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In my last article I covered with the basics of telehealth. In this article I wanted to keep the focus on telehealth and share my thoughts and analysis of how it could help in the fight against COVID-19. COVID-19 is the synonym for panic these days. The novel coronavirus which originated in China has quickly become the global pandemic with far reaching consequences that no one thought about in the modern era. I will not go into details about what is the COVID-19 or how it has impacted the world as there is a ton of literature already available. However, before delving into the topic I do want to share some figures:

• As of 12^th April, 1.85M people have been tested positive to COVID-19 and 114k have died (source)
• As of 12^th April, US had ~560k cases and ~22k deaths due to COVID-19 (source)
• COVID-19 has an infection rate between 1.5% – 3.5%. Seasonal flu has infection rate of 1.3% while SARS and Ebola had a rate of 3% and 2.5% respectively

These numbers are horrifying and have put the most developed countries in the witness box on their capability to handle a pandemic. Based on the study conducted in March 2020 by HealthAffairs.org US has a total of 738,401 inpatient and 84,750 ICU beds. Further, per data from AHA and American Hospital Directory the current occupancy rate is 60-65%. Reducing the availability of beds to ~270-300k inpatient and ~30-40K ICU. Total number of active cases in US as of April 12^th are ~505k. Comparing the two numbers (beds available and active cases) we can clearly understand there is a shortage of beds. Based on the data from ‘Covid19.healthdata.org’ US currently has a deficit of approx. 13k inpatient and 8k ICU beds. This shortage has been alleviated to great extent by setting up temporary hospitals, cancelling non-urgent medical appointments and by using hospital ships. Although telehealth cannot help to reduce the existing cases, it can be used to reduce the burden on healthcare system.

Telehealth can come to rescue by allowing clinicians to focus on infected members. CDC is urging medical staff to use telehealth to perform any non-urgent communication to reduce pressures facing clinics and hospital facilities. Telehealth solutions can help the members who suffer from other medical ailments can receive care at home, without entering medical facility, thereby minimizing the risk of contracting the virus. In addition, telehealth can be used in the process of forward triage.

Everyone including members, healthcare system and government have understood the importance of telehealth as an alternative source of medical consultation in last few weeks. The data reported by Teledoc validates this thought – the demand for telemedicine went up by 50% in March 2020 as compared to previous months. With wait times to see a doctor reaching as high as 22 hours and most of these visits being consultative in nature, it makes sense to switch to telehealth wherever feasible. Telehealth has also witnessed rising numbers in the area of post-acute care

According to me telehealth can help in the following ways in dealing with the pandemic

• Initial screening or forward triaging. This can be used to screen patients for flu-like symptoms and to remotely take care of patients who don’t need medical intervention and can be treated at home. Patients with minor symptoms like cough and body aches can be examined while the member stays at home
  • Clinicians based on the data gathered via questions on phone or video can group members as low-risk, medium-risk and high-risk. The stratification will help clinicians monitor the situation closely and help them make a call if you need to visit a hospital for a checkup
• Providing routine care to patients with chronic diseases who are at a high risk for infection if exposed to the virus
• Protecting the front-line workers. No matter the numbers of precautions taken, there is a possibility that front line workers are exposed to the virus. By triaging the members upfront, we are protecting this critical work force who we cannot afford to lose at this point in time.

Telehealth allows hospital staff to use video conference or phone calls to gather information that can help them determine if urgent care is needed, or if a person can continue to self-monitor at home. Frequent check-in can be scheduled with clinical staff to continuously monitor the situation.

What are the some of the current challenges associated with Telehealth

• Most of the hospitals and private facilities are not equipped with the hardware and IT infrastructure required to support telehealth.
  • Internet is one of the major concerns for hospitals. Some hospitals still struggle with running a quality wi-fi connection. This problem is specific for hospitals situated in the rural areas
  • While many of the tele-medicine programs are hardware agnostic but hospitals and facilities need to ensure that hospitals are equipped with right tech such as good quality camera and sound
• In additions to IT infrastructure, there is a learning curve involved to use and understand the technology. Based on my experience from working in healthcare IT world, this could be a big bump in the process to utilize technology
• Another big challenge for telehealth is the availability of credentialled doctors who can provide service over internet. Doctors who are providing services need to be licensed for states they are providing services in. This is not a lengthy process but still time-consuming and may affect with telemedicine strategy for COVID 19 attack

In the latest move, CMS has added 85 new services to the catalogue covered by Medicare. As I discussed in previous article on patients over paperwork, CMS to support the ongoing crisis have eliminated the paperwork requirements allowing doctors to spend more quality time patients. By adding these 85 services what CMS wants to ensure is how patients can stay home and still be connected with the doctors. Further, FCC has announced the $200M telehealth fund to counter the effects of coronavirus. The goal is to create an environment for providers to treat patients while maintaining physical segregation, thereby minimizing the risk of further transmission. The support provided through the COVID-19 Telehealth Program will help eligible health care providers purchase telecommunications services, information services, and devices necessary to provide critical connected care services, whether for treatment of coronavirus or other health conditions during the coronavirus pandemic. This COVID-19 Telehealth Program is funded through a $200 million appropriation signed into law as part of the CARES Act, and this program will not rely on USF support.

References and reading material

• Origin of COVID in china: https://www.ncbi.nlm.nih.gov/pubmed/32202824
• Infection Rate: https://www.statista.com/topics/5994/the-coronavirus-disease-covid-19-outbreak/
• Estimates of the severity of coronavirus disease 2019: a model-based analysis
• Understand the infection rate: http://health.utah.gov/epi/diseases/HAI/resources/Cal_Inf_Rates.pdf
• US healthcare capacity analysis: https://www.healthaffairs.org/do/10.1377/hblog20200317.457910/full/
• How Scientists Quantify the Intensity of an Outbreak Like COVID-19
• Can telehealth help flatten the curve of COVID-19?
• https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19
• Employment numbers for Registered Nurses: https://www.bls.gov/oes/2018/may/oes291141.htm
• Employment number for Physician and surgeons: https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-6
• XhealthIntellegent podcast with ATA CEO Ann Mond Johnson:  Maintaining Telehealth Progress Beyond COVID-19, ATA 2020 (Available on Spotify)
• FCC fund: https://docs.fcc.gov/public/attachments/FCC-20-44A1.pdf
• https://covid19.healthdata.org/united-states-of-america