Virtually Perfect? Telemedicine for Covid-19.
11 Mar 2020-The New England Journal of Medicine (Massachusetts Medical Society)-Vol. 382, Iss: 18, pp 1679-1681
TL;DR: Telemedicine for Covid-19’s payment and regulatory structures, licensing, credentialing, and implementation take time to work through, but health systems that have a...
Abstract: Virtually Perfect? Telemedicine for Covid-19 Telemedicine’s payment and regulatory structures, licensing, credentialing, and implementation take time to work through, but health systems that have a...
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TL;DR: The peer-reviewed and preprint literature pertaining to cardiovascular considerations related to COVID-19 are reviewed to highlight gaps in knowledge that require further study pertinent to patients, health care workers, and health systems.
1,484 citations
Cites background from "Virtually Perfect? Telemedicine for..."
...risk, this is a technology that will likely prove important to promote viral containment (91)....
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TL;DR: The role that telehealth has played in transforming healthcare delivery during the 3 phases of the U.S. COVID-19 pandemic is described and how people, process, and technology work together to support a successful telehealth transformation is examined.
986 citations
Cites background from "Virtually Perfect? Telemedicine for..."
...Telehealth also proves useful for inpatient care, in particular to help balance the supply of clinical services with surge in demand across physical or geographical boundaries, conserve personal protective equipment, and provide isolated patients connection to family and friends.(3,4)...
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TL;DR: This systematic review identified the role of telehealth services in preventing, diagnosing, treating, and controlling diseases during COVID-19 outbreak through searching five databases including PubMed, Scopus, Embase, Web of Science, and Science Direct.
Abstract: The outbreak of coronavirus disease-19 (COVID-19) is a public health emergency of international concern. Telehealth is an effective option to fight the outbreak of COVID-19. The aim of this systematic review was to identify the role of telehealth services in preventing, diagnosing, treating, and controlling diseases during COVID-19 outbreak. This systematic review was conducted through searching five databases including PubMed, Scopus, Embase, Web of Science, and Science Direct. Inclusion criteria included studies clearly defining any use of telehealth services in all aspects of health care during COVID-19 outbreak, published from December 31, 2019, written in English language and published in peer reviewed journals. Two reviewers independently assessed search results, extracted data, and assessed the quality of the included studies. Quality assessment was based on the Critical Appraisal Skills Program (CASP) checklist. Narrative synthesis was undertaken to summarize and report the findings. Eight studies met the inclusion out of the 142 search results. Currently, healthcare providers and patients who are self-isolating, telehealth is certainly appropriate in minimizing the risk of COVID-19 transmission. This solution has the potential to prevent any sort of direct physical contact, provide continuous care to the community, and finally reduce morbidity and mortality in COVID-19 outbreak. The use of telehealth improves the provision of health services. Therefore, telehealth should be an important tool in caring services while keeping patients and health providers safe during COVID-19 outbreak.
969 citations
Cites background from "Virtually Perfect? Telemedicine for..."
...that is made possible by the reduction of person-toperson contact [7, 8]....
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...These days, suitable adaptation of local systems with changes regarding to payment and coordination of services are major barriers for the largescale use of telehealth to deal with COVID-19 infection [8]....
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...In addition, covering multiple sites with a tele-physician can address some of the challenges of the workforce [8, 23]....
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...Physicians who are in quarantine can employ these services to take care of their patients remotely [8, 22]....
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TL;DR: The COVID-19 pandemic has driven rapid expansion of telemedicine use for urgent care and nonurgent care visits beyond baseline periods, and this reflects an important change in teleomedicine that other institutions facing the COVID the pandemic should anticipate.
877 citations
TL;DR: For countries without integrated telemedicine in their national health care system, the COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for supporting wide adoption of telemedics, including in emergency and outbreak situations.
Abstract: On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak as a pandemic, with over 720,000 cases reported in more than 203 countries as of 31 March. The response strategy included early diagnosis, patient isolation, symptomatic monitoring of contacts as well as suspected and confirmed cases, and public health quarantine. In this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission, especially in the United Kingdom and the United States of America. Based on a literature review, the first conceptual framework for telemedicine implementation during outbreaks was published in 2015. An updated framework for telemedicine in the COVID-19 pandemic has been defined. This framework could be applied at a large scale to improve the national public health response. Most countries, however, lack a regulatory framework to authorize, integrate, and reimburse telemedicine services, including in emergency and outbreak situations. In this context, Italy does not include telemedicine in the essential levels of care granted to all citizens within the National Health Service, while France authorized, reimbursed, and actively promoted the use of telemedicine. Several challenges remain for the global use and integration of telemedicine into the public health response to COVID-19 and future outbreaks. All stakeholders are encouraged to address the challenges and collaborate to promote the safe and evidence-based use of telemedicine during the current pandemic and future outbreaks. For countries without integrated telemedicine in their national health care system, the COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for supporting wide adoption of telemedicine.
