Virtual care

LLUH transitioned last year to virtual care within a matter of days. While many patients and providers still want personal interaction, virtual options are creating possibilities for delivering healthcare in a new and even post-COVID-19 era.

This story first appeared in Scope magazine.


It was a stark and gloomy plight. The World Health Organization had just declared COVID-19 a global pandemic, and Loma Linda University Health needed to transition to virtual care for as many service lines as possible within a few days.

On Sunday morning, March 15, 2020, a team of technology leaders, doctors, and administrators assembled to figure out how to make the swift transition. Already, tech teams had launched a telehealth delivery platform for the organization — though in the preceding months, 20 virtual visits a week were considered a lot.

At issue was reimbursement from insurers and other payers. With a few exceptions, most payers didn’t consider a virtual visit a payable visit, and many healthcare organizations, including LLUH, had held off. Within days, Congress changed that, approving new legislation mandating insurers to cover virtual visits and care for COVID-19.

By February of that year, Information Services had been piloting virtual solutions with clinicians to prepare for greater adoption of virtual care. That weekend in March, the challenge was on: how to turn on virtual care fast.

With the green light from administration, the team now needed to support hundreds of doctors with processes, training, and technology to deliver the care. One challenge seemed especially daunting — procuring hundreds of Apple iPads and other devices amid scarcity to the point of unavailability.

Bert Chancellor, executive director of technical services, says calls to suppliers didn’t sound promising until one called him back. Hundreds of iPads had arrived that day on a loading dock in Las Vegas but were somehow still unsold. He immediately bought 500 and later purchased 200 more.

“It was great timing,” Chancellor recalls. “I would say we were miraculously blessed.”

Over the next week, it became an all-hands-on-deck sprint to set everything up — unboxing 700 iPads, provisioning them with software and security, and delivering training to each of the hundreds of doctors who would soon be using them. Tech teams behind the scenes were able to build, test, and deploy processes in a matter of hours for what might have normally taken months.

“Can you even imagine the logistics of doing that with a small team?” Chancellor says. “But by the end of the week, we had done it.”

The quick ramping up of virtual medicine meant that patients could get the care they needed. It also became a seminal week that reignited the technology team’s previous work on telehealth. By the middle of 2020, LLUH was providing more than 4,500 virtual patient visits a week.

“Everyone’s mindset about virtual care changed almost overnight,” says Mark Zirkelbach, MS, chief information officer for Loma Linda University Medical Center. “Something that had been seen as not ideal quickly became the standard of care.”

A few gaps were soon identified and filled. Some providers needed more training on the devices. Some patients needed help as well. A technology command center was established, where calls could immediately be serviced and tech experts could guide doctors with over-the-shoulder support through a few patient visits.

Today, some 30% to 50% of LLUH doctor’s visits are conducted virtually, depending on the specialty and department culture. Both patients and providers are still getting comfortable with which parts of telemedicine work well and which are performed better with in-person visits.

The verdict is not in regarding what virtual visits will look like post-pandemic. That will depend largely on payers and their willingness to fund virtual visits. Yet, many LLUH leaders are confident telemedicine in some form is here to stay.

“I think there’s enough consumer, government, and provider demand that some sort of virtual visits will continue long-term,” says Anthony Hilliard, MD, chief operating officer of Loma Linda University Faculty Medical Group.

Hilliard says mental health services have experienced a huge boom as many physicians saw overt manifestations of mental health issues such as anxiety and eating disorders. These and many other mental health issues may have been suppressed in individuals for years, only coming to the surface during the pandemic because of fear and social isolation.

Care for chronic conditions, too, has been feasible with virtual care. For care that is heavily reliant on test results, physicians can remotely monitor a patient’s numbers and make recommendations or adjust medication dosages. Urologists can follow PSA numbers, cardiologists can examine blood pressure, and endocrinologists can monitor diabetes. New healthcare monitoring apps created by emerging companies can further augment virtual visits. Nutritionists, too, can ask a patient to show them the contents of their refrigerator, pantry, and cooking space.

Even the ability to provide primary care has been transformed, Hilliard says. Instead of taking time off work to drive to an appointment, a patient can remotely explain to their doctor what they’re feeling, the doctor can order some tests, and then an in-person visit afterward may be even more meaningful.

In a way, the pandemic further unmasked some social determinates of health. Those who have the means to purchase smartphones and other devices had the opportunities for care in a way that others didn’t. The next step could explore how to get devices into underserved areas of the community.

Placing tablet devices in a church, market, or drugstore could open up more opportunities to virtually bring a doctor to an underserved patient in the community. New ways of delivering healthcare may involve growing a team of community health workers so they can go into the home and bring the technology and access to a provider. Hilliard says this could be a new twist on the old-school doctor house call.

“These are all very deliverable possibilities of bringing technology to the patient,” he says.

Loma Linda University Health’s tech teams stand ready to enable the organization to grow into future phases when called upon. Leaders have supported clinical operations with everything from ramping up virtual care, setting up systems for surge tents, and establishing mass vaccination clinics.

Earlier this year, Anna Finegan-Redell, executive director of Application Services, found herself working at the Drayson Center’s vaccination clinic — in which the entire basketball gym had been transformed to serve up to 2,000 patients a day for months. The all-hands-on-deck setup had several tech workers on the front lines interacting with patients.

“I remember several patients I helped get through the process,” Finegan-Redell says. “It’s a good reminder to all of us that we’re contributing to something bigger.”