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