A recent paper details how telehealth has been implemented and should continue to be used through three stages of a pandemic.
Two DCRI fellows, one former and one current, recently contributed to a paper published in Journal of the American Medical Informatics Association on the role telehealth has played in U.S. health care during the COVID-19 pandemic.
The paper, for which DCRI cardiology fellow Jedrek Wosik, MD, is the corresponding author, details how telehealth has transformed both within the Duke Health system and beyond through the collaboration of people, processes, and technology. The paper focuses on three distinct phases of the crisis caused by the novel coronavirus: outpatient care during the stay-at-home orders, the initial COVID-19 hospital surge, and recovery post-pandemic.
Throughout the stay-at-home orders, the authors write, outpatient care administered via telehealth has increased dramatically. Before the pandemic, telehealth visits accounted for less than 1 percent of visits at Duke; just four weeks later, telehealth visits account for 70 percent of visits with over 1,000 patients seen virtually per day. To streamline this transition, Duke created a centralized telehealth call center and deployed a “train the trainer” model to rapidly onboard over 1,300 providers in three weeks.
Telehealth has also been useful in caring for inpatients during a time when many hospitals have been overloaded. “Telehealth is ideally suited to meet the demands of inpatient care while at the same time reducing virus transmission, stretching human and technical resources, and protecting patients and healthcare workers in the inpatient care setting,” the authors write.
At Duke, specialists have been using a Tele-ICU system that enables them to remotely manage intubated patients. Physicians can see data describing ventilator settings and patient breathing while consulting with the bedside team from a remote location. This approach not only decreases exposure risk, but also conserves personal protective equipment (PPE).
Not much is known about telehealth in the third stage—recovery post-pandemic—because the pandemic is ongoing. However, the authors make recommendations about important areas of focus during this stage. While telehealth was leveraged quickly to respond to a crisis, it will be critical to ensure that data security and patient privacy remain paramount as telehealth becomes a sustained offering integrated into everyday care. This could present an opportunity to leverage the electronic health record, which already provides the infrastructure for patients to securely access test results. Health systems should proactively engage patients, the authors write, while also creating systems that allow for efficient use of hospital space and staff.
The COVID-19 pandemic has ushered in a new era of telemedicine, and “delivery of patient care by the American health system will be forever changed,” the authors write. There is more work ahead to determine how to administer telehealth most efficiently and equitably—for example, by linking rural hospitals to existing telehealth programs from larger hospitals.
Former DCRI fellow Marat Fudim, MD, and DCRI faculty member Ziad Gellad, MD, MPH, also contributed to this paper. Their Duke co-authors include Blake Cameron, MD; Alex Cho, MD, MBA; Donna Phinney, BSN, MS; Simon Curtis, MHA; Eric Poon, MD, MPH; Matthew Roman, MHA, MCCi; Jeffrey Ferranti, MD, MS; Jason Katz, MD, MHS; and James Tcheng, MD.