Telemedicine: Telehealth tech is at the forefront of treatment for coronavirus. And it does help. But what are its constraints, and how do hospitals adopt it?

As the COVID-19 virus is wreaking havoc with the healthcare system, telemedicine is stepping into the spotlight and helping healthcare provider organizations and caregivers respond better to the needs of Americans who have contracted the virus and Americans who need to reach out to their providers about their health status.

During the pandemic, telemedicine makes a very positive contribution to healthcare and is used in a number of ways. But when it comes to treating patients during a pandemic, telehealth technologies do have certain limitations. Additionally, there is a chance that telemedicine could add to the overwhelming hospitals unless it is used well.

Telemedicine - How telemedicine is being used in the context of COVID-19?

How Live Streaming In Telemedicine Is Helpful For People
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During this global pandemic, telehealth is emerging as an effective and sustainable precautionary, preventive, and treatment solution to curb COVID-19 spread.

Telehealth bridges the gap between people, physicians and health care systems, allowing everyone, especially symptomatic patients, to stay at home and communicate with physicians via virtual channels, helping to reduce the spread of the virus to mass populations and frontline medical staff, said Dedi Gilad, CEO, and co-founder of Tyto Care, a telemedicine technology company. Critically, hospitals are fast adopting telehealth to treat COVID-19-infected quarantined patients, he added.

"In addition, the CDC urges the public and medical staff to use non-urgent communication telehealth solutions in an effort to reduce the pressures facing emergency rooms and clinics," he explained. "By deploying telehealth solutions and programs, people who have other medical conditions during this time can receive home care without entering medical facilities to minimize their risk of contracting the virus." Telemedicine is used extensively in patients' "forward triage" long before they arrive in primary care clinics, said Dr. Siaw Tung Yeng, founder, and CEO of MaNaDr, a company for telemedicine technology and services.

Minimizing risk to healthcare workers

"The primary care doctors are at ground zero working tirelessly in the frontlines," he said. "With MaNaDr, we can divide the patients into the groups at risk and non-risk. Appropriate measures can then be taken to minimize the risks to patients and health care workers. The right actions can then be taken for the pre-screened patients, saving valuable time and minimizing transmission risks to all.

Many chronic patients can have teleconsultations scheduled from home to avoid face-to-face clinic visits and thereby minimize their risk of COVID-19 exposure, he added.

"They can deliver chronic medicine to their house," Yeng noted. "And many in-clinic visits with mild, acute respiratory infection can be very closely monitored, almost daily. If there are any changes in their clinical state, suitable action can be taken immediately. Telemedicine offers patients a 24/7 lifeline to connect with their providers. This offers patients great comfort and assurance during these difficult times."

A telehealth surge - Telemedicine

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Dr. Jason Hallock, Chief Medical Officer at SOC Telemed, a telemedicine technology and service provider, reports that healthcare is witnessing an increase in the number of direct-to-consumer telemedicine providers operating on a large scale to help provide care to patients who may wonder if they need care after exhibiting potential coronavirus-related symptoms.

"We're also seeing a rapidly growing need for acute care on-demand via telemedicine at the same time," he said. "This includes ICU programs that offer the most critical patient intensive care. That helps limit the exposure of providers to the virus and other infectious diseases.

"As we know, if a hospital worker were exposed without adequate protection, they would be put into 14 days of self-quarantine," he noted. "The use of acute telemedicine for tele-triage helps to keep employees in a low-risk infection category by completely eliminating exposure to those doctors or other hospital staff."

Playing catch-up with telehealth

Unfortunately, providers and policymakers are currently playing catch-up with telehealth technologies and are just beginning to recognize that they are essential solutions to keep potentially infected individuals out of hospitals and doctor's offices, G said. Cameron Deemer, president of DrFirst, a communications healthcare and telehealth technology firm. However, as this public health crisis continues to escalate, telemedicine is rapidly gaining recognition as a critical instrument to slow COVID-19 spread, he added.

