Innovative Telehealth Programs Across Medical Specialties

Innovative Telehealth Programs Across Medical Specialties

Telemedicine – electronic audiovisual technology that enables health care at a distance – comes in many forms. Now, the COVID-19 pandemic is accelerating the adoption of telehealth programs and features in health care facilities throughout the country.


As telemedicine expands, it brings opportunities to deliver health care in new ways. Telemedicine offers these major advantages:


  • Convenience. You can bypass doctor’s offices and waiting rooms with virtual visits in your home and may be able to communicate with health care providers outside of regular office hours.


  • Specialist access. Specialists whose services are in high demand can evaluate and recommend treatment for many more patients from afar, and share their expertise with other physicians in real time.


  • Immediacy. Working from central locations, critical care doctors use continually incoming data, virtual examinations and team communication to take care of patients across multiple sites with miminal delay.


  • Decreased exposure. Patients, health care providers and entire communities benefit by reducing potential episodes of direct exposure to people with contagious illnesses like COVID-19.


  • Field hospital capabilities. Hospitals faced with overwhelming numbers of pandemic patients have been able to stretch their hospital beds – including intensive care – to nontraditional venues as sophisticated patient data monitoring can be enabled from a central location.


Here’s a glimpse at specific telemedicine programs and different ways health care providers are incorporating telehealth features to treat a growing range of conditions.


Remote ICU Access

With COVID-19 patients stretching New York hospitals beyond capacity, something had to be done. Turning the Javits Convention Center in New York City to a temporary hospital was part of the solution as New York cases surged.


Originally intended to treat patients with non-coronavirus illnesses, the temporary medical venue was approved to treat COVID-19 patients in early April. Its intensive care unit accommodated the sickest patients. Another field hospital set up in Central Park also had ICU capability.


Some of the knowledge and ability allowing these makeshift operations to provide care outside the traditional hospital setting stemmed from an earlier telemedicine innovation: the eICU.


“We actually get to pat ourselves on the back as being the first tele-ICU in the country,” says Dr. Steven A. Fuhrman, an intensivist and eICU medical director at Sentara Healthcare, based at Sentara Norfolk General Hospital in Virginia. In 2000, the program established remote access to ICU rooms.



The Sentara eICU team works from the control center in Norfolk to continuously monitor intensive care patients, covering 132 beds at seven Sentara hospitals in Virginia and North Carolina. A network of monitors, cameras, communication links and alert systems allow doctors and critical care nurses to make virtual rounds with patients at the in-person ICU sites.


At the control center, intensive care specialists observe each patient’s condition and view his or her X-rays, vital signs and laboratory data in real time. Using tablet devices, clinicians at the control center within Sentara’s Norfolk facility can continually interact with onsite physicians, nurses, patients and family members at each participating hospital ICUs.



Through remote technology and coordinated workflow, doctors in the tele-ICU immediately know when a patient’s condition is taking a downturn, and can jump on the situation, Fuhrman says. “It doesn’t take waiting for the elevator to come or getting from one hospital to another – it takes the flip of a switch.”



With iPads deployed to each ICU, specialty consultants can evaluate patients remotely. An endocrinologist could review the case of a patient with diabetes with the critical care nurse at the bedside and adjust insulin therapy. An infectious disease doctor might evaluate a patient’s cellulitis – a serious bacterial skin infection – and treat it.



The eICU model is effective, Fuhrman says. “We established a significant impact on ICU mortality and hospital length of stay for ICU patients and those (lower rates) have been maintained throughout the years,” he says. “And that’s really the genesis of the popularization of the tele-ICU.”


About 15% of ICU beds across the U.S. are now covered by tele-ICU, according to recent estimates from several studies.



Telehealth is well-poised to provide care during the coronavirus pandemic. “Where we have COVID-positive patients, we try to limit the number of caregivers at the bedside, while we recognize that there are bedside roles that must continue,” Fuhrman says, noting the need to protect the staff and community from unnecessary contact with infected patients.



“The tele-ICU is not born of the pandemic,” Fuhrman notes. “It has extended and expanded in the face of the pandemic, and it’s being recognized as an important adjunct to care.”
Fortunately, with New York cases decreasing and hospital beds reopening, makeshift operations in New York have served their purpose and are winding down.



Face-to-Face Virtual Visits


If you feel sick and need to see a doctor, telemedicine allows you to do so from home. Cold or flu-like symptoms, rashes or hives, gastric complaints such as nausea and vomiting or diarrhea, joint or back pain, minor injuries and chronic urinary tract infections are just some of the concerns that doctors, nurse practitioners and other clinicians can treat at a distance.


In some ways, a virtual visit can actually improve the patient-doctor dynamic and make you feel more at ease than, say, when you’re sitting in an exam room in a gown.

“When you’re eye to eye with your doctor, and you’re both seated, and you – the patient – are in your own home, in your own clothes with a bit more control of your own environment, it’s possible to have an interaction that can be a little bit more forthright,” says Dr. Ethan Booker, medical director for the MedStar Telehealth Innovation Center in Washington, D.C., and for MedStar eVisit.


Telehealth providers can get a better sense of their patients in the context of their day-to-day lives. “Patients would never bring their grandkids, or their dog, much less their house, with them to an office appointment,” Booker says. “But actually seeing a patient in their home, or with their family around, is a very different experience than being in an office environment where you don’t sort of bring your life with you.”


