In the current COVID-19 crisis, hospitals and clinics are prioritizing the most urgent cases and asking those with mild symptoms to quarantine at home. In tandem, providers are experiencing a sudden and significant uptick in telehealth visits for patients suffering milder COVID-19 symptoms as well as patients with appointments for routine care or preexisting conditions who currently cannot access their hospital.
Almost 80% of hospitals in the U.S. have some sort of telehealth service, but, prior to the last few weeks, patients utilized these services at a considerably lower rate. The 2019 American Well Telehealth Index reported that, while only 8% of consumers had used telehealth, 66% were willing to try it.
In early March, The Center for Medicare & Medicaid Services expanded reimbursements for telehealth services to ensure that patients are practicing social distancing and reducing their risk of COVID-19. These telehealth services include a wide range of healthcare services, like common office visits, mental health counseling, and preventive health visits, to help more patients get the care they need during this unprecedented time. Consider these recent changes from healthcare institutions across the country:
- According to the Advisory Board, Woodhill Medical Center in Texas reported 1,400 telehealth visits in 2019. During the week of March 9, 2020, Woodhill had 1,400 telehealth visits in just three days.
- After just one week in March, a major academic cancer center reported that 62% of their clinic visits are now conducted via video. The number was previously near zero.
- A west coast academic medical center reported that they were previously conducting approximately 1,000 telehealth visits per month. Now they are conducting 1,000 per day.
- University of California, San Francisco Health implemented an automated telephone outreach system to screen patients with upcoming appointments for COVID-19 symptoms and connect potentially infected patients with a virtual care team for treatment.
- At NYU Langone Health, patients with minor medical conditions are being directed to a virtual urgent care platform, while patients with preexisting medical conditions are being asked to conduct virtual visits.
With so many patients, providers, and insurers rapidly gaining exposure to, and increasing their comfort with, telemedicine during the current pandemic, it is likely to impact the long-term approach to how care is delivered. It is also likely we could see a surplus of exam rooms at existing and planned outpatient clinics if telemedicine use stabilizes at or above current usage rates post-pandemic.
ZGF has worked alongside our healthcare clients for decades as they have navigated rapid industry change on the order of what we’re seeing now with the industry-changing potential of telehealth. Below we’ve suggested a few scenarios for how outpatient clinic design might transform as virtual care becomes as common as in-person visits.
New Uses for Existing Spaces
Universal rooms and layouts—including patient rooms, patient units, and clinic modules—are increasingly common, supporting health systems as workflow and technology requirements evolve.
For example, the standard 120 SF patient exam room presents considerable opportunity to toggle between different care uses without structural changes. Strategic decisions during planning ensure that wall-mounted casework and furniture selection can support a variety of uses, while mobile carts enable fast changes.
The program for the Memorial Sloan Kettering Cancer Center (MSK) Universal Exam / Infusion Suite includes 12 dual-use rooms for examination and infusion visits. Demountable partitions allowed an accelerated construction timeline and more efficient MEP routing. These partitions, which separate patient and visitor paths to provide privacy and minimize unnecessary interruptions, can be easily be adapted and re-purposed should MSK’s space needs change over time. State-of-the-art telemedicine technology is integrated into the demountable partition system to connect patients with physicians located remotely.
In the future, hospitals could relocate a portion of the care team or administrative staff to a central location, like an outpatient clinic, to provide virtual consultations to both patients and caregivers in nearby or remote locations. For example, a more experienced physician can walk clinical staff through a trauma situation in a rural Emergency Department that has not seen many cases like the one they are dealing with. Some clinics may even transition to support a full virtual care team for some patients, without in-person patient care.
The duration of the COVID-19 pandemic is unknown, but it has highlighted the need for healthcare spaces that can be erected quickly, without the typical construction timelines.
Prefabrication has been lauded for the ability to bring facilities online faster. A hospital in San Antonio, Texas that is currently under construction is utilizing prefabrication for several pieces of patient rooms, including headwalls, MEP racks, and patient toilet rooms. Decentralized nurse stations between patient rooms are also prefabricated. The National Institute on Aging Alzheimer Disease and Related Dementias Temporary Research Facility at the National Institutes of Health campus in Bethesda, Maryland will be constructed with prefabricated modular units assembled on site. The 24,000 SF modular facility will be delivered in under two years.
Less consideration has been given to modular design for interior components, but ample opportunity exists. Best practices from workplace design, as well as strategies for space conversion, can be brought to healthcare to rethink patient and staff experience. Possible opportunities include exam room partitions and casework that convert to meeting rooms or work rooms. Other elements borrowed from workplace design include phone pods or mobile meeting rooms, including American Disabilities Act-compliant options, that providers can use specifically for telehealth visits.
Addressing Digital Inequities
Americans living in rural areas have increasingly limited access to physical clinics, making telehealth a critical link to care there and in other underserved communities. As health systems continue to invest in their ability to offer virtual care, they’ll also be thinking about solutions for those who cannot benefit due to lack of home internet access or mobile data plan.
Modular and drive-through units in rural areas are one path to address these inequities. Drive-through telehealth outposts, similar in concept to a bank drive-through, blocked from weather and equipped with private monitors, are a viable option to provide best-in-class care. Modular units that are quickly fabricated, transported, and assembled onsite can provide additional access to telehealth along with limited in-person patient care. These units could be equipped with partitions or utilize rolling privacy screens or panels to provide a sense of individualized care.
In dense urban areas, buses or other fleet vehicles that are converted into mobile hot spots and parked in neighborhoods could provide connectivity and care to the greatest amount of people.
While COVID-19 is the source of many uncertainties, there is no question that it will cause fundamental shifts in both our healthcare system and the patient experience. The rapid adoption of telehealth services is a promising path to increase access to care and rethink outpatient clinic design to best support providers and patients no matter how care is delivered.