"In the course of this crisis we see three primary roles for telehealth technologies," he said. "The first is simple, screening patients remotely instead of having them visit the hospital or practice. They can be used to triage patients with cold and flu-like symptoms, and to care remotely for those who do not need medical intervention or might receive home care. By keeping potentially infected individuals out of the offices of hospitals and doctors, the healthcare system can reduce the risk of transmission to other patients and healthcare personnel."

Telemedicine 's second role during the pandemic is often overlooked: To help provide routine care for patients with chronic diseases at high risk if they are exposed to the virus, Deemer added.

The third important role is counterintuitive but equally important: Providers and their staff are not immune to infection and are at increased risk of contracting COVID-19 because of their continuous exposure to infected patients, he said. These providers will be quarantined once tested and confirmed, and will become unavailable to the healthcare system just when it needs them most, he added.

Limitations to telehealth from COVID-19?

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Telemedicine can be an instrument used to manage COVID19. There is one glaring disconnect, however, that needs to be resolved, said NostaLab president John Nosta, a digital health think tank.

"Testing is the basis for the out-of-hospital management," he said. "A pandemic's linchpin of management is widespread testing, and conventional telemedicine may not offer that today. Maybe a 'crisis-based' telemedicine evolution can help find local test centers and also manage the flow of patients seeking a test." As far as COVID-19 is concerned, the data suggest that most people will have a mild infection, and the clinical course is unremarkable. Telemedicine may not really be all that's needed in these instances, Nosta said.

"But the clinical course may not be consistent with conventional telemedicine for a smaller subset of higher-risk patients," he explained. "These patients often have a more serious condition which leads to rapid decompensation and requires hospitalization. The reality might be that telemedicine, as it now exists, needs to be modified for COVID-19 to help manage early testing, diagnosis, and triage for those who may need in-patient care.

Not yet equipped for telemedicine

The most significant limitation in the COVID-19 response to telehealth use right now is that while some hospitals and large physician practices are equipped to provide care in this way, most hospitals and private practices are not, Deemer of DrFirst said.

"Telemedicine has not traditionally been used in response to public health crises, but with COVID-19, that is changing," he said. "I am encouraged that policy changes are being made by the government and private insurance companies to promote its use. The CDC is calling for healthcare facilities to adopt telemedicine to protect patients and staff, and many large hospitals are racing at their frontlines to implement and expand these capabilities.

Telehealth is also being implemented in more doctor's offices. "MedChi, the state-run medical society, has called for increased use of this technology in Maryland to help doctors care better for patients in the midst of the pandemic," he noted. "MedChi provides physicians in its Care Transformation Organizations with DrFirst's secure collaborative care tool, which includes telehealth functionality, to help them cure their patients more safely and effectively." In the traditional provider/patient relationship, Deemer added, there is a learning curve to use telemedicine.

"Practices need to notify patients that office visits can be replaced by telemedicine consultations; they need to train providers to use the tools, revise scheduling processes, determine triage procedures, review payer telehealth policies, and establish accounting practices," he suggested. "This is not necessarily a lengthy process, but providers will find it helpful to have a set of guidelines to ease the transition."

Lack of hardware

There are some limitations; the main one is a lack of endpoints within hospitals to be able to implement telemedicine-meaning limited access to hardware, SOC Telemed's Hallock said.

"While some hospitals may have technology dedicated to programs such as stroke care, hospitals are now repurposing some of these endpoints for other work such as tele-triage," he explained. "While many telemedicine programs are hardware-agnostic, providers still need to ensure that this technology is equipped with the right tech for exam type, such as quality of the camera, sound, etc."

A provider organization doesn't need best-of-breed technology to get a program up quickly. However, the better the technology is, the better the patient's experience is, and the wider the services it can provide, he added.

"Another issue is access to broadband – some hospitals struggle to have a quality connection within their facilities and we are now faced with taking this into potentially new care areas, such as an outside tent," he explained. "As hospitals plan a disaster capacity, they need to consider Wi-Fi connections. Acoustics can also be a limitation within a building depending on the construction of the room.

For example, concrete or tiled rooms create echoes, where hearing and talking to a patient can be challenging. This is easily remedied with some acoustics accommodations, such as wall soundboards, he advised.