With telehealth, you don’t need to bring in your medications or a medication list for your doctor to evaluate and adapt as needed. Instead, a doctor can literally look inside your medication cabinet and discuss its contents with you.


Now, with nationwide restrictions on office visits, this convenience of virtual medicine has become a necessity. MedStar Health has delivered more than 100,000 telehealth sessions during the COVID-19 outbreak through a variety of formats.



Streamlined Emergency Care

Telemedicine use in emergency rooms isn’t brand-new. What is novel are the crisis circumstances and the speed with which emergency care must be deployed, Booker says.
If you’re an ER patient, telehealth changes the experience. Instead of being sent back to the waiting room after the ER nurse assesses your condition as he or she triages patients, your treatment can begin right away via the video connection initiated by the nurse.


“That way the doctor sees you immediately,” Booker says. If you came to the ER with severe nausea and vomiting, for instance, the doctor will order intravenous fluid and medication to treat the nausea then and there – alleviating your suffering sooner.



Reducing the time patients spend in the ER – and reducing their exposure to fellow patients and clinicians – is a clear advantage of telemedicine in the COVID-19 era. The streamlined ER workflow and video access for clinicians often allows patients to be discharged in less than an hour with reduced contact for everyone.



“That’s a lot safer for them as a patient,” Booker says. “It’s a lot safer for our staff if instead of (patients) seeing seven people, they only come into contact with two.”
Telehealth in the ER also conserves a lot of personal protective equipment, Booker notes. “We’ve saved more than 500 individual kits of PPE by using that methodology as opposed to an in-person evaluation.”


Telehealth for Every Specialty


Some medical conditions and specialties lend themselves particularly well to telehealth. Other specialties, by their very nature, continue to rely more on in-person visits.
Even so, telehealth can be a component of almost any medical specialty as a complement to necessary in-office visits when appropriate. Here is a small sample of ways that medical and mental health fields are incorporating virtual visits:


  • Psychiatry and cognitive behavior therapy. Talk therapy can often take place through video-based visits or even with a simple phone call. Virtual treatment for mental health crises like suicidal intervention is possible. Best practices for treating mental health patients via telehealth during the COVID-19 pandemic have been outlined by the Suicide Prevention Resource Center.


  • Dermatology. Patients can use their tablets or smartphones to let doctors visualize trouble skin spots, which increases patients’ access to dermatologists, whose practices are spread thin in many parts of the U.S.


  • OB-GYN. Telehealth allows maternal-fetal specialists to observe ultrasound recordings remotely. Blood pressure monitoring of the mother with Wi-Fi-connected devices, online childbirth and lactation classes – and just the opportunity to increase communication with patients between visits – help maintain care continuity despite pandemic-related restrictions.


  • Stroke care. Through telemedicine, specialists like vascular neurologists can treat emergency stroke patients from afar. That allows ER physicians and other clinicians to tap into their expertise in the critical moments following a stroke. The specialist can interact directly with the patient, review CT scan or MRI brain images and make recommendations on patient care, Booker explains.


In addition, cardiologists, pediatricians, geriatricians, allergy and asthma specialists, podiatrists and dentists are among practitioners in every field introducing telehealth into their practice.


Future Is Now

When you have a chronic condition – such as diabetes, congestive heart failure, asthma or cancer – telehealth can make managing these diseases less disruptive.
A Delaware-based managed care program uses an information technology platform that sythesizes a range of patient information such as medical records, imaging reports, medication usage and prediction analytics in its data-driven approach. The intent is to provide preventive care and avoid the need for hospitalizations or emergency department visits among people with chronic conditions.


“Our visiting nurse association has been using home biometric monitoring for chronic disease patients for several years with great success,” says Sharon Anderson, chief virtual health officer at ChristianaCare health system and the president of CareVio, a care management company and ChristianaCare subsidiary.


For example, nurses track key biometric measurements, including blood pressure, weight and heart rate, to identify trends that may indicate changes in the condition of a patient with heart failure. “We provide care management services and population health services to over 110,000 people,” Anderson says. Audio-visual interactions and secure text messaging are program features.
It’s also possible to receive routine primary care to stay healthy via telemedicine. Many companies and organizations are introducing online primary care options to employees. About two years ago, ChristianaCare established a virtual primary care practice for its employees and family members that’s 100% virtual, Anderson notes.



Underserved communities, rural residents and seniors can have increased access to health care with greater ease through telehealth programs. Patients recovering from COVID-19 need care continuity after they’re discharged from the hospital. Every patient needs new venues to receive care with restrictions on doctor’s office visits and hospital-based procedures.
In late April, the Federal Communications Commission awarded grants to 17 U.S. health care providers, including ChristianaCare, to support telehealth services during the COVID-19 pandemic, like increasing broadband access to vulnerable and underserved populations.


Telehealth is clearly here to stay. Although some types of patient monitoring or treatments could be challenging to do at home – like intravenous chemotherapy – it’s not necessarily impossible. “It’s surprising, if you think it through, how few things really need to be done in person,” Anderson says. “A lot of chemotherapy is moving to oral medications and away from infusions. It’s all migrating from facility-based medicine.”


Everyone will benefit from the differences made by telemedicine, Anderson says. “We’re in a new health care frontier,” she says. “The changes you’ll see over the next five years will be amazing.”





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