Hospitals are using telehealth options to treat patients remotely and triage COVID-19 cases as concerns grow about bed capacity and the possibility of spreading the virus within hospital walls.
Health systems and the state emergency service are watching capacity as they prepare for an influx of patients over the next several weeks while also remaining wary of contact between people.
A feature of telehealth is, “its ability to remove providers and patients from the physical contact between them that could spread disease,” said Dr. Ethan Booker, medical director of the MedStar Telehealth Innovation Center and MedStar eVisit.
COVID-19, the disease caused by the novel coronavirus, is a disease where the vast majority of patients can recover at home without medical intervention. Using telehealth, those patients can be monitored remotely.
“Even those that are positive and are well, we are recommending you stay at home,” said Dr. Jonathan Thierman, chief medical information officer for LifeBridge Health and medical director of the system’s virtual hospital. “There is no treatment for this illness right now, so there is no reason to come into a health care facility unless you are having trouble breathing and actually need health care (intervention).”
LifeBridge Health is one of several Maryland health systems that have begun using telehealth to triage COVID-19 patients and to treat them. At LifeBridge, a virtual hospital triages patients through initial phone calls before moving cases to private video consultations.
It helps improve social distancing and keeps patients who do not need to be treated in the hospital at home, where they are less likely to spread the virus, Thierman said.
The University of Maryland Medical System has also set up telehealth to triage patients.
“Utilizing telehealth technology, we are standing up a centralized hub with emergency medicine physicians specifically to focus on the evaluation and management of patients identified as High or Low Risk COVID-19,” Elizabeth Groncki, director of program development for telehealth services at the system, wrote in an email. “This planned shift to telehealth will help ensure that patients are even more quickly triaged and evaluated and have timely access to care as we address the outbreak.”
LifeBridge has also set up drive-through testing sites at its Carroll Hospital and Sinai Hospital locations. Patients getting tested at these sites need to have a testing order through the health system.
Telehealth will also help hospitals conserve space, necessary resources and treat patients more efficiently, Booker said.
Using video consultations, he could treat 40 patients during the same amount of time it would take him to treat 20 patients in-person. Rather than having to change his personal protective equipment – which includes masks, gloves and gowns – between each patient, he does not have to use it at all.
“That’s really valuable,” Booker said. “I think it’s an area where telemedicine is exactly the right set of tools.”
Telehealth could also help providers treat patients even if they have contracted the virus themselves, Booker said.
Treating regular cases
As hospital and state leaders grow concerned about capacity to treat COVID-19 patients, telehealth is also seen as an avenue to treat patients outside of the coronavirus response.
“Telehealth would allow, for instance, a primary care doctor who has patients who need to see that doctor, that are being told to avoid doctor’s offices if they are frail or fragile, to reach out and see that doctor still,” Booker said.
Telehealth is seen as a means to check in on patients, update prescriptions and write doctor’s notes, all without having an in-person visit at a time when that can take up resources and risk spreading the virus.
And while physicians are focused on treating the pandemic, they do see a future where using telehealth in the coronavirus response could help popularize the platform.
Getting providers and patients to use telehealth services for the first time has been a challenge, Booker said.
“We’ve been working away at promoting and building telehealth for quite some time,” he said. “Having people do it the first time around, I think a lot of patients and a lot of doctors are going to say, Why haven’t I been doing this before?”
Still, barriers remain, even in this crisis, to implementing telehealth fully.
The first obstacle is one familiar for providers treating patients in-person right now, too: staffing shortfalls.
“The hurdle is really going to be the provider and the human resources on the other end of the telehealth visit. Health systems are already short-staffed,” Thierman said.
As more elective services begin to shut down, he hopes that the providers in those areas will become available to help.
Gov. Larry Hogan also announced Monday that he is activating the state’s reserve medical corps and allowing providers with out-of-state or expired licenses to practice in Maryland.
There have also been cost reimbursement barriers for telehealth since its inception. Payers, particularly Medicare and Medicaid, have been slow in allowing patients to utilize telehealth services.
Federal payers have begun to loosen a lot of those restrictions during this crisis, which has helped, Thierman said.
“We intend to take advantage of those allowances,” he said, otherwise they could not use these services. “People need to be paid for their time.”