Research News

At the beginning of the COVID-19 pandemic, the Center for Personalized Genetic Healthcare (CPGH) became one of the first medical genetics programs in the country to expand its telegenetic services to accommodate the stay-at-home orders and social distancing guidelines. An analysis of the CPGH team’s data and experiences during the first five weeks of the pandemic demonstrated that they were able to scale up virtual visits quickly and continue to provide genetic services to a wide range of patients in all genetic subspecialties, according to a new study published in Health and Technology.

“A major key to our success is that we have team members who had been conducting virtual visits long before the pandemic occurred, so they were able to set up and train our other providers to use the virtual visit platforms as well as troubleshoot and solve problems on the fly,” said David Flannery, MD, Director of Telegenetics and Digital Genetics in CPGH and the study’s corresponding author.

In this study, the authors conducted a chart review of all out-patient telegenetics encounters scheduled in CPGH during the first five weeks of the pandemic and compared the data to out-patient encounters in 2019. During the study period, CPGH scheduled 465 virtual visits, of which 428 were completed. The completed virtual visits involved all subspecialties offered by CPGH (cancer, cardiovascular, general, ocular, prenatal and pharmacogenetics) and 86% of CPGH providers. By week four, the visit volume was 82% of the 2019 volume for the same time period. Notably, the no-show plus cancellation rate during the pandemic was significantly lower than the rate in 2019 (8% versus 34%).

“We were well-positioned to navigate this influx of virtual visits. Cleveland Clinic is highly attuned to the benefits of digital health services, so virtual visit platforms were already in place and directives regarding telemedicine came quickly from Cleveland Clinic leadership,” said Ryan Noss, MS, CGC, a cancer genetic counselor and the virtual visit team lead in CPGH and the study’s first author. “Also vitally important was the willingness of the CPGH team as whole to adapt to the workflow changes required by the unprecedented circumstances in order to best serve patients.”

They also looked for evidence of a potential “digital divide” by analyzing data from those patients 60 and older and from those identifying as Black and then comparing that data to the rest of the patients seen virtually. They found that patients over 60 and Black patients were significantly more likely to use phone-audio only appointments, which suggests that these groups were not able to access audiovisual telemedicine platforms or chose not to use them.

“These differences could be due to any of several factors, including lack of access to computers or smartphones, lack of access to broadband connectivity, unfamiliarity with apps or discomfort with technology,” said Dr. Flannery. “This possible digital divide may be underestimated because we do not have data on patients who were offered a virtual visit and declined. Currently, we are looking for ways we can address this divide during the initial appointment scheduling process.”

Katherine Carlotti, MS, CGC, and Deanna Leingang, MS, CGC, both genetic counselors in CPGH, were co-authors on the study. CPGH is the clinical component of the Genomic Medicine Institute. Aligned with Cleveland Clinic Community Care, CPGH is committed to offering patients the most comprehensive clinical genetics services available.