EHR vs Covid-19: Trends in Testing, Telehealth and Hospitalizations

Welcome back to, ‘Where does the data lead?!’

Here we are, eight plus months into the pandemic, and our testing volume and our positivity rates have been up and down. Testing volumes have varied because of limitations on receiving re-agents for our labs to process the specimens. It does appear that our test positivity rate, on the red line above, is increasing this month. This is also concordant with Colorado state-level data.

During this time, UCHealth has continued to grow as a system. We have opened a few new facilities in the past year, and so the clinic volume, the patient population we serve, and the test volume have increased. Lots going on here, and probably no one factor explains the pattern.

Visit Volumes at UCHealth

Our in-person visit volume for 2020 showed a precipitous drop in mid-March (light red) and then nadir at mid-April, with gradual recovery to 90 percent volume by July. At the same time (light green), our telehealth volume exploded, starting at a baseline of 20 visits a day, and reaching a peak of about 4,000 visits a day by mid-April.

As we figured out how to see patients safely in clinic, our in-person visits gradually returned and our telehealth volume declined; we are now steady-state at about 1,000 telehealth video-visits per day. Magenta is the scheduled telephone visits, a new visit type that Medicare began reimbursing. Blue is the regular telephone volume, essentially unchanged. Dark red represents a gradual but consistent increase in patient portal messages. It’s both gratifying that our patients have found a way to connect with their provider, and also worrisome in that this near-doubling of volume impacts the unreimbursed workload of providers in our system.

Cliffhanger

We are now back to our “cliffhanger” TV series. What will happen tomorrow? UCHealth has restarted our Incident Command Center given the increase in hospitalizations. Like many hospitals around the country, we are seeing a bump in inpatients with COVID-19. We had a peak of about 120 in April, then gradually fallen to a nadir of 17 inpatients in late summer, and are back up to mid-50’s this week, and rising.

CMIO’s take? Hang on to your hats.

[This piece was originally published on The Undiscovered Country, a blog written by CT Lin, MD, CMIO at UCHealth and professor at University of Colorado School of Medicine. To follow him on Twitter, click here.]