Even before the pandemic, safety net health clinics wanted a secure, HIPAA-compliant digital solution to their paper form-filling woes. Once the COVID-19 crisis emerged, the need to move paperwork to patients’ phone, tablet, or computer became still more pressing. Enter mobile-friendly online intake forms to collect patient information that patients can complete from any device from anywhere. And a bonus: Some automated programs were easily integrated into existing electronic health records.
During the swift ramp-up to telehealth required by the pandemic, health clinics like Petaluma Health Center and West County Health Centers embraced online form solutions to help serve their patients remotely to deliver quality, compassionate virtual care accessible to all as part of CCI’s Connected Care Accelerator.
Petaluma Health Center: An urgent need to streamline workflows“I just consented. It was easy.” --PHC Patient In the fall of 2020—six months into telehealth services—it became urgent for the Petaluma Health Center to streamline its workflows. Providers, medical assistants, and telehealth support staff were feeling overwhelmed by the amount of administrative work associated with each visit. One of the most burdensome parts of telehealth: Seeking verbal consent for virtual visits. So the health center decided to investigate whether it was possible to leverage technology to move the consent process to a text sent to patients – a process that would ease the workload for care teams. That’s where the online form solution FormDr came to the aid of Petaluma Health Center, a federally qualified health organization that serves 35,000 rural and suburban residents annually in several clinics across Sonoma and Marin counties in Northern California. The center started testing on a very small scale. The innovation team configured its standard consent (in English and Spanish) in FormDr and sent it out to one shift’s worth of clinic patients. They didn’t receive many responses and realized the text message wasn’t very clear. After adjusting it accordingly, they tried again and received a good response. Next, the organization wanted to establish a workflow for sending and handling consent responses. Staff designed and tested that workflow in the informatics department prior to transitioning the workflow to the medical records department. Then they rolled out the tool to its largest site, Petaluma Health Center, before following up at two other clinics: Rohnert Park Health Center and Coastal Health Alliance. Care teams were pleased with the results, which left less than a handful of patients each shift that require a verbal consent. Those patients are identified by a care-gap huddle. Taking this responsibility away from care teams allows them to focus on clinical care. The innovation was later rolled out to all the center’s sites. One unexpected benefit: The pilot drew attention to the volume of texts the health center sends its patients for each appointment – a number so high that patients found it confusing. Given that, Petaluma has worked to improve appointment messaging to better serve patients. And as it turned out, the software tool was used for much more than consent forms. Since the pilot, the health center has used FormDr for gauging interest in COVID vaccinations, to collect patient occupation data for vaccine scheduling, to enable patients to send photos of blood pressure results and skin rashes, to collect ID and insurance card details, and to ask patients if they have or are interested in having home blood pressure monitors.
- Note that the links from FormDr to the fillable forms look like spam. Using the URL shortener ly’s paid subscription, West County was able to condense and customize the links to create the look and feel that they originate directly from the health center system, so patients are more likely to open them.
- Safety first: West County did not include behavioral health screenings as a digital questionnaire in case a patient screened positive for an emergency such as suicidality and there was a danger in a lag in staff seeing and responding to the disclosure. Obviously, immediate attention to a positive screen in this case is an important clinical and legal consideration.
- Constant monitoring and maintenance of the web scraper was necessary because FormDr randomly updates the site.
- Adding templates to the EHR that are sent out as text massages to patients with direct links to the FormDr forms helps to streamline the system for support staff.
The COVID-19 pandemic upended the way California delivers health care. Health care systems completely restructured their services to keep both their patients and employees safe. Federal policymakers acted quickly to expand coverage and payment for virtual care. The California Department of Health Care Services also dismantled previous barriers to telehealth and began requiring Medi-Cal managed care plans to pay providers for telephone and video visits at the same rate as in-person visits.
As a result, many California health care providers rapidly pivoted from in-person visits to virtual patient visits. For these organizations, this shift has been transformational, as they’ve adopted new technology, overhauled workflows, and redefined team member roles.
The Connected Care Accelerator -- a partnership between CCI and the California Health Care Foundation, with additional funding from the Blueshield of California Foundation -- selected 40 safety net healthcare centers in California to participate in a 12-month program that provided funding, methods, tools and hands-on technical assistance to enhance virtual care initiatives. In a series of case studies, CCI showcases the most sustainable and impactful solutions and shares advice for fellow safety net clinics who want to integrate similar virtual care strategies.