{"id":26467,"date":"2020-03-07T20:15:20","date_gmt":"2020-03-07T20:15:20","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=26467"},"modified":"2020-03-07T20:15:20","modified_gmt":"2020-03-07T20:15:20","slug":"coronavirus-scare-gives-telehealth-an-opening-to-redefine-healthcare","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/coronavirus-scare-gives-telehealth-an-opening-to-redefine-healthcare\/","title":{"rendered":"Coronavirus Scare Gives Telehealth an Opening to Redefine Healthcare"},"content":{"rendered":"\n

With the coronavirus threatening to become a pandemic,\nhealth systems and telehealth vendors see this as an opportunity to bring\nconnected health to the forefront – and reshape the future of healthcare.<\/p>\n\n\n\n

 By Eric Wicklund<\/a><\/p>\n\n\n\n

March 05, 2020 – As Congress votes on a funding package that includes Medicare\nwaivers for some telehealth services<\/a> and the Health Information and Management Systems Society\n(HIMSS) cancels its conference in Florida<\/a>, healthcare providers\nacross the country are looking at how connected care programs can be used to\nhandle the coronavirus – also called COVID-19 – threat.<\/p>\n\n\n\n

Most see the exercise as an extension of their preparations\nfor flu season. Some see this as an opportunity to lobby for telehealth\nadoption across the board, saying a possible epidemic offers ample evidence of\nthe value of telehealth and mHealth.<\/p>\n\n\n\n

DEFINING TELEHEALTH\u2019S VALUE IN A\nCHANGING LANDSCAPE<\/strong><\/p>\n\n\n\n

\u201cCOVID-19 is different because we do not know all the\nfactors surrounding transmission and its effects on patients,\u201d Jason Hallock,\nChief Medical Officer for SOC Telemed, points out. \u201cBecause coronavirus is\nnew and there have been a significant number of deaths, the uncertainty\nsurrounding that is scaring both patients and the general public. Our\nhealthcare workers do not have all the answers yet. Telehealth providers\nare challenged to make recommendations when there are still many unknowns. Telemedicine\ncan be useful to evaluate and reassure patients in alternative settings, and\nalso can be used to help patients decide who needs to be seen in the hospital\nor an alternative setting like an urgent care.\u201d<\/p>\n\n\n\n

Hallock says telehealth can help by enabling healthcare\nproviders to treat isolated patients, thus preventing the spread of what has so\nfar been an extremely contagious virus.<\/p>\n\n\n\n

In a Q&A with mHealthIntelligence<\/em>, Peter\nAntall, MD, President and Chief Medical Officer for American Well, offered an\nin-depth take on how telehealth might be used.<\/p>\n\n\n\n

Q. Telehealth has long been seen as\nan ideal means of expediting care during flu outbreaks. How is the coronavirus\nscare different? Does this pose any unique challenges that telehealth can\naddress?<\/strong><\/p>\n\n\n\n

A.<\/strong> The\nnovel coronavirus, or COVID-19, is similar to influenza in how it is\ntransmitted (airborne), how symptoms manifest themselves, and the fear it stirs\namong those individuals at risk. When evaluating patients through telehealth,\nwe use similar methodology as that used for influenza, except that the current\nCenters for Disease Control and Prevention (CDC) recommendations call for risk\nstratification based on known exposure or travel to endemic areas and referral\nfor testing for those at high risk or those who are sick enough to need\nhospital care. Also, unlike with influenza, there are no current specific\ntreatments, like antivirals, for the coronavirus at this time. <\/p>\n\n\n\n

If local person-to-person spread expands to wide community\nspread, we expect care will need to evolve to a method that is quite similar to\nhow we treat influenza today. Under those circumstances, we will likely begin\ndiagnosing coronavirus-like illness (CLI) on a clinical basis, without testing.\nWe would likely then only be expected to refer inpatients with CLI who need\nhospital care clinically, while those with milder symptoms will likely be\ntreated and monitored at home so as to limit the spread of this disease and not\noverwhelm our healthcare facilities.<\/p>\n\n\n\n

In this way, telehealth is an ideal venue for an outbreak\nlike this. We can increase access to care. We can offer care that is\ncommensurate with the acuity and nature of the symptoms and make referrals as\nneeded. This helps with infection prevention and control and also allows\npatients to receive their care in the home without exposing themselves to\nfurther illness.<\/p>\n\n\n\n

