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Analysis

Telemedicine Playing Front Line Role in COVID-19 Outbreak

By Christopher Cheney  
   March 10, 2020

Benefits of telemedicine screening for COVID-19 include convenience for patients and safely assessing patients in their homes.

Some health systems are offering virtual screening for the novel coronavirus, COVID-19.

After reaching epidemic proportions in Wuhan, China, in December, COVID-19 has spread to 110 countries or territories, with more than 113,000 confirmed cases and more than 4,000 deaths, according to the World Health Organization. As of March 10, there had been 729 confirmed cased in the United States, with 27 deaths, worldometer reported.

Grand Rapids, Michigan-based Spectrum Health, which features 15 hospitals and 11 urgent care centers, began free telemedicine screening for COVID-19 last week.

"Telemedicine is a good fit for screening. For screening, it is a matter of asking the appropriate questions and ensuring that you have the right answers and a triage plan. We can't do a full examination of someone with telemedicine, but we can screen to determine whether someone is at low risk and can wait to see their doctor the next day, or is at high risk and needs to be seen right away, says Darryl Elmouchi, MD, MBA, chief medical officer at Spectrum Health.

He says the free telemedicine screening initiative has four advantages.

1. It is much more convenient for people to be screened in their homes rather than having to visit an emergency room or urgent care center. The convenience should lower the barrier to get screening easily.

2. From a public health standpoint, telemedicine screening can help avoid inundating healthcare settings with patients who are at low risk of having COVID-19, which maintains capacity to treat patients who are at high risk.

3. The telemedicine screening can help prevent the spread of COVID-19 because as long as patients are not critically ill, they can be triaged at home rather than visiting an emergency room or clinic, where other people could become infected.

4. The free screening lowers the cost barrier to getting a COVID-19 assessment.

How the screening works

The screening process is simple, Elmouchi says.

"A person can call a hotline number, which is answered by someone who walks them through downloading our app if they don't have the app already on their phone or tablet. They can also log in on a computer. Then a time is scheduled when a provider will be available for the virtual visit, which is a video visit much like FaceTime or Skype," he says.

The telemedicine screening is following Centers for Disease Control and Prevention guidelines such as asking about COVID-19 symptoms—fever, cough, and shortness of breath—and travel to infection hotspots such as China, Iran, and Italy.

Ideally, if a patient is at high risk of COVID-19, testing can be conducted at the patient's home, Elmouchi says.

The virtual visit is conducted by a physician, physician assistant, or nurse practitioner. Most of the clinicians work at the health system's telehealth platform, Spectrum Health Now, but they are being supplemented with clinicians from urgent care centers and primary care clinics who have spare time, he says.

For now, there is enough staff to provide the telemedicine screening, Elmouchi says. "We launched this on Friday evening, and on Saturday and Sunday we averaged about 20 patients each day. By 11 a.m. Monday morning, we already had 33 people who had called to schedule visits. At this point, we have untapped capacity through the rest of our medical group, but if we had to screen several hundred people per day that would be challenging.

Telemedicine opportunity

The screening initiative has revealed a largely unexplored frontier of telemedicine, Elmouchi says. "This is definitely an example of the untapped potential of telemedicine. There are many different areas where talking with someone and looking at someone virtually can be important for communication, getting information, screening, and reassurance."

The screening is an opportunity to rise to a public health challenge, he says.

"We think this is our duty as a caretaker for the community. We want to make sure that we prevent infections and we make it easy for people to dispel concerns. We are not directing any of the care to our own settings specifically. We are redirecting people back to their primary care doctor or a health system where they already get their care. The goal here is not to increase business. The goal is to make sure people get the right care, where they need it, and when they need it."

Other health systems offering telemedicine screening for COVID-19 include Indianapolis-based IU Health and Charleston, South Carolina-based MUSC Health.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Last week, Spectrum Health started offering free telemedicine screening for COVID-19 to Michigan residents.

The video-based visits determine whether a patient is at low risk or high risk of COVID-19 infection.

The screening initiative is an example of the "untapped potential of telemedicine," Spectrum Health's chief medical officer says.


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