717 citations
Cites background from "Virtually Perfect? Telemedicine for..."
...In this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission, especially in the United Kingdom and the United States of America....
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...In this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission, especially in the United Kingdom [1] and the United States of America [2,3]....
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References
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325 citations
TL;DR: In-Person Health Care as Option B and a system focused on high-quality nonvisit care would work better for many patients.
Abstract: In-Person Health Care as Option B Face-to-face interactions will certainly always have a central role in health care. But a system focused on high-quality nonvisit care would work better for many p...
124 citations
TL;DR: It is found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity and provides support for broader EMS mobile integrated health programs in other regions.
Abstract: Background Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy This research describes the development and comparative effectiveness of one large urban program Methods “Blinded for Peer Review” EMS initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014 ETHAN combines telehealth, social services, and alternative transportation to navigate primary care related patients away from the ED where possible Using a case-control study design with multiple outcome variables, we describe the program and compare differences in effectiveness measures relative to the control group Results During the first 12 months, 5,570 patients received the intervention We found a 76% decrease in ambulance transports to the ED with the intervention (18% vs 74%, P<001) EMS productivity (median time from EMS notification to unit back in service) was 44 minutes faster for the ETHAN group (39 vs 83 minutes, median) There were no statistically significant differences in mortality or patient satisfaction Conclusions We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity This provides support for broader EMS mobile integrated health programs in other regions
95 citations
TL;DR: Remote tele-intake provided in an urban community hospital ED reduced LWBS and time to provider but increased left without treatment complete rates and had no impact on LWOT.
Abstract: OBJECTIVES More than 2 million patients present to a U.S. emergency department (ED) annually and leave without being seen (LWBS) due to delays in initiating care. We evaluated whether tele-intake at the time of presentation would reduce LWBS rates and ED throughput measures. METHODS We conducted a before-and-after study at an urban community hospital. The intervention was use of a tele-intake physician to triage patients from 11 am to 6 pm, 7 days per week. Tele-intake providers performed a triage history and physical examination, documented findings, and initiated orders in the medical record. We assessed the impact of this program using the domains of the National Quality Forum framework evaluating access, provider experience, and effectiveness of care. The main outcome was 24-hour LWBS rate. Secondary outcomes were overall door to provider and door to disposition times, left without treatment complete (LWTC), left against medical advice (AMA), left without treatment (LWOT), and physician experience. We compared the 6-month tele-intake period to the same period from the prior year (October 1 to April 1, 2017 vs. 2016). Additionally, we conducted a survey of our physicians to assess their experience with the program. RESULTS Total ED volume was similar in the before and after periods (19,892 patients vs. 19,646 patients). The 24-hour LWBS rate was reduced from 2.30% (95% confidence interval [CI] = 2.0% to 2.5%) to 1.69% (95% CI = 1.51% to 1.87%; p < 0.001). Overall door to provider time decreased (median = 19 [interquartile range {IQR} = 9 to 38] minutes vs. 16.2 [IQR = 7.8 to 34.3] minutes; p < 0.001), but ED length of stay for all patients (defined as door in to door out time for all patients) minimally increased (median = 184 [IQR = 100 to 292] minutes vs. 184.3 [IQR = 104.4 to 300] minutes; p < 0.001). There was an increase in door to discharge times (median = 146 [IQR = 83 to 231] minutes vs. 148 [IQR = 88.2 to 233.6] minutes; p < 0.001) and door to admit times (median = 330 [IQR = 253 to 432] minutes vs. 357.6 [IQR = 260.3 to 514.5] minutes; p < 0.001). We saw an increase in LWTC (0.59% [95% CI = 0.49% to 0.70%] vs. 1.1% [95% CI = 0.9% to 1.2%]; p < 0.001), but no change in AMA (1.4% [95% CI = 1.2% to 1.6%] vs. 1.6% [95% CI = 1.4% to 1.78%]; p = 0.21) or LWOT (4.3% [95% CI = 4.1% to 4.6%] vs. 4.4% [95% CI = 4.1% to 4.7%]; p = 0.7). Tele-intake providers thought tele-intake added value (12/15, 80%) and allowed them to effectively address medical problems (14/15, 95%), but only (10/15, 67%) thought that it was as good as in-person triage. Of the receiving physicians, most agreed with statements that tele-intake did not interfere with care (19/22, 86%), helped complement care (19/21, 90%), and gave the patient a better experience (19/22, 86%). CONCLUSIONS Remote tele-intake provided in an urban community hospital ED reduced LWBS and time to provider but increased LWTC rates and had no impact on LWOT.
39 citations