Source: New York Times
The use of virtual visits climbs as a way of safely treating patients and containing spread of the infection at hospitals, clinics and medical offices.
By Reed Abelson
March 11, 2020
The man had recently traveled, including a brief stop in Tokyo. He had a fever and cough about a week ago, but was now feeling fine.
He called the virtual medical line set up by Rush University Medical Center in Chicago recently to help screen patients for coronavirus.
“He said all the right buzzwords: cough, fever, fatigue,” said Dr. Meeta Shah, an emergency room physician at Rush.
After talking with him, Dr. Shah did not think he needed to be admitted but referred him to the city’s health department.
Rush and other large hospitals across the country are quickly expanding the use of telemedicine to safely screen and treat patients for coronavirus, and to try to contain the spread of infection while offering remote services.
“This is a kind of turning point for virtual health,” Dr. Shah said. “We’re actually seeing how it can be used in a public health crisis.”
While the notion of seeing a doctor via your computer or cellphone is hardly new, telemedicine has yet to take off widely in the United States. Health insurance plans do typically offer people the option of talking to a nurse or doctor online as an alternative to heading to an emergency room or urgent care center, but most people don’t make use of it. Now doctors, hospital networks and clinics are rethinking how the technology can be used, to keep the worried well calm and away from clinical care while steering the most at risk to the proper treatment.
“The use of telemedicine is going to be critical for management of this pandemic,” said Dr. Stephen Parodi, an infectious disease specialist and executive with The Permanente Medical Group, the doctors’ group associated with Kaiser Permanente, one of the leaders in the use of virtual visits for its patients.
Telemedicine got an additional boost under the $8.3 billion emergency funding measure from Congress, which loosened restrictions on its use to treat people covered under the federal Medicare program. At a news conference on Monday, Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, praised the government’s efforts to expand the use of telemedicine under Medicare, the federal program for people 65 and older.
In a meeting on Tuesday at the White House with President Trump, private health insurers also said they would pay for the virtual visits for people who may have coronavirus to improve access to care for their customers.
By using their phone or computer, patients will be able to get guidance about whether they need to be seen or tested instead of showing up unannounced at the emergency room or doctor’s office. Patients, particularly those who would be at high risk for a serious illness if they were infected, can also opt to substitute a trip to a doctor’s office with a virtual visit when it is a routine check in with a specialist or a primary care doctor. That way they can avoid crowded waiting rooms and potential infection.
When Rush admitted a student last week who was believed to have the virus, the hospital was able to prepare for his arrival by clearing the ambulance bay of people and vehicles to protect patients and hospital staff from possible infection. Taken to an isolation room, he was examined by Dr. Paul Casey, an emergency room physician, and a nurse, both in protective gear.
An infectious disease specialist was consulted over an iPad. The patient, who did have the virus, was released last Friday, and Rush was able to avoid the fate of other hospitals in the United States, where patients with Covid-19 led to the widespread quarantine of health care workers.
“When the news of coronavirus broke last month, we saw the opportunity,” Dr. Casey said.
Health systems are racing to adapt and even develop virtual services that can serve as their front line for patients. “Telehealth is being rediscovered,” said Dr. Peter Antall, the chief medical officer for AmWell, a company based in Boston that is working with health systems across the country. “Everybody recognizes this is an all hands on deck moment,” he said. “We need to scale up wherever we can.”
Other systems are also readying their telemedicine offerings. “The Covid-19 outbreak is going to serve as an impetus,” said Dr. Shabana Khan, the director of telepsychiatry at NYU Langone Health. “We have no choice.”
Patients concerned about the coronavirus are being directed to NYU’s virtual urgent care, which they can gain access to via their phone or a computer.
“Our volumes are showing they are hearing that message loud and clear,” said Dr. Paul A. Testa, an emergency medicine doctor who is the system’s chief medical information officer.
NYU is also encouraging its doctors who are self-quarantined because of recent travel to see patients using video, as well as directing patients who are particularly vulnerable because of existing medical conditions to consider a virtual visit instead of heading to a doctor’s office.
But Dr. Testa emphasized that patients who need to be seen in person should not hesitate to seek care. “We’re not discouraging anybody from coming in,” he said.
Virtual care has its limits, of course, and many of the start-ups and others promoting their offerings may not be fully equipped to handle patients who might have the virus. At Zoom+Care, a chain of clinics in Oregon and Washington, consumers are being encouraged to use the company’s online chat feature so that their risks can be assessed.
“We’re being very explicit at Zoom+Care that we can’t test you for Covid-19,” said Dr. Mark Zeitzer, who is the clinics’ medical director of acute care services. Instead, people may be told to self-quarantine and keep a careful eye on their symptoms.
But the idea of using telemedicine to prevent further spread of the virus is being adopted quickly. At Intermountain Healthcare, the Utah system that cared for an infected patient at its Salt Lake City hospital, the concern over a potential measles outbreak last year led executives to consider how to better protect the community from infectious diseases.
“When coronavirus hit the streets, we took the measles work-flow and expanded on it,” said Kerry Palakanis, a nurse practitioner who is the executive director of Intermountain’s initiative, Connect Care.
The system is also thinking about how it can use the same technology to deliver home health care, particularly for patients who are at high risk because of chronic medical conditions or have Covid-19 but can be treated safely at home. People at home could be equipped to take their blood pressure or test their blood sugars, and a doctor or nurse could be available over video.
By monitoring more patients virtually, Intermountain will be able to limit the potential exposure of nurses who conduct home visits. “Those nurses are traveling out throughout the community,” Dr. Palakanis said.
Telemedicine companies say they are getting an increase in the number of calls, both from those who want to know more about what they can do to minimize their risk of catching coronavirus and those with worrisome symptoms. “We see the whole spectrum of patients,” said Dr. Kristin Dean, medical director for Doctor On Demand, a company whose service is offered to customers of some of the major health insurance companies.
In evaluating whether patients may be safely monitored at home, doctors take into account people’s medical history and the severity of their symptoms, she said.
“The patients have been appreciative of that switch,” said Dr. Parodi of Permanente. “Many of them don’t want to come in and be exposed in a clinic or office setting.”
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