Virginia Mason Franciscan Health in Seattle ramped up its telehealth efforts to facilitate more virtual clinical and urgent care visits — more than 425,000 since March 2020 — with appointments ranging from annual check-ups to pre- and post-surgical check-ins. Notable results include improvements in quality of care and patient satisfaction.

Patients were reluctant to come in for physical visits during the COVID-19 pandemic, so Virginia Mason had to find a way to pivot and maintain connections with patients, says Francis Mercado, MD, ambulatory associate chief medical officer with Franciscan Medical Group, part of Virginia Mason Franciscan Health.

“Our mission was to continue delivering high-quality care to our patients. If seeing them in person wasn’t possible, we had to find another way. We knew that cancer wasn’t taking a break, and diabetes wasn’t taking a break,” Mercado says. “We were already doing telemedicine services in some departments, with neurology doing telemedicine fairly frequently, for example. But in primary care, we [ran] just a few pilots, and mostly for follow-ups.”

The health system had to train a few thousand physicians and staff in a matter of weeks, making sure they were adept at telemedicine and virtual visits.

“It was a little bit of an art form. Folks were used to seeing patients in front of them, doing a physical exam with a stethoscope, and they had to learn how to do similar things without the patient in front of you,” Mercado says. “We were able to achieve a lot of the same quality of care virtually, everything from making sure patients were checking their blood pressure and not having any side effects. It was an invaluable tool for us to continue providing good care to our patients.”

Besides facilitating social distancing, virtual visits have been particularly beneficial for patients with barriers to care, including transportation issues, work schedule conflicts, childcare needs, or other barriers.

Good for Behavioral Health

Virtual visits even seemed to offer advantages over in-person visits for some patients. In behavioral health, patients were more comfortable and receptive with telehealth.

“With some types of care, there is a real inertia to starting that care process. A virtual visit eliminated the need to make that drive to a facility and see the behavioral health provider, a visit that might be difficult or prompt anxiety,” Mercado says. “Adherence to their appointments and treatment regimens overall improved for behavioral health patients.” Mercado concludes telemedicine favorably affects quality of care. Data from a national study conducted by CommonSpirit Health, Virginia Mason Franciscan Health’s parent company, indicate 83% of patients in 2020 stated their virtual visit was “just as good, better, or much better” than an in-person visit.

Wellness visits also benefitted from virtual sessions. The ease of telehealth made it possible for clinicians to check in on patients more often to ask whether they were following their diets, treatment plans, exercise regimens, testing schedules, and other care needs.

There is a substantial segment of the patient population that prefers a telehealth visit, especially if the appointment is for something minor such as a medication refill. Others remained concerned about exposure to COVID-19.

“There is still some hesitancy out there, even though we have assured people that we have no shortage of personal protective equipment and have implemented ways to social distance and be safe in our physical environments,” Mercado says. “The availability of telehealth makes it possible for us to provide quality care to these patients while accommodating their concerns.”

Mercado notes the quality improvements that come from increased use of telehealth do not happen automatically. They are the result of an intentional effort to use the technology in the most effective way.

“It’s a different type of art form. We train to be sure we are providing the same level of care, making sure the patients are engaged,” Mercado says. “It involves everything from making sure you are maintaining eye contact to eliciting a meaningful response from the patient. There can be a challenge in [optimizing] that interaction by a computer screen and still provid[ing] really good care.”


  • Francis Mercado, MD, Ambulatory Associate Chief Medical Officer, Franciscan Medical Group, Virginia Mason Franciscan Health, Seattle. Email: