Maimonides Medical Center is an academic medical center located in Brooklyn, New York. It is Brooklyn's largest hospital, with more than 600 beds, 6,500 staff, 43,000 annual inpatient discharges and 600,000 annual outpatient encounters.

It is Brooklyn's tertiary care hub serving diverse communities that have large Medicaid, Medicare and uninsured populations. It was an early adopter of electronic health records and sponsored one of New York State's first health information exchanges.

THE PROBLEM

In 2018, Maimonides' leadership established digital health as a strategic priority for the medical center. At the time, Maimonides was not engaged in any telemedicine or other digital health initiatives. It was falling short of its patients' expectations in an increasingly digital world, and it was at a competitive disadvantage relative to peer organizations in the market.

"I was asked to lead this new department, charged with crafting and executing a digital health strategy that would be dynamic [and] responsive, and enable Maimonides patients and consumers to engage with our providers easily and effectively," said Rob Cimino, vice president of digital health strategy and implementation at Maimonides Medical Center.

"Our long-term goal is to advance and evolve digital capabilities that ensure optimum patient experience and benefit from innovations that allow for seamless care access and delivery.

"To ensure a broad range of perspectives, we formed a steering committee composed of clinical and administrative leaders from across the organization who were engaged and eager to support these efforts," he continued. "By late 2019, we created a definition of digital health to differentiate our responsibilities from those of our colleagues in IT and marketing, with whom we collaborate to align objectives, assets and resources."

Together, the teams engaged in research and dialogue with other health systems that were further along in their digital journeys. These efforts allowed Maimonides to identify four key virtual care technologies that were areas of focus, aligned with Maimonides strategy: virtual patient visits, virtual consults, e-consults and remote patient monitoring.

"At the same time, we were scrambling to stay abreast of the changing COVID-related telemedicine regulations, hunting down webcams, speakers and headsets for hundreds of providers, and doing everything possible to support our heroic frontline colleagues."

Rob Cimino, Maimonides Medical Center

"At the end of 2019, my team's commitment to the medical center was that we would research available solutions and pilot each of the four target virtual care models in 2020," Cimino recalled. "We identified leading vendors for each of the four models and began evaluating potential solution providers with whom we could partner. And then March came."

PROPOSAL

Cimino focuses here on virtual visits – telemedicine – because this was the foremost priority of Maimonides prior to the pandemic, identified as an essential opportunity to improve patient experience and address the increasing patient demands to engage in healthcare through digital channels.

"It is impossible to describe what came next without the context of COVID-19," Cimino said. "New York City, and specifically the region of Brooklyn served by our institution, was the epicenter of the first COVID wave in the spring of 2020. At that time, we had a department of three people, no virtual visit platform in place, and no experience training providers in telemedicine.

"Fortunately, we had learned a great deal from our RFI process at the start of 2020," he added. "With the full support of our executive leadership, we made several significant, high-dollar strategic decisions in a matter of days."

Telemedicine technology and services vendor Amwell could support Maimonides' initiatives, and it offered options to deeply integrate its virtual-visit technology into Maimonides' planned patient mobile app. 

Maimonides signed an enterprise agreement with Amwell for its home (scheduled virtual patient visits and virtual urgent care) and hospital (virtual consults) technologies and purchased a small fleet of telemedicine carts.

"Amwell was able to support the immediate deployment of virtual care technologies, a critical capability given the urgency of the situation regarding COVID-19," Cimino said. "Amwell was inundated with requests for implementations. We launched on a temporary, shared Amwell environment, while we planned and configured our own, branded instance of their technology."

MARKETPLACE

There is a wide variety of vendors of telemedicine technology and services on the health IT market today. Healthcare IT News has published a special report listing many of these vendors, with details about their products and services. Click here to read the special report.

MEETING THE CHALLENGE

Faced with the dual challenges of rolling out multiple technology platforms and training staff and providers to conduct virtual visits, Maimonides engaged Health Management Associates, a specialty consulting group that supported Maimonides' RFI work, to augment staff with a team of project managers and trainers.

"A small internal telemedicine workgroup – one of many formed to address the myriad challenges of COVID – prioritized and sequenced our specialties and practices for virtual visit training and implementation," Cimino explained. 

"Our award-winning Cancer Center was the first to be trained, partnering with my team to refine the implementation processes and training, while allowing them to engage their fragile, high-risk patients virtually through the new Amwell platform.

"At the same time, we were scrambling to stay abreast of the changing COVID-related telemedicine regulations, hunting down webcams, speakers and headsets for hundreds of providers and doing everything possible to support our heroic frontline colleagues."

By August, Maimonides had trained hundreds of providers and staff to adapt workflows, develop effective "web-side" manners, and use the Amwell platform to deliver care to more than 1,500 patients. While they waited for Maimonides implementation teams to get to them, providers did what they needed to do to engage patients remotely – on Zoom, WebEx and FaceTime.

"In November of 2021, we launched MaimoCare, our new patient app and digital front door, which features a full SDK implementation of Amwell's virtual visit technology for patients, as well as an API integration with our R1/SCI scheduling platform that allows patients to self-schedule appointments," Cimino said. 

"The app is built on Unqork's no-code platform and integrated with solutions from Okta (access management), Verato (enterprise master person index) and LexisNexis Risk Solutions (identity proofing).

"Our systems integrator for this project, and several others underway, is Persistent Systems," he added.

"We've come a long way in two years."

RESULTS

"The 'we' in 'results we have achieved' is not about my team," Cimino explained. "My team is amazing and I am proud of the work they have completed during such challenging times, but our achievements are the result of many collaborations across our entire organization. In some regards, the technology efforts – significant as they are – pale in comparison to the change management required to bring these solutions to our patients and providers.

"Virtual care is now implemented across all Maimonides ambulatory practices, with more than 400 providers trained and, on average, 2,000 patients – 7% of all ambulatory encounters – engaged through virtual visits each month," he continued. "In some practices, there are visit types that are now 'virtual by default' unless the patient is unable to engage virtually."

Maimonides has a dedicated training and support team that works with staff, providers and patients across all digital health initiatives.

USING FCC AWARD FUNDS

Maimonides Medical Center was awarded $1,000,000 by the FCC telehealth award program for

• A telehealth platform
• A remote patient-monitoring platform
• Telemedicine carts that were deployed at newly configured remote inpatient sites as part of response to the surge in patient volume due to the COVID-19 emergency
• Remote monitoring equipment installed in COVID-19 inpatient rooms to reduce the staff required to manage intensive care units, to allow clinicians to quickly make critical healthcare decisions and initiate appropriate intervention based on alerts generated from central monitoring

"We were very fortunate to have been among a handful of organizations who received the maximum funding through the 2021 FCC award process," Cimino noted. "We had already engaged with Amwell for hardware [and] virtual-visit and virtual-consult technology. Additionally, we funded a remote patient-monitoring program with Philips, and used the FCC funds to help finance inpatient video monitoring systems to reduce staff exposure to COVID and PPE utilization in the hospital.

"The FCC funding allowed us to support these programs when the financial pressures of COVID might otherwise have forced us to make alternate decisions," he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.