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Virginia Hospitals Report Surge in Telemedicine Use

Before the coronavirus arrived in Virginia, the average number of telemedicine visits within Sentara Medical Group was about 20 a day. Now, it is more than 2,000 a day, according to the company.

Marcia McNelly, a registered nurse, views a room at Sentara Princess Anne Hospital in Virginia Beach on her computer monitor at the eICU from Sentara Norfolk General Hospital on Thursday morning, June 25, 2020. The eICU has the ability to watch over up to 132 critical patients at various hospitals simultaneously from a control room.
(TNS) — When Sentara Healthcare first launched its “eICU,” the plan was to provide an extra set of eyes on critical patients, especially overnight when staffing was down to a skeleton crew.

The hospital system — the first in the country — wired bedside video cameras and microphones on a secure network in 2000 so a medical team could monitor patients at multiple hospitals’ intensive care units from one command center around the clock.

Since then the program has expanded, with up to 132 patients being watched and treated by a doctor who’s often miles away.

But Dr. Steven Fuhrman, medical director of Sentara’s eICU, said he couldn’t have foreseen how the technology would be used today. The highly contagious coronavirus has overwhelmed ICUs around the world and infected many frontline health care workers as they have come in contact with patients.

“I would have never thought that this particular need would rear its head,” said Fuhrman, whose remote-monitoring crew hit a 20-year milestone last week. “We’re lucky that we had it.”

Sentara’s eICU is one of many types of telemedicine programs the health care industry has found to be invaluable during the height of COVID-19, a new respiratory illness with no known prevention or approved treatment.

Suddenly, virtual technology became the primary way of giving and getting medical care. Health care workers leveraged these services to reduce their own exposure to the virus and to keep patients at home whenever possible.

Experts say the public health crisis led to a swift surge in the adoption of telemedicine, and Hampton Roads health systems have reported record numbers of usage.

Before the coronavirus arrived in Virginia, the average number of telemedicine visits within Sentara Medical Group was about 20 a day. Now, it is more than 2,000 a day, according to the company. Between March and June 21, its clinicians had 314,000 total patient visits, with about 51 percent of them happening virtually.

Bon Secours Mercy Health, which also runs several medical practices and hospitals in the region, has seen a similar rise. From mid-March through last week, virtual visits have made up about 68 percent of all visits for the Hampton Roads medical group. Before the pandemic, a spokeswoman said, “that number was essentially zero.”

Patients used telehealth to keep previously scheduled appointments during the lockdown. Hospitals and clinics used chat bots and apps to screen patients for COVID-19 symptoms before waving them into the office or ER. Even therapists helped clients manage agoraphobia and depression by talking to them over phones, tablets and computers.

Some patients and physicians had been reluctant to adopt electronic platforms, said Christy Helsel, Riverside Health’s telehealth program director.

If not for the crisis, some might never have tried, she said. But family members have helped older or less tech-savvy relatives learn the ropes, and a large portion of Riverside’s users are in their 60s and 70s. Helsel recently learned of a 99-year-old patient who had a virtual appointment.

The learning curve extends to the doctors and nurse practitioners.

“It’s a mixed response,” she said. “If they love it, they love it. Some find a lot of value in it. They find it’s a great time saver.”

State and federal policy changes and insurers waiving out-of-pocket charges have aided telehealth’s rapid growth.

Doctors are now being reimbursed for visits wherever their patients are and can use common forms of communications, such as Facetime and even landline phones. Medicare and Medicaid also began to reimburse for twice as many types of telemedicine visits as before.

The question is whether such temporary changes will remain. The U.S. Senate Committee on Health, Education, Labor and Pensions heard from the telehealth industry this month on lessons learned during the pandemic. The panel, headed by Tennessee Sen. Lamar Alexander, will consider legislation that could make some of those new rules permanent.

“We had 884 million doctor-patient visits last year, according to the CDC. If 20 percent of those, or 25 or 30 percent of those, continue to be telehealth visits, that’s hundreds of millions of doctor-patient visits that will occur by telemedicine rather than in person,” Alexander said during the hearing. “I don’t know enough to know whether that’s the biggest change in health-care delivery services in our history or not, but it would be hard to think of one that is more significant.”

But the concern about future investments in telemedicine infrastructure is that it leaves out people who don’t have access to tech devices, computers and the Internet — some of the most vulnerable among the population. Some lawmakers cautioned that going too far with these services could drive larger health disparities.

As many states, including Virginia, are reopening and slowly returning to business as usual, patients are reverting back to in-person appointments. But several Hampton Roads health system leaders say virtual visits are continuing to be popular.

At UVA Health, a survey of more than 1,900 patients who had used its telehealth services from April to June 12, 2020, found that 83.4 percent said they would be willing to do more electronic visits after the COVID-19 quarantine is over.

That wouldn’t surprise Dr. Anhtai Nguyen, Bon Secours Hampton Roads’ chief clinical officer. The system’s own surveys have shown many people’s previous discomfort with using tech devices for their visits is declining.

“That’s why I think the shift has sort of been made,” he said. “I don’t see people going to a crowded waiting room with sick people now when they can be seen through a virtual platform.”

When the crisis was at its peak, Sentara set up special COVID-19 units outside of the traditional ICUs.

Staffers rigged carts with cameras and speakers to roll wherever they were needed, Fuhrman said. Doctors and nurses remotely monitoring coronavirus patients helped limit the staff exposure to the infected patients and reduced the masks and gowns needed overall to care for them, he said.

From the eICU’s command center on the Norfolk General Hospital campus, the crew can do virtual rounds, talk to patients who aren’t intubated, zoom in to examine pupils, get live vitals readings and even prescribe medications and treatments. The team helps care for patients in eight hospitals, from Elizabeth City, N.C., to Williamsburg.

Bracing for perhaps a second wave of the pandemic, Fuhrman believes other hospitals without the tech capability are now coveting it.

“Absolutely,” he said. “It’s not just ‘think’ — it’s ‘know.’”

©2020 The Virginian-Pilot (Norfolk, Va.) Distributed by Tribune Content Agency, LLC.