TELEMEDICINE: “FORWARD TRIAGE” FOR SCREENING PATIENTS DURING COVID-19

 Direct-to-consumer (or on-demand) telemedicine, a 21st-century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure.

Interview with Dr. Judd Hollander on how health systems can use telemedicine services during the Covid-19 pandemic.

It can allow physicians and patients to communicate 24/7, using smartphones or webcam-enabled computers. Respiratory symptoms — which may be early signs of Covid-19 — are among the conditions most commonly evaluated with this approach. 

Health care providers can easily obtain detailed travel and exposure histories. Automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.

Disasters and pandemics pose unique challenges to health care delivery. Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients. Payment and regulatory structures, state licensing, credentialing across hospitals, and program implementation all take time to work through, but health systems that have already invested in telemedicine are well positioned to ensure that patients with Covid-19 receive the care they need. In this instance, it may be a virtually perfect solution.

Read full article at NEJM

TELEMEDICINE: “THE MOST COMMON USES AND HIGHEST VALUE FOR PATIENTS”

Telehealth had been gaining momentum in recent years, but the COVID-19 pandemic is propelling physician practices to quickly figure out how they can best use the technology to provide patients with care while practicing physical distancing.

(From an AMA article -April 29, 2020)

COMMON USES FOR TELEHEALTH INCLUDE:

VIRTUAL HEALTH: “CHRONIC CARE MANAGEMENT” PROVES VALUE OF TELEMEDICINE

From a ComputerWorld article (April 27, 2020):

While the pandemic will prove the value of virtual care in a crisis, it will also demonstrate the effectiveness for ongoing chronic care management,” she said. “This moment will have a lasting effect on the adoption of virtual care and accelerate the shift from in-person care to virtual first engagement for multiple conditions and use cases.”

While the need for remote care will not be as acute once the pandemic crisis subsides, demand for telehealth systems will likely remain high. Forrester now expects more than one billion virtual care visits this year, the vast majority of them related to COVID-19.

“…After the crisis subsides, there will be a patient population that will want to continue to receive care online for some things, like managing chronic conditions, follow-up visits after an inpatient stay, surgery or to discuss diagnostic results,” she said.

In this case, it will be important for healthcare providers to ensure that patients are aware of the availability of services.

Read full article

TELEMEDICINE: STANFORD MEDICINE UTILIZES IPADS IN EMERGENCY DEPARTMENT

From a Stanford Medicine article (April 27, 2020):

“Far from separating us from our patients, it is actually expanding on what we can do,” said Ryan Ribeira, MD, clinical assistant professor of emergency medicine at the Stanford School.

An iPad in a patient room at Stanford Health Care’s emergency department. Photo by Susan Coppa

Caring for patients remotely greatly reduces the use of protective equipment — an estimated 80-120 sets per day. The risk of exposure has also been minimized for physicians, nurses and other caregivers, particularly those who are pregnant, immune-compromised or otherwise at high risk of complications from COVID-19. 

When the staff at Stanford Health Care’s Marc and Laura Andreessen Emergency Department started connecting with patients in isolation via iPad, they found an unexpected benefit: The approach offered a more personal, human-centered experience. 

The iPad project moved from conception to implementation in just eight days, starting with a drive-through program in a Stanford Health Care garage: Patients remained in their cars while a physician assessed them by video from inside the emergency department. 

To bring the program into patient rooms, technology specialists at Stanford Health Care ensured the tablets had necessary features, such as the ability to auto-answer calls. When a caregiver calls to check in, the patient receives a few rings as advance notice, then the iPad answers itself. 

The iPad has also been paired with portable handheld ultrasound scanners that quickly plug in, eliminating the need for a bulky ultrasound cart that requires decontamination after every use. And patients participating in clinical research can consent via iPad.

Read full article

ENDOCRINOLOGY: BENEFITS OF TELEMEDICINE IN DIABETES MANAGEMENT

From an EndocrinologyAdvisor online article (April 27, 2020):

In the diabetes world where data from meter, pump, and sensor downloads are critical to management, telemedicine is an ideal way to interact with patients. The missing pieces are vital signs, especially blood pressure and weight, but often the patient can monitor these at home and provide trends. Diabetes experts can manage the majority of patients using the HbA1c test and other data the patient has recorded and downloaded to a website. These are easily accessible. I have had patients write down their glucose readings and fax the results as well.” Mark H. Schutta, MD, medical director of the Penn Rodebaugh Diabetes Center

In perhaps one of the most significant changes to occur in health care as a result of the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has suddenly reached the widespread adoption many proponents have championed for years. Recognizing the necessity of telemedicine in light of the current crisis — both to address increased treatment needs and to prevent unnecessary in-person contact — some payors and state legislators have loosened certain restrictions regarding its use across clinical specialties.

