Telemedicine offers an ideal strategy to enable more health care providers to address more patients’ needs while minimizing exposure to infectious diseases such as the currently notorious coronavirus (COVID-19). As shown by the recent expansions for Medicare reimbursement for telemedicine, our Congress and President clearly recognize the potential benefits of utilizing telemedicine for coronavirus screening and other health care concerns. Even the New England Journal of Medicine came out a week ago with a strong statement of support for telemedicine’s benefits. Now, the question is how to deploy the technology quickly and in a way that will drive better outcomes for patients, providers and society as a whole.
Given the highly infectious nature of COVID-19, telemedicine is a quintessential tool for the current situation. By allowing patients to seek and receive health care from their homes, telemedicine enables them to reduce unnecessary exposure—and to reduce the chances that they will help propagate the virus while seeking treatment. Just as importantly, providers can also benefit from telemedicine; even if they have been exposed and are on quarantine, providers can still practice from home, whether it’s seeing patients virtually or consulting with colleagues. By keeping as many health care professionals as possible on the front lines, we enhance our ability to respond and continue to provide care as exposure widens.
When a patient is ill enough to require a trip to the emergency department (ED), incorporating telemedicine for coronavirus into the forward triage process can lower general exposure to infectious diseases and shorten the ED visit. Both telemedicine at home and mHealth can be used to screen the patient initially; the sickest patients can skip the ED and be admitted directly into a hospital bed, while less severe cases can be guided to a designated quarantine area in the hospital. In this way, staff and other patient exposure is minimized.
In the nation’s hardest-hit areas with COVID-19, some facilities are already surging ahead with adding telemedicine tools to these forward triage and split flow processes. For instance, the University of California San Francisco Medical Center (UCSF) has implemented an automated, interactive telephone system that screens patients arriving at UCSF for appointments, thus helping to identify possible cases and limit the virus’s spread. As of March 16, over 50,000 patients have been screened.
Similarly, the University of Washington (UW) in Seattle directs patients to either contact its virtual clinic or schedule a telemedicine visit through their patient access portal, rather than automatically traveling to a clinic or hospital. Patients are even being discouraged from heading to the ED; medical emergencies warrant a call to 911. Other facilities have followed suit, including New York University Langone, Oregon Health and Science University, and Rush University Medical Center in Chicago. During the virtual visits, patients are instructed on how to get tested without unnecessarily exposing staff or other patients to the risk of contagion.
Another approach is flourishing in South Korea and Germany: drive-through testing. By keeping the patients in their cars, this method increases the safety, efficiency, and capacity of coronavirus testing. In the US, drive-through stations are being established in Colorado, Connecticut, and Texas—some of which promise free testing with telemedicine for coronavirus. UW Medicine, being in one of the epicenters of the outbreak, is performing drive-through testing on their employees; by March 10, more than 200 individuals were tested. The patients’ turn is coming next. In Minneapolis, the University of Minnesota Health (M Health) Fairview has been taking things one step further: Patients must be pre-screened online to determine whether a test is even needed. If a patient shows up for testing without a prior evaluation, he/she is directed to the online portal. Unfortunately, in light of limited COVID-19 testing supplies, M Health Fairview has closed their drive-up testing centers temporarily as of March 17.
Despite these encouraging starts, several barriers are preventing more widespread adoption of such screening and triage processes, two of the largest hurdles being infrastructure and reimbursement. The above health systems were already running telemedicine systems before COVID-19 hit US shores; facilities without existing initiatives are finding themselves hurrying to assemble a functional telemedicine program. And even in the regions that are screening patients via telemedicine for coronavirus, more patient education is needed to raise awareness and encourage use of the technology. swyMed’s Rapid Response option may be suitable for organizations that don’t have a quick and easy telemedicine answer that can operate at scale. Click here for more information.
Aside from infrastructure, however, perhaps the main barrier remains reimbursement. Medicare is now poised to cover telemedicine visits at in-office rates for a wider range of patients and originating sites (e.g., homes as well as clinics), but Medicaid and many commercial insurers are beginning to eliminate restrictions on the originating site and ensure payment parity. Commercial payers such as Aetna, Humana, Blue Cross Blue Shield of Massachusetts, and Horizon Blue Cross Blue Shield of New Jersey have volunteered to broaden their telemedicine reimbursement policies in response to the current pandemic.
Of course, telemedicine offers far more than faster coronavirus testing; between video visits, e-visits, secure messaging, remote patient monitoring, and virtual check-ins, the potential gains of applying telemedicine to existing (or new) processes are enormous. In today’s environment of shifting healthcare delivery systems, telemedicine for coronavirus testing comprises just one portion of the overall trend of bringing healthcare to the patient rather than the patient to healthcare. Whether a patient needs chronic disease management, follow-up visits, preventive check-ups, or something else, a well-designed telemedicine program can fully support such undertakings. Perhaps the silver lining from the COVID-19 pandemic will be the mainstream adoption of effective technologies for telemedicine with broad support from health systems, physicians, legislatures and private payers.