The use of telehealth rapidly escalated when COVID-19 halted in-person clinic visits. Health systems across the country were scrambling to optimize virtual healthcare to continue caring for patients during a unique time of social distancing. 
The Centers for Disease Control (CDC) identified the highest risk patients for COVID-19 were those with chronic illnesses that require monitoring and ongoing care to avoid hospitalization. High on this list were patients with one of more of the following conditions: diabetes, hypertension, older than 65, liver disease, or lung disease. 
To begin proactive outreach to patients most at risk, Ascension Wisconsin clinicians coordinated with the IT department to sort medical records to identify people who were at higher risk for hospitalization if they contracted COVID-19. Using the Charlson Comorbidity Index (CCI), which predicts 10-year survival in patients with multiple comorbidities, and certain diagnosis codes the technology team scored patients using the CCI and the clinical team then began to contact them based on their risk score. Those who had not been seen recently were proactively contacted and encouraged to set up a virtual visit with their provider.
The Ascension Wisconsin team developed tools that would guide clinicians during a telehealth visit. This included critical questions related to mental health at a time when people were isolated due to in-home sheltering. Asking questions about their sleep habits, lifestyle, ability to exercise and whether they are interacting with others in meaningful ways can help the clinician determine how the patient is doing. Based on their responses, medications can be adjusted or changed. And with that, the physician also can ask if their patient can access medications by having home health or the pharmacy deliver them. In some cases, the physician might determine that a virtual visit with a behavioral health professional would be beneficial. 
From mid-March to June 1, 2020, Ascension Wisconsin clinicians provided more than 107,300 virtual care visits. More than 1,000 providers and specialists across the state now offer virtual care visits so patients can feel supported and safe during an unprecedented time.