Switchboard

A full-service digital platform for secure virtual visits

Opportunity

 
The COVID-19 pandemic required health systems to scale telemedicine rapidly to ensure access for patients while reducing infection risk. Unfortunately, the capacity of Penn Medicine's legacy video platform was quickly exceeded due to the increased demand, creating a need for a new enterprise solution.
 
During initial interviews, providers and other care team members described the manual and inefficient nature of conducting virtual visits and identified specific pain points such as fear that more than one patient could join a virtual "exam room" at a time and the high occurrence of errors associated with meeting links.
 
As part of Penn Medicine's rapid response to COVID-19, we collaborated with colleagues from across the health system to explore solutions to these problems.
 

Intervention

 
Switchboard is a feature-rich, user-friendly, sustainable, and adaptable platform that makes it easy for providers and patients to participate in secure virtual visits. It leverages a commercial, cloud-based video meeting platform and facilitates an end-to-end virtual care encounter workflow. 
 
The platform is desktop and mobile-friendly, integrates with Haiku, Canto, and Doximity Dialer, and does not require users to sign in or download an app to ensure accessibility. 
 
To reduce the administrative burden on clinical staff, Switchboard automatically generates and sends unique visit links, appointment reminders, and setup instructions to patients. In addition, it prompts patients to share feedback on their experience via text. 
 
For providers, Switchboard offers a dashboard view of daily appointments with encounter-specific links. Live status indicators show when patients have joined a virtual exam room, and QR codes can be utilized to transition between desktop and mobile devices.
 

Impact

 
Switchboard enabled patients to receive high-value virtual care from the comfort and safety of their own homes amid the COVID-19 pandemic. 
 
The platform supported approximately 30,000 virtual appointments a week at its peak, with over 10,000–20,000 text messages being exchanged each day. 
 
With Switchboard, Penn Medicine converted from an average of 75 percent of telehealth visits being conducted over the phone to 75 percent conducted via video within weeks and eliminated incidences of multiple patients inadvertently joining the same session. 
 
Today, Switchboard remains an integral part of our telemedicine operations, with 2,000 - 3,000 visits happening per week. Providers, staff, and patients all report high satisfaction with the platform, and the team continues to iterate on and add features as opportunities arise. 

Innovation Methods

A day in the life

One of the best ways to learn more about a problem area is to experience it yourself. Immerse yourself in the physical environment of your user.

Do the things they are required to do to gain a firsthand experience of the challenges they face. Completing a day in the life exercise will enable you to uncover actionable insights and build empathy for the people you're hoping to help.

A day in the life

We immersed ourselves in the patient and clinician experience. We conducted virtual visits on Switchboard, attended visits as patients, and helped family members attend their appointments.

This helped us gain deep insight into the user experience, learning how they used the platform and what it felt like to do so.

Deletion
Frequently, our work involves reimagining processes to achieve better results.
 
The concept of deletion is about isolating part of a process that is problematic and solving for its absence. Imagine solving for airport security without the security line or collecting tolls without tollbooths.
 
With this technique, you're not allowed to improve the flawed part of a process. You must delete it and then, making sure you understand what essential benefits it provided, if any, introduce alternative approaches.
Deletion

During early concierge pilots, patients told us they were frustrated that they had to download an app to participate in virtual visits.

We leveraged deletion to brainstorm how the process might work if downloading an app was not possible. In partnership with BlueJeans, we launched an app-less meeting join feature that negated the need for patients to download the native app. Eliminating that step enabled a more seamless process for patients and reduced dropoffs.

The concierge
A concierge provides hands-on, efficient, and proactive services for customers.
 
Similar to the concept of walking in someone's shoes, a concierge walks alongside someone and helps them get things done.
 
Acting as a concierge or high-touch helper for a small sample of people will enable you to get deep into the reality of their journey and learn about the barriers they face, because like a real concierge, you'll help them navigate those barriers. You can also test solutions in real time as you explore the problem space in context.
The concierge

We supported more than 300 patients to prepare for virtual visits over the phone. Acting as a concierge for users enabled us to learn where patients were getting stuck and determine where enhancements needed to be made.

For example, in early pilots, we found that downloading an app to join visits was a significant barrier for patients. This led us to develop a chatbot powered by Way to Health that, if triggered, got over 95 percent of patients to a successful setup on their own.

Down the line, we were able to launch an app-less meeting join feature, negating the need for the chatbot, but it was crucial for early adoption rates.