Virtual care system designed for COVID-19 grows into a multiuse digital health tool

By Bill Siwicki

In 2019, Cleveland-based University Hospitals saw an opportunity to use automation and digital care technologies to improve patient engagement, clinical care and outcomes.



Ultimately, the health system was looking for ways to improve patient engagement first and foremost and then wanted to see how it could use automated tools to improve outcomes.

It also recognized the foundational changes occurring in the health system – especially when it came to consumer behavior and increased competition from nontraditional healthcare disruptors. The organization wanted to offer its patients tools and options that support their personal healthcare journeys in these ways.



“We implemented Amwell Automated Care Programs to help us achieve our goals,” said Dr. Brian Zack, system medical director for digital health at University Hospitals and associate chief medical officer at Ahuja Medical Center. “We first started with pre- and post-discharge chats with the goal of preventing readmissions and helping patients better manage their care after leaving the hospital.

“We now have about 18 chats available,” he continued. “Several are focused on chronic diseases, like asthma and diabetes. We also have one to help patients with congestive heart failure. Our goals for our chronic disease programs are more tightly linked to how we can prevent admissions in the first place.”

When the pandemic hit, University Hospitals’ use of automation to manage care for people with chronic conditions prompted it to consider: How could it leverage automation as a patient-facing symptom-checker for COVID-19? And how could it use the technology to determine when clinicians need to take a step away from clinical activity and get tested for the safety of themselves and their patients?

“We also needed a way to relieve the administrative burden of care for our team at a time when clinicians already were at risk of burnout,” Zack explained. “In 2020, half of physicians and clinicians reported feelings of burnout – and the numbers were even higher for medical assistants, nursing assistants, social workers and inpatient workers.

“Automating tasks that are routine and time-consuming enables frontline workers to focus on what they do best: providing medical care and emotional support,” he noted. “It also boosts their own feeling of connection with patients and their families, and increases professional satisfaction.”

In these use cases, care managers can focus on the higher acuity patients requiring intervention and allow stable patients to use the engagement chats as their principal contact modality, he added.



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During the pandemic, University Hospitals leveraged a public-facing patient symptom-checker – available on its website and through its digital app – to help patients determine: “Do I need to get tested? Should I stay home or isolate from my family? How do I use this information to manage my life?”

“That last point is key,” Zack stressed. “People don’t want to put their lives on hold each time they feel a little under the weather or fear they have been exposed to the virus. They want to know, with as much certainty as possible, what to do when, and for how long.

“We put a digital screening tool in place for consumers who were concerned they had COVID-19,” he continued. “During the first months of the pandemic, the screener provided a starting point for the tens of thousands of University Hospitals patients who were experiencing COVID symptoms during a time of high transmission.”

In doing so, this automated system strengthened the organization’s ability to manage capacity at its hospitals, urgent care centers and emergency departments. In effect, it gave the organization the tools to ensure the right patients received the right care in the right setting.

“We then leveraged this relationship to launch an employee screener for COVID-19,” Zack recalled. “During the Omicron surge, this became our primary tool for employees to be declared safe to go to work. Each day, employees would input their information into the tool to make sure they had the green light to attend work safely.”



The digital screener provided a starting point for more than 100,000 of University Hospitals’ patients who were experiencing symptoms of COVID to receive medical feedback from the safety of home.

“It kept patients from unnecessarily exposing others to the virus and – in instances where they did not have COVID – eliminated the risk of exposure in a healthcare facility,” Zack reported. “It also freed up overburdened physicians and nurses by providing patients with on-demand access to COVID symptom screening.

“Today, this tool continues to help protect capacity in the health system’s EDs and urgent care centers,” he continued. “Meanwhile, the ability to remotely screen our 29,000 employees gives our frontline workers peace of mind during each difficult surge of the virus. Employees used the screener more than two million times.”

University Hospitals also found that many patients liked the automated chats.

“The chats can not only track patients’ progress and vital signs, but they also can alert clinicians and care managers when interventions are needed,” Zack explained. “Ultimately, this helps strengthen relationships between patients and care managers.

“Care teams also benefited from how the chats enabled care managers to focus on interactions that allowed them to put their clinical judgment to use,” he added. “They also eliminated the administrative aspects of care that get in the way of relationship-building and contribute to clinician burnout.”

The chats have helped improve care for patients with chronic disease. Since 2019, use of chatbots to interact with patients with chronic disease has reduced readmissions among patients with chronic disease, improved health outcomes and helped build strong, trusting relationships with care managers, Zack said.

“More than 2,162 patients have used the tool to date,” he reported. “It’s a solution that increases care touchpoints for people with asthma, diabetes, heart failure and more without putting added stress on care-delivery teams and care managers.”



One of the biggest lessons University Hospitals learned has been around communications.

“Generally, patients really like the chat, but we found much better engagement results when doctors communicate the solution as an important part of the care-management process,” Zack advised. “This type of communication from doctors and care teams is key to help patients understand the value and utilize the solution.

“When implementing digital platforms, it’s also important to design KPIs that are attainable and reasonable – including around engagement,” he continued. “For instance, we’ve found there is a significant difference between patients who engage once, those who engage more than once, and those who don’t engage at all.”

Through data capture and analysis, the health system is beginning to gain a greater understanding of who these populations are, and how it can make opportunities for digital care management available to more people via an engagement strategy that resonates with each patient.

“Finally, my biggest advice is to establish an intake process for digital health implementation,” Zack said. “This will help you define your organization’s goals for the platform and build a program that provides value.

“Be very clear about what you are trying to achieve, and make sure you have access to pre-intervention data,” he concluded. “If you don’t, you will be working 10 times as hard to put that data together later as you evaluate the ROI.”

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