Rapid implementation of patient screening, triage & telehealth for ambulatory & inpatient addiction psychiatry services using Microsoft Teams, Microsoft Lists, & Microsoft Power Apps

What might the attendee be able to do after being in your session? Attendees will be able to prototype, implement, and immediately use commercial off-the-shelf (COTS) Microsoft 365 software — including Microsoft Teams, Microsoft Lists, and Microsoft Power Apps — in a highly regulated environment for knowledge management and asynchronous team communication using Plan-Do-Study-Act (PDSA) cycles.

Description of the Problem or Gap: Highly specialized, interdisciplinary medical specialties — such as addiction medicine and psychiatry — face enormous challenges in internal team communication, case management coordination, with a shortage of quality specialty-specific software. Our interdisciplinary mental health clinicians identified needs to improve and streamline coordination, patient triage, assessments, and scheduling. These functions were previously collated manually through e-mails, internal team paging, phone conversations, and desktop office software.
We identified that coordination could be transitioned to Microsoft 365 software — including Microsoft Teams, Microsoft Lists, and Microsoft Power Apps — which have been implemented throughout the VA Healthcare System nationally in 2020.

Methods: At the VA Palo Alto Healthcare System, the Addiction Treatment Service group adopted IT-supported tools over the summer of 2020. Our group created an online, cloud-connected hub using Microsoft Teams, Microsoft Lists, & Microsoft Power Apps, based on Sharepoint and Microsoft 365 infrastructure, to support a dual-diagnosis substance use disorder (SUD) and psychiatric inpatient residential program in a HIPAA-compliant manner. The adoption and use of Microsoft Lists and customized workflows were refined and iterated through weekly huddles and brief, ad hoc work sessions from June 2020 through December 2020 during concurrent clinical operations
Power Apps & Lists were customized to allow social workers, psychologists, psychiatrists, internal medicine specialists, and nurse practitioners to screen, approve, and request additional follow-up — such as labs, imaging, medical visits, and psychiatric visits. Microsoft Lists’ built-in calendaring views allowed us to schedule and visualize patient progress for admission, discharge, and transfer (ADT). Finally, Microsoft Lists allowed us to track telehealth equipment assets & integrate with VA Video Connect-supported Apple iPads and Cisco telehealth equipment, allowing clinicians and nurses to make direct video calls to patient rooms without requiring the patient to have Teams access. Additional workflows transitioned to Microsoft Teams allowed us to edit team operating procedures, checklists, and schedules.

Results:
The adoption of Microsoft Teams and Microsoft Lists reduced the amount of previous weekly meetings from 6 hours to 1 hour, as much of the synchronous meetings, check-ins, and numerous communications modalities were converted into asynchronous chat. Transitioning to Microsoft Teams required no formal training time, as the VA had transitioned from Teams’s predecessor software Skype For Business.

Discussion of Results/Conclusions:
Asynchronous tools and COTS enterprise software can be customized and adopted by front-line clinicians across multiple mental health specialties and other medical specialties that do not otherwise have dedicated software. Key results include:
• VA-wide support & work culture using Microsoft chat tools allowed for rapid Teams adoption, but required knowledge of best practices in using Microsoft Teams & Lists
• Iterative PDSA cycles supported incremental changes with rapid design & build
• Adoption of Microsoft Lists’ visual formatting rules & Javascript Object Notation (JSON) customizations supported our ability to quickly visualize patient statuses and facilitate one-click telehealth calls

Attendee’s Take-away Tool: Attendees will be able to prototype, implement, and use off-the-shelf Microsoft 365 software — Microsoft Teams, Lists, & Power Apps — in a highly regulated healthcare environment for knowledge management and asynchronous team communication using Plan-Do-Study-Act (PDSA) cycles. Successful use of these tools depend on stakeholder management, workflow and operations knowledge, a culture of technology adoption, and institutional support.