When the first U.S. patient with COVID-19 sought medical care at Providence Regional Medical Center Everett (Wash.) in February, there were a host of concerns: providing high-quality care, keeping up-to-date on emerging information and reducing other patients' exposure to the virus, not to mention minimizing exposure among the hospital's own medical staff.
Infection control is an area where telemedicine carts proved essential. The carts allowed workers roll video cameras and other telemedicine equipment into a patient's room so a physician could check in without physically being at the bedside.
"We had people outside the room talking to the patient, evaluating them with the (electronic stethoscope) and keeping those communication lines open," said Dr. Todd Czartoski, chief medical technology officer at Providence. That meant "the hospitalists, infectious disease doctor and other specialists didn't have to gown up and go in and out of the room multiple times a day."
As more U.S. patients are diagnosed with coronavirus, health agencies have urged hospitals to expand their use of telemedicine, both within their facilities and to reach patients at home.
The Centers for Disease Control and Prevention recommended using telemedicine to direct patients to the right site of care during the outbreak. The World Health Organization—which designated COVID-19 a global public health emergency in January—said healthcare organizations should consider using telemedicine while evaluating suspected COVID-19 cases as a way to minimize the use personal protective equipment, such as gloves and masks.
Lawmakers agreed, and Congress included $500 million for the use of telemedicine services in an emergency aid package passed this week. The appropriations bill also waived some Medicare restrictions on payment for telemedicine so that seniors can use remote services for coronavirus treatment.
Health insurers are also encouraging expanded telemedicine use and giving providers and patients incentives to use this delivery model. CVS Health on Friday said Aetna would waive copays for coronavirus testing, and all telemedicine visits would have zero co-pay for the next 90 days.
But while telemedicine can help to reduce the spread of COVID-19, keeping patients at home and out of crowded waiting rooms, standing up and expanding remote care programs is only the first step. The next frontier is raising awareness among patients about why they need to be taking advantage of the technology.
Bergen New Bridge Medical Center created a dedicated telemedicine service for COVID-19 in just "a few hours," said Deborah Visconi, the medical center's president and CEO. Now, the hospital is focused on "getting the word out, making sure people know that they have access to it," largely by pushing information about the new service on Bergen New Bridge's website and social media.
The Paramus, N.J.-based hospital had just launched its telemedicine service in October, but in the wake of the virus decided to expand it. Patients concerned about coronavirus can dial a hotline for a screening with a nurse, who will refer them to a video consultation with an infectious disease specialist if they need further evaluation.
Bergen New Bridge nurses use the CDC's guidelines to screen patients for COVID-19, which include asking about a patient's travel history and exposure to the virus as well as their symptoms.
There can be some limitations to telemedicine screenings. Clinicians wouldn't be able to listen to a patient's lungs without specialized equipment, and ultimate diagnosis requires a laboratory test.
If Bergen New Bridge suspects a patient may have coronavirus, a staff member contacts the New Jersey Department of Health to coordinate an assessment with the agency's epidemiologist, as well as the CDC to authorize testing.
Health systems in the last week have been ramping up marketing for their telemedicine services in connection with COVID-19, according to Jose Santana, healthcare analyst with market research and consulting company Corporate Insight.
"This is definitely an evolving issue," Santana said. "What we saw in the past week is changing from what we've seen in the past several days, and what we might anticipate seeing in the next couple days."
To encourage patients who can to stay home, Czartoski said Providence plans to roll out an online chatbot that screens patients who are worried about COVID-19 and suggests next steps, such as a telemedicine or in-person visit, depending on the severity of their symptoms. It's an adaptation of a symptom-checker chatbot that the system launched in 2018.
Using the chatbot would help screen out the "worried well," or those who are worried about coronavirus despite not being sick or being at risk. That in turn would free up healthcare resources for those who need them, Czartoski said.
"There are a lot of folks out there who are anxious," he said.
Telemedicine company Teladoc Health hasn't seen an uptick in its visit volumes in response to the COVID-19 outbreak, said chief medical officer Dr. Lewis Levy. This time of year already tends to be the company's busiest period on account of the flu season, he said.
"We have certainly been receiving calls about those who are concerned," he said.
American Well, another telemedicine company, has seen an 11% higher-than-expected volume in urgent care visits over the last week, according to Dr. Peter Antall, the company's chief medical officer.
Some of that increase is from patients who are concerned about coronavirus, most of whom have been deemed low-risk patients, Antall said. But it's also driven by patients who said they would typically visit their physician in-person, but are worried about spending time in a waiting room and possibly opening themselves up to COVID-19 exposure.
That's been a particular point of concern for patients who are already immunosuppressed or have other serious conditions, said Linda Branagan, director of telehealth programs at the University of California, San Francisco. Staff members at UCSF are proactively reaching out to patients with various conditions ahead of their scheduled in-person appointments, to see if they can be converted to a video visit, she said.
But while video visits tend to be a viable option for patients who are medically stable and not in immediate need of an exam, Branagan noted it can vary by condition—so it's important to work with clinicians when determining which patients should be pushed toward remote care.
"Doctors will need—and deserve—time to confer with colleagues, consult literature and access other resources as they learn how to best integrate telehealth into their clinical toolbox, even in the midst of an outbreak," she said.