One other notable point is the potential for telehealth to\nhelp in providing routine care for other conditions and offset coronavirus\nfears in the . Patients have other healthcare needs unrelated to coronavirus,\nbut many are afraid to go to healthcare settings for fear of catching disease.\nThis has begun to result in a migration of patients to telehealth. For example,\non February 25, we saw telehealth urgent care patient volume that was 11\npercent higher than expected. Many patients are now sharing anecdotes\nindicating they were afraid to sit in a waiting room, so they used telehealth\ninstead.<\/p>\n\n\n\n

Q. Are there new tools or\ntechnologies available that can be useful in dealing with the coronavirus?<\/strong><\/p>\n\n\n\n

A. <\/strong>Telehealth\nitself is a tool in this fight. Keep in mind that there are many varieties of\ntelehealth. It can be used to connect a doctor or other provider with a patient\nin the home via smartphones or tablets. It can also be used for provider\n(specialist)-to-provider consultations in remote areas, for example. Telehealth\ncarts also exist in healthcare settings and can be used not only to import\ncare, but also to limit healthcare workers\u2019 exposure to the virus by using a\ncart in the isolation room.  We see patients primarily through live video\ninteractions, but we also can fall back to informed telephone calls,\nsynchronous chatting for therapy and asynchronous secure messaging for ongoing\ncommunications.<\/p>\n\n\n\n

The use of symptom trackers and chatbots is another\npromising area for coronavirus response. These technologies allow algorithms to\nbe created and adjusted as more is learned about the coronavirus. These bots\ninteract with patients and can perform assessments, triage and ongoing support.\nThe bots can even escalate an interaction to a telehealth encounter or refer\nthe patient for in-person care.<\/p>\n\n\n\n

Finally, home monitoring and medical tricorders are another\npromising approach to care. Traditional remote patient monitoring has\nestablished value for managing certain chronic conditions, but the next wave of\nhome monitoring includes consumer devices like smartwatches (like\nthe Apple Heart Study), home TVs, and home medical tricorders\nlike Tytocare that can perform a remote examination. These tools aid\nclinicians and patients and provide more robust health data conveniently from\nthe home setting. Providers can also use the data generated to better care for\nthe patient or regularly monitor certain conditions.<\/p>\n\n\n\n

Q. What must care providers know\nabout telehealth before using it to deal with the coronavirus?<\/strong><\/p>\n\n\n\n

A.<\/strong> Providers\nmust know and understand their role in this or any other healthcare crisis.\nThey should be well informed and trained to follow current CDC or World Health\nOrganization guidelines. They should also understand that telehealth is a\npowerful tool for helping fight this outbreak. And they should know that\ntelehealth is a safe way to treat and\/or triage these patients. Whether the\nprovider is a primary telehealth provider or is not using telehealth today,\nthere is a real opportunity to participate and play a role in the\nresponse. <\/p>\n\n\n\n

Providers who have a brick-and-mortar practice should be\nencouraged to use telehealth as a triage tool. Providers also need to\nunderstand that during this time, patients with other non-respiratory conditions\nalso need care. These patients should be afforded a safe way to access care\nwithout risk of infection. Telehealth is also a tool to aid in this process, as\nsome patients are fearful of going to healthcare facilities right now. The\noffice-based provider can likewise process other patients by practicing this\nway.<\/p>\n\n\n\n

Q. What are the barriers or\nchallenges associated with using telehealth to deal with the coronavirus scare?<\/strong><\/p>\n\n\n\n

A.<\/strong> Telehealth\nvisits are typically sufficient to complete a robust initial assessment. This\nallow the provider to assign a risk category, make other diagnoses, or deem the\npatient as \u201cworried well.\u201d Some patients may require additional care, as most\ntelehealth in the home lacks certain medical peripherals that might be needed.\nOther reasons for referral would include a high-risk patient who needs to be\ntested or a patient who requires escalation of care due to the severity of\ntheir illness. Telehealth visits are generally sufficient for screening\npatients, assigning a risk category, answering questions and recommending the\nnext steps a patient should take.<\/p>\n\n\n\n

The barriers to telehealth\u2014such as instances when the\npatient and provider do not yet have a relationship\u2014are easily overcome\nproviders receive similar training around the use of telehealth and as\nlongitudinal patient records become more available to guide care. Occasionally\nthe lack of medical peripherals or the inability to touch the patient during an\nexam is a barrier, as some patients need hands on care (e.g., IV, procedures).\nWe have policies that mitigate these problems in most cases. However, on\noccasion, a telehealth patient must be referred for in-person evaluation.<\/p>\n\n\n\n

