management and clinical care processes.
A significant reduction in face-to-face patient care interaction was the main target for MOHAP. With the essential phases of clinical transformation and effective deployment of telehealth strategies in mind, the team identified areas of focus in outpatient workflows. The intention was to create a sustainable model of telehealth that would be scalable in the post-pandemic recovery stage as well. Cerner took into consideration all aspects of people, process, and technology while designing the solution while MOHAP focused on clinical consultation and medication dispensation in the outpatient settings.
Outpatient clinic workflow
With a vision of providing world-class healthcare to their patients, MOHAP did not let the situation impact their caregiving process. They innovated new workflows and adjust to the unprecedented situation. MOHAP & Cerner joined forces to design an end-to-end workflow that would establish telehealth at their outpatient clinics, starting with familiarizing patients with the telehealth concept and establishing e-clinic workflows that include registration, nursing assessments and physician consult. A detailed workflow was developed encompassing telephone and video conferencing options.
Patients are now given options to choose the mode of telehealth consultation (video or telephone) and receive a short messaging service (SMS) detailing the steps to access the telehealth service remotely. The MOHAP registration team engages with the patient before consultation and an “e-clinic” encounter type is created to identify patients availing telehealth services.
Nursing and physician documentations were designed considering virtual patient assessment requirements and MOHAP documentation standards. A specific Cerner MPages® workflow was built embedding guided documentation for caregivers and nursing forms were designed incorporating subjective patient assessments and patient-reported results. Specific instances of e-clinic Dynamic Documentation™ were designed for each specialty clinic for physicians. The MPages® workflow became the default in the electronic health record (EHR) for caregivers based on the e-clinic visit type. In addition, caregivers had tools for COVID-19 screening as part of the workflow.
Pharmacy workflow
MOHAP initiated medication delivery to patients post-consultation to forego personal interactions when patients collect their medication and adhere to COVID-19 protocols. With this change, one of the crucial challenges that stood out was medication education for patients. Pharmacy-patient engagement is important to educate patients about medication adherence. In a virtual environment, apart from getting the medications to patients on time, another important aspect that cannot be compromised is the quality of the patient experience. As we strive to make the medication process safer and faster for patients, the personal interaction whereby a pharmacist may educate a patient is an important factor in the patient’s experience. Whether it be answering patients’ concerns or explaining the possible side effects of a medication, patient education plays a major role in medication adherence.
Two pharmacy processes were considered when developing virtual pharmacy workflows: prescription dispense and medication refill. Cerner developed a custom MPages view that helps alert patients via SMS with information to guide them to join pharmacy virtual education sessions. Pharmacists are then able to educate patients thoroughly on their medications and answer any concerns.
A medication refill worklist was built to track all the patients who are due for refills, allowing pharmacists to proactively contact patients and deliver the medications to their homes. This is a significant step forward in helping patients with chronic diseases manage their illnesses and ensuring medication adherence.
MOHAP is focused on the quality of care and patient satisfaction and this element was not ignored amidst the pandemic as well. MOHAP partnered with Cerner to send surveys to patients to assess patient satisfaction in medication delivery and pharmacy e-clinic, the new pharmacy services introduced during the pandemic. We used the OPENLink™ platform to interface with the SMS gateway. Patient satisfaction was rated at 92% in May 2020.
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