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HHS Website: “Telehealth – Health Care From The Safety Of Our Homes”

For patients

Wondering how to get started with telehealth? Check out the information below to better understand your options.

Patient standing and looking at a huge phone screen (larger than life) that has a doctor inside of it. Waving to each other.

Finding telehealth options

If screening tools and self-checkers do not lead you to the care or information you are seeking, you can reach out directly to your doctor or health insurance company for options that can help connect you to a provider online. Understanding telehealth

Find out what it is, what to expect during a visit, and what kinds of care may be available. Telehealth during the COVID-19 emergency

Whether you’re looking for health care related to COVID-19 or something else, find out more about how to prepare for the visit. Preparing for a video visit

WEBSITE

TELEMEDICINE: TRANSITION TO WIDESPREAD ADOPTION

APRIL 8, 2020

Until recently, there were several barriers preventing widespread adoption of telemedicine. The two broad themes were:

  1. Providers, health systems, and payers were slow to embrace change
  2. A failure to appreciate that telemedicine is not a new type of medicine, but rather simply a care delivery mechanism that can be utilized with some patients, some of the time, to provide high-quality care

Addressing the Telemedicine Myths

Myth 1: Telemedicine is “too hard.”

This was not true before Covid-19 and we have further demonstrated that it is not true now. Almost every provider and the great majority of patients in the U.S. already possess the technology needed to conduct a telemedicine visit — a smartphone, tablet, or computer. 

It turns out that when fear of catching a potentially fatal disease strikes, telemedicine is no longer too hard.

Myth 2: Patients prioritize existing relationships with their provider over transactional episodic care.

Data argues otherwise: The majority of times, patients just want care. Falling primary care visits rates, coupled with growing emergency department and urgent care visit rates, suggests convenience as more important than an established relationship.

Myth 3. You cannot do a physical examination.

It turns out you can. A new 21st-century physical exam utilizing telemedicine emphasizes the importance of general appearance (sick or not sick, weight, distress), respiratory effort, and environmental factors including a visual assessment of the home that is not something that can be accomplished at an office visit. 

The majority of times, patients just want care.

Myth 4: Virtual visits are less effective than in-person visits.

Focusing on the comparison in diagnostic accuracy between virtual and in-person visits sets up a false dichotomy. Focusing on actionable information is more important than diagnostic accuracy.2 Actionable information recognizes providers might not always make a diagnosis within a single visit, whether in-person or telemedicine. 

Like every other new challenge, you have to try telemedicine to get comfortable with it.

Myth 5. There is not a payment model supporting telemedicine.

While it is true that the Centers for Medicare & Medicaid Services (pre-Covid-19) had limited reimbursement based upon site of service and geography, since the Covid-19 outbreak, to the credit of the federal government and commercial payers, telemedicine is now covered.

Read full article

Health & Aging: The Importance Of Exercise (Scientific American)

Health journalist Judy Foreman talks about her new book Exercise Is Medicine: How Physical Activity Boosts Health and Slows Aging

This is Scientific American’s Science Talk, posted on April 24th, 2020. I’m Steve Mirsky. And under our current, often locked-down situation, it’s still really important to try to get some exercise. Judy Foreman is the author of the new book Exercise is Medicine: How Physical Activity Boosts Health and Slows Aging. She’s a former nationally syndicated health columnist for the Boston Globe, LA times, Baltimore Sun and other places, and an author for the Oxford University Press. We spoke by phone.

Website

COMMENTARY

This Podcast is worth listening to in full. It will introduce some of the upcoming themes of DWWR.

Exercise is one of the 4 pillars of health, thriving and longevity, along with Diet, Sleep, and Intellectual Stimulation.  We look forward to highlighting and reveling in these subjects.

Judy Foreman’s thesis “ exercise is medicine” is true in many dimensions, including industries desire to capture the many beneficial biological effects of exercise in a pill; it requires effort to get off your duff, and you need to budget the time to work out.

My preference is WALKING and WATER EXERCISE. I make passing the time PLEASANT by listening to BBC “in our time”, recorded on a water-proof mp-3 player. EXERCISE is both VALUABLE and ENJOYABLE!

—Dr. C.

Empowering Patients Through Education And Telemedicine