Q. Is there anything that the CDC or\nany other government agency can do to support telehealth adoption to deal with\nthe coronavirus? <\/strong><\/p>\n\n\n\n

A.<\/strong> It is\nuseful for the CDC (and the WHO) to highlight the important role of telehealth\nin this outbreak because it certifies our role within the broader medical\ncommunity and raises awareness about this tool.<\/p>\n\n\n\n

It would be helpful if the CDC were to make specific\nrecommendations to telehealth providers that relate to telehealth evaluation of\nthe coronavirus and associated referrals, coding and monitoring. It would also\nbe helpful if the CDC were to play a role in advocacy efforts focused on government\nreimbursement, particularly in this emergency situation. Efforts to increase\nconsumer awareness about telehealth as a safe option for care also could prove\nessential. When this outbreak settles down, we would encourage the CDC and HHS\nto collaborate around coronavirus standards of care and preparedness so that\npatients can expect telehealth providers to be ideally prepared and\nwell-coordinated for the next outbreak and so that we can offer high-quality\ncare in this manner to all Americans.<\/p>\n\n\n\n

We also believe that our public health system would benefit\ngreatly from owning its own telehealth network infrastructure. This would allow\nthe CDC to better scale up, solve for geography and improve surveillance. It\nwould even allow its public health workers to use technology to monitor\npatients under quarantine in the home, saving themselves travel and limiting\nhealthcare workers\u2019 exposure.<\/p>\n\n\n\n

Q.  What more can be done with\ntelehealth in the future to plan for these types of outbreaks, or to perhaps\naddress them before they become serious?<\/strong><\/p>\n\n\n\n

A.<\/strong> Much\nneeds to be done throughout our country to better prepare. We need permanent\nleaders placed at the U.S. Department of Health and Human Services, the\nNational Institutes for Health, the US Department of Homeland Security and other\nkey areas, and we need to reinstate a pandemic-preparedness role at the\nNational Security Council. We need to fund international efforts to improve\nscreening and research for emerging diseases, and we need surveillance programs\nand good international coordination. We need to fund (not decrease funding) for\nour frontline groups, like the CDC, HHS and local public health services. These\nare our fighters, and we need them ready and funded properly as an outbreak\nlike this is a national security issue. We need stockpiles of materials.\nFinally, we should be partnering with the pharmaceutical industry on affordable\nmedications and vaccine research.<\/p>\n\n\n\n

Our national telehealth operation today acts like an\nemergency alert system. We see cases or potential cases before they are\nreported. At American Well, our influenza activity indicator map is more\naccurate and more timely than that of the CDC. We already play a meaningful\nrole in many disease states, including outbreaks. There are still many adoption\nand awareness challenges that exist when it comes to telehealth. Hopefully this\nunfortunate event will help consumers, providers and others start to more\nclearly see how they can and should use telehealth for future healthcare needs.<\/p>\n\n\n\n

Another barrier that we continue to work on is that of\nreimbursement. Telehealth is a cost-effective way of receiving care, but it is\nstill not always a covered benefit by insurance. Most commercial plans are\nreimbursing and there is increasing adoption in Medicare Advantage and Medicaid\nmanaged care. But there are still gaps, including a big gap in fee-for-service\ncoverage for Medicare coverage in the home. Efforts at reform are underway (see\nthe CONNECT Act<\/a>), but more work\nneeds to be done so that all Americans can take advantage of this amazing\nservice.<\/p>\n\n\n\n

Additionally, with coordination being so important during\noutbreaks like this, the simple step of integrating telehealth with other\nhealth information systems, such as EHRs or clinical-decision support, can make\ncare more seamless and foster better care coordination. This would speed up\naccess to critical care. Case in point: Consider a scenario where a patient\nconsults with a physician over a telehealth network and displays symptoms of\nCOVID-19 while presenting one or more correlating risk factors. The physician\ncould easily document the experience, dispatch an alert to a local ED, and\nensure precautions are taken by medical staff to usher this patient into a\ncontained room or unit to begin testing and treatment. We\u2019re working to ensure\nthis type of communication is happening at all levels, but there\u2019s still much\nroom for improvement on this front. <\/p>\n\n\n\n

