Telehealth and Medicine Today

TMT Editorial: The Future of Virtual Health – Near Term Analysis of the COVID-19 Pandemic

2020-08-13T18:38:06-07:00

Telehealth has received a lot of attention over the past few months as healthcare providers necessarily shifted. This was initiated by the need to decrease virus exposure and PPE usage, and then further enabled by pro-telehealth reimbursement and regulatory changes. What lessons were learned that help us envision what the future might look like over the next 12 months?

Feasibility and Effectiveness of Mobile App for Active Case Finding for Tuberculosis in India

2020-08-13T18:38:02-07:00

Background: Tuberculosis (TB) is an infectious disease with 2.8 million cases and 480,000 deaths each year in India. The city of Indore alone with a population of 3.5 million had 7,839 identified TB cases in 2017. However, about two to three thousand additional cases remain unidentified per district officials. The unidentified cases lead to an endemic TB and hamper the efforts of organizations such as The Collaborative to Eliminate TB from India (CETI) to reduce the incidence of TB with the method of Active Case Finding (ACF).¹ Previously, 1,332 mobile apps attempted to use technology to overcome the challenge of unreported TB patients in Indian slum areas due to the inaccurate, lost, or unhelpful data collected in ACF; yet the existing apps for TB prevention and treatment possessed minimal functionality. Over a period of 3 months, the CETI developed a mobile data collection app to generate a TB diagnostic survey and to collect data from patient registration form.

Methods: To study the feasibility and effectiveness of the app, a pilot survey was conducted of 163,496 homes covering a population of 828,020 in the slum areas of Indore and Bhopal.

Findings: Between the years of 2018 and 2019, 14,349 pulmonary suspected cases and 4,357 extra pulmonary suspected cases of TB were identified. Among the total of 18,706 cases identified, 7,756 patients (48.1%) had low-grade fever for over 2 weeks, 6,331 patients (39.2%) had persistent cough for more than 2 weeks, 7,693 patients (47.7%) had weight loss, and 251 patients (1.6%) had cough with blood.

Interpretation: This pilot experience shows that an app is a useful tool for TB case recording and follow-up in the field. Further training of the health workers, and more widespread availability and ease of use of mobile phones will be necessary.

Telemedicine Provides Enhanced Care for Low-Acuity Pediatric Urology Patients

2020-08-13T18:38:12-07:00

Methods: A survey was developed and sent to patients participating in a pediatric teleurology program at an academic medical center. This survey evaluated the patient’s history using this telemedicine platform, satisfaction with various aspects of the application as well as associated details about transportation and costs of traditional in-person visits.

Results: Of the 50 survey respondents, the majority reported that they found the app easy and comfortable to use as well as just as useful as in-person visits. Respondents also indicated that they incurred lower costs, traveled less, and faced less time lost from work.

Conclusions: Telemedicine is a useful tool to enhance low-acuity pediatric urology care while minimizing the financial and opportunity costs of these visits as compared to in-person visits.

Applying Servant Leadership in a Telehealth Environment

2020-08-13T18:38:11-07:00

This article presents an application of servant leadership to respond to the global pandemic, COVID-19. The application of servant leadership is applied to the telehealth environment and healthcare delivery.

Implementation and Optimization of Telehealth during the COVID-19 Public Health Crisis—Our Journey

2020-08-13T18:38:08-07:00

Telehealth offered a great opportunity for the clinicians at West Tennessee Healthcare to provide an essential service to the community at large during these unprecedented times. Our telehealth footprint continues to enlarge daily with more clinicians and specialties becoming comfortable with the workflows and technology. The program is described herein.

The COVID-19 pandemic tests the ability of many primary care, urgent care, and hospital systems to adapt quickly to new circumstances. In many of these offices, virtual telehealth visits have become a strategy to decrease the use of personal protective equipment, and mitigate the risk of exposure of providers, staff, or patients to the coronavirus, among many other opportunities.¹ West Tennessee Healthcare noted these same strong headwinds, as the pandemic and emergency decelerations began to send individuals to continue to reschedule appointments for a multitude of reasons—including fear.

West Tennessee Healthcare is located in an underserved area with a lack of access to healthcare in all of our servicing districts. Each of these districts holds a classification of a partial or full healthcare professional shortage area. In our over 40 primary and specialty care clinics, face-to-face visits began to shudder near the end of March with the Tennessee governor’s first social distancing and business step-down regulations. With the foresight of other health systems being impacted by COVID-19, our medical practices were forced into a dilemma to creatively continue to offer quality care, but from a new environment. Prior to this federal and state emergency, our clinics were in the planning stages of creating a telehealth environment but had not completed any medical telehealth visits.

Emergency Medical Technician-Facilitated Telehealth Visits: A New Model to Expand Home-Based Primary Care for Homebound Seniors

2020-08-13T18:37:59-07:00

Objective: As the number of older adults living in the United States grows, the gap between the capacity of home-based primary care (HBPC) services and the community demand will continue to widen. Older adults, living longer with mobility difficulties and multiple chronic medical conditions, often prefer to age in place, and new models of care are needed to meet this need. This article provides a framework for an innovative emergency medical technician (EMT)-facilitated telehealth program, the mobile telemedicine technician (MTT) program, which aims to increase access to medical care and efficiency within an HBPC program.

Design: A descriptive framework outlining the deployment of an innovative telehealth model.

Setting: An HBPC program serving homebound seniors in downstate New York.

Participants: Homebound individuals enrolled in an HBPC program with advanced age (over half >90 years), 67% with 5–6 activities of daily living (ADL) dependencies, and high rates of dementia, congestive heart failure, chronic obstructive pulmonary disease (COPD), and diabetes requiring evaluation and treatment of acute conditions.

Interventions: HBPC program enrollees requiring evaluation and treatment of acute conditions received a home visit from a telehealth-enabled EMT who has received additional training to provide in-home care. Following an evaluation, the EMT facilitated a telehealth visit via a two-way video conference between the patient and the primary care physician.

Main outcome measures: Description of a novel telehealth care model, preliminary results from the first 100 MTT visits including the reason for visit, patient/caregiver, physician, and telehealth-enabled EMT satisfaction survey results.

Results: The primary care provider was able to evaluate twice as many patients in a given time period using the new model as in the regular home visit care model. The most common visit reasons were related to skin conditions (22%), neurological conditions (19%), cardiovascular conditions (16%), and respiratory conditions (15%). Satisfaction rates were high from patients/caregivers (45% response rate, 60% strongly agreed and 29% agreed that they were satisfied with the care delivery experience), physician (six surveys over time from one physician, 100% strongly agreed on the effectiveness of care delivery model), and telehealth-enabled EMTs (eight surveys from four EMTs, 100% strongly agreed that they were satisfied with the care delivery experience).

Conclusions: In this descriptive article, we outline a new model of care using telehealth-enabled EMTs making home visits to connect with a patient’s primary care physician who is centrally located. This model shows promise for expanding primary care services within the home.