The pandemic jumpstarted innovations in telemedicine

The coronavirus pandemic has been tragic and intractable in Kentucky, where the number of COVID-19 cases rose to 108,642 last week and the number of deaths topped 1,489.

As heartbreaking as the pandemic has been, Northern Kentucky health professionals say the virus brought about an innovation that might not have occurred otherwise.

They are talking about telemedicine, the use of technology to connect a patient and doctor who are in different locations. Visiting patients via cellphone on a widespread basis was overdue, they say.

“If there's a silver lining from COVID, what it would be is it really helped expand our horizons on innovation and what we could do with telemedicine,” says Dr. Barry Wendt, assistant vice president of clinical transformation at St. Elizabeth Healthcare.

In March, Americans began to realize that the novel coronavirus was contagious and deadly. Schools and businesses shut down or sent employees home to work remotely. Concern about spread of the virus affected clinics, hospitals, and health professionals, who were fearful of patients and staff getting sick.

“When the pandemic hit, we needed to really ramp up our way to communicate with the patients,” says Dr. Robert Tracy, medical director for quality at St. Elizabeth Physicians. “So very quickly, our quality and clinical transformation team kicked into gear and we started really ramping up our telemedicine, working on ways to make it more user-friendly, both for the providers as well as for the patients.”

A year ago, before reports of the new virus trickled out of Wuhan, China, St. Elizabeth Healthcare charged a team with advancing telemedicine, to work out the bugs, and get technology and workflows launched.

“In 2019, we did 250 video visits,” Dr. Wendt says. “And I’ll be honest, we were kind of dragging patients and providers along” to get telehealth to take off. “We actually had a project that was supposed to take six months to complete.

“And when COVID hit, we had to finish that project in three days. So, we pretty much locked everybody in the room for the weekend and got it all completed,” Dr. Wendt says.

Since March 2, St. E providers have done close to 180,000 video visits. That’s 700 times more than in 2019.

And 2020 is not over yet. Today most of St. Elizabeth’s providers are examining some patients over smartphone, but not at the same level as March, April and May. Safety practices at the hospital were incorporated, screening got more sophisticated.

Even with practices reopened, St. E is doing about 3,000 telemedicine visits a week.

Other physician practices had different experiences before the pandemic, but the same crush of patient care issues last spring.

In 2016, OrthoCincy’s Dr. Michael Greiwe, known in Northern Kentucky medical circles as the “shoulder guru,” launched a side business to leverage telehealth technology for orthopedic care.

“I have a lot of patients that come from a few hours away to see me and sometimes from across the country,” Dr. Greiwe says. To improve care for those patients, he searched for an orthopedics telehealth platform, but wasn’t satisfied with what he found.

“So, I embarked on the journey of trying to build a platform that really worked well for medical specialists,” Dr. Greiwe says. The result was OrthoLive. Dr. Greiwe has demonstrated the platform from coast to coast, conducts consultations overseas and creates YouTube videos. The 15-member business takes care of providing needed software to around 15 to 20 percent of orthopedic private practices in the U.S.

By March 2020, the pandemic surge created a “huge, huge influx” and desire for OrthoLive’s app. The surgeon spent weeks making sure they had enough server capacity for the spike in clients, insuring video services could withstand the new broadband challenges. “We saw like a tenfold increase in our user base, almost overnight, and it was within about a two-week period,” Dr. Greiwe says.

“I knew telemedicine was going to have its day. I just didn’t know when it was to be and how quickly that was going to happen,” he says.

Dr. Chris Bolling, a founder of Pediatric Associates in Northern Kentucky, says many in his field were waiting for telemedicine to explode. He has been part of the American Association of Pediatrics sections on childhood obesity and telehealth. He wanted telemedicine to bring access to obese children in rural areas where there are food deserts. “There’s been this real push in that world for how we get access to those kids in those areas.”

“When is that ever going to come to fruition? Then COVID-19 hits and – boom,” Dr. Bolling says. “It’s been a godsend and some of these patients really need to be seen and you don’t want to expose everybody.”

Temporary waivers on patient privacy and financial reimbursement allowed telehealth to break out. One “bugaboo” the pediatrician worries about: “Are we going to go back to the way before where it was not reimbursed? That will kill us.”

Over at St. Elizabeth, “our patient satisfaction (with telehealth visits) has gone through the roof,” Dr. Wendt said. Another surprise is how accepting people are. “Once they've done a video visit, they come back and they want to do them again,” he says.

“The kids get a kick out of seeing their doctor on the computer,” Dr. Bolling says. For older adults, it was a little tough to adapt at first, Dr. Wendt says. But they have gotten the hang of it. “We're seeing patients at 80, 90 being able to do this with relative ease.”

Most of the doctors recommend using a smartphone rather than desktop computer. That way, the patient or guardian can move the phone wherever the doctor needs to look; for instance, a throat exam.

Think you have an unusual rash? That is a very typical complaint that can be checked by telehealth. Migraines, pink eye, gout are others. On the other hand, appendicitis or chest pain need immediate attention, in person.

“Our behavioral health specialists are using it a lot,” says Dr. Tracy, who practices internal medicine. “The pandemic has created a lot of anxiety and depression.”

Nurses have played a huge role in the ramp-up and acceptance of telemedicine, according to Dr. Tracy, helping patients sign up for apps and using their smartphones. “It was inspiring and amazing to watch people step out of their traditional roles and do something different in order to help our patients.

“It was crazy how quickly it moved. Yes, we had to be very nimble and adaptive. And that's not always easy in medicine. It's a profession that is slow to sometimes change.”

With the growth of telemedicine, will you be ready when your doctor suggests a video visit? Here are tips suggested for patients:
  • Test your app before the video visit.
  • Hold the cellphone horizontally.
  • Pick a well-lit place that is quiet and comfortable.
  • Show your provider what's going on and have an easy discussion with him or her.
  • It’s helpful to have a blood pressure monitor to share those numbers with the nurse or doctor.
  • Get familiar with the practice’s patient portal. You can ask questions and get lab results. These secure websites give patients 24-hour access to personal health information.
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