HEALTH SYSTEM EXECS RESPOND TO THE\nTHREAT<\/strong><\/p>\n\n\n\n

In an op-ed prepared for the Alliance for Connected Care,\nTodd J. Vento, MD, MPH, Intermountain Healthcare\u2019s Medical Director of\nInfectious Diseases Telehealth Service; Ethan Booker, MD, Medical Director of\nMedStar\u2019s Telehealth Innovation Center; and Lawrence \u201cRusty\u201d Hofmann, MD,\nStanford Health\u2019s Medical Director of Digital Health, made their pitch for\ntelehealth:<\/p>\n\n\n\n

\u201cTelehealth, which has proven to be\na very useful tool in addressing patient needs during flu season, will improve\nour collective ability to address COVID-19 if it hits on a larger\nscale. Telehealth offers several advantages over in-person care in the\nevent of a pandemic.<\/em><\/p>\n\n\n\n

One key advantage of telehealth is\nspeed,\u201d the three wrote. \u201cPatients can access clinicians 24\/7 without an\nappointment or physical trip to the doctor. Using telehealth, our providers in\nthe Stanford Primary Care team, MedStar Health and Intermountain Healthcare\nhave been actively evaluating and treating patients with influenza. \nCurrent providers at Stanford Health estimate that almost 50% of patients are\ngetting oseltamivir (Tamiflu).  Because there is no current, specific\nmedication for Coronavirus, we must be able to advise patients of reasonable\nself-directed treatment and surveillance to keep them home. <\/em><\/p>\n\n\n\n

Keeping patients at home is a\nsignificant advantage of telehealth. In-home video visits limit community\nexposure by allowing patients to avoid contact with other patients in waiting\nrooms and direct contact with providers during the exam.  Our health\nsystems have providers who are equipped to work from their own homes,\nsignificantly increasing the safety of providers and bolstering the workforce\nto respond to crisis.  Workforce readiness in a crisis that may include\nsuch dramatic measures as school and day care closures is a significant concern\nfor health systems which may be strained to respond.  Health systems are\nalso using telehealth to continue surveillance of patients already identified\nas at risk while keeping them at home.<\/em><\/p>\n\n\n\n

Next, telehealth ensures that\ntreatment in brick-and-mortar settings is reserved for high-need\npatients.  Moreover, with patients being seen in their own homes,\nproviders and health systems will be able to triage and screen exponentially\nmore patients with telehealth vs. an in-person visit.<\/em><\/p>\n\n\n\n

Finally, telehealth allows patients\nwho do not have access to infectious diseases (ID) specialists to access this\nspecialized care from the small number of experts across the country. When\nIntermountain first offered ID telehealth consultation to rural systems\nthroughout the west, one provider fielded 1,000 consultation requests in the\nfirst fifteen months. To date, the service has provided telehealth care to over\n4,700 patients, 50 percent of whom are over 65 years old.<\/em><\/p>\n\n\n\n

Each of these advantages illustrate\nhow telehealth can thwart the spread of COVID-19 and stop it from overwhelming\nour already stretched medical system.\u201d<\/em><\/p>\n\n\n\n

The three health executive also urged lawmakers to take\naction to reduce barriers to telehealth that have kept adoption low:<\/p>\n\n\n\n

\u201cCongress must act to ensure that\nseniors \u2013 a particularly vulnerable population generally and for this virus in\nparticular \u2013 are able to receive necessary triage and care through\ntelehealth. <\/em><\/p>\n\n\n\n

Today, there are restrictions in\nMedicare that prevent providers outside of very rural areas from being paid for\ncare provided through telehealth. As a result, many providers do not offer\ntelehealth services to seniors. The lack of reimbursement creates a perverse\nincentive of encouraging patients to come for in-person care, which will only\noverwhelm our health system as well as augment the virus\u2019s spread.<\/em><\/p>\n\n\n\n

Congress must give the Secretary of\nHealth and Human Services the ability to waive these restrictions in times of\npublic health emergencies. As part of the bipartisan, bicameral CONNECT for\nHealth Act, telehealth champions in Congress foresaw this need and drafted a\nprovision that would give the Secretary the ability to waive telehealth\nrestrictions just as he\/she would waive Conditions of Participation, Stark Laws\nlicensure, or other requirements when public health emergencies are declared.\u201d<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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