"The credential of new doctors may need to be another limitation for hospitals," Hallock said. "That is an area that organizations including the Joint Commission are highly scrutinizing. While the process can be accelerated, it still requires any addition of temporary staff to have the proper credentials and licensing to provide patient care.” Telemedicine programs have their own network of broadly licensed doctors who are ready and capable of doing the work that helps remove the barrier of bringing new doctors into the mix, he said.

Are telemedicine overwhelming hospitals?

In a pandemic, telemedicine has the potential to get more patients into the hospital. Telemedicine programs also require the functioning of carers and other staff. One question today with COVID-19 is: Is telehealth anyhow overwhelming hospitals or group practices?

Most hospitals still don't have the ability to deliver telehealth because, previously, it was largely seen as an outpatient or post-acute care tool, Dr. Deemer of First said.

"Now, of course, they are moving to ramp up quickly, so their emergency departments can triage patients outside the hospital's four walls," he said.

"Telemedicine can also help first responders in the field to communicate with ED physicians, helping to ensure that those who need hospital care get it quickly and efficiently – while at the same time diverting those who don't need hospital care to other facilities or keeping them safe at home."

In normal times, most hospitals operate at near full capacity, so if anything, telehealth will significantly reduce the additional pressure, Gilad of Tyto Care said.

Actually reducing the burden

Telemedicine actually reduces the burden on hospitals as they deal with COVID-19 spread and the associated increased caseload, so Lisa Hedges, senior content analyst at Software Advice said. Although some doctors are now required to devote time to screening patients through telemedicine while keeping other patients being treated, they would do that anyway – and worse, they would do it in person, she noted. "It is worth noting that hospitals currently have varying capacities to deploy telemedicine, but those capable of offering telehealth services to any degree are seeing benefits," she said. "Even something as basic as using the online waiting room features keeps patients from piling up close to each other while waiting for their exams in person, so that's all proving to be a great help in flattening the curve and relieving the overall burden on all hospitals."

How are hospitals adapting to telemedicine during the pandemic?

Hospitals routinely prepare for crises, but in the past, they have not actually leveraged telehealth technologies, DrFirst's Deemer said. "Nevertheless, as the healthcare system clashes with COVID-19, we will see more and more hospitals adopting these technologies to limit front-line exposure and protect staff and other patients," he said. "Hospitals that choose well will find that telehealth benefits extend beyond this current need for public health – because other crises will surely come in."

Gilad of Tyto Care notes that, for example, hospitals in Israel have integrated telehealth solutions from Tyto Care to examine COVID-19 patients in quarantine wards, and to monitor patients in isolation at home by delivering the TytoHome kit.

"The partners of Tyto Care in the USA and Europe are also expanding their use of the solution to tackle this pandemic," he said. "The solution can be deployed rapidly and on a scale, with medical staff training and possible implementation within a single day. Tyto Care is able to ship directly to the home of the quarantined patient for home deployments and the onboarding process is simple and intuitive."

Conclusion: Expanding programs and training

There are two main areas of telemedicine adaptation at this time: Hospitals are expanding their telehealth services, as well as finding ways to train staff on a shorter timeline, Hedges of Software Advice said. "The first is a no-brainer: Telemedicine is such a perfect, ready-made solution for addressing COVID-19 that it wouldn't make sense not to use it, and many hospitals are making efforts to expand their telehealth services to serve patients better during this time," she said. "The extent to which hospitals can deploy telemedicine features varies, but it could include investing in anything from video hardware to facilitate remote consultations or telemedicine carts to conduct examinations with hospitalized patients from outside their rooms."

Training is a big obstacle for those health-care organizations that did not have telemedicine in place before the outbreak or those that add additional services at this time, she added. Luckily, most telemedicine providers are offering robust training modules to help users launch their software, so practitioners are leaning heavily on these resources to quickly deploy telemedicine.

"I would also add that telemedicine patients are very much onboard outside of the COVID-19 context," she concluded. "We found from a recent survey of U.S. patients that 84 percent are more likely to select a provider that offers telemedicine over one that doesn't, so it's clear that this technology is what patients want. Practices are investing in telemedicine today because of a need to better equip themselves for coronavirus, but they should see it as a long-term investment to also provide a better patient experience."