'Tipping point for telehealth'

Mar. 19--ATLANTA -- The push for telemedicine across Georgia has been slow, but with health officials cautioning patients to avoid hospitals amid the COVID-19 outbreak, proponents say it's needed more than ever.

The state's top health officials have urged the elderly and chronic disease patients to stay out of hospitals for risk of infection and have pleaded that healthy, low-risk residents stay at home to reduce spread of coronavirus.

While rural hospitals are facing shortages of equipment, beds and doctors -- the health care industry is scrambling to continue regular care on top of executing emergency responses. Leaders in telehealth have jumped in on the urgent and expansive need for doctors to treat patients miles away or in quarantine.

For years, Jeff Robbins, director of neurodiagnostics and telehealth at Tift Regional Medical Center, has been pushing the benefits of telehealth and telemedicine.

In a matter of days, demand has "exploded," he said.

"For the 15 years of attempted projects that have been very successful and some others not so," Robbins said, "we never stopped trying or believing in telehealth and how virtual care will fit into this model of health care that we're in right now. For the people like Tift Regional who have stuck with this technology, it's paying off."

A sudden pandemic, an urgent need

During regular coronavirus briefings, Georgia's top health official, Dr. Kathleen Toomey, commissioner of the Department of Public Health, has continually urged residents to stay out of emergency rooms and primary-care offices to prevent further spread of the virus.

The department has been working with the medical community to keep patients from "flooding" emergency rooms and primary-care practices, Toomey said.

"What I've always emphasized is make sure that individuals who are or want to be tested don't just go to the emergency room," she said during a March 12 briefing. "Don't just go to a physician's office, because we don't want anyone with coronavirus or influenza, or measles to expose those individuals in the waiting area."

But with growing demand for tests and limited testing capacity, urban and rural hospitals are strained.

President Donald Trump announced this week expanded Medicare telehealth coverage to pay clinicians to provide telehealth options to recipients across the country.

Telehealth has been slow to catch on, said Rena Brewer, chief executive officer of the Global Partnership for TeleHealth, but with the urgent need for remote treatment, the network is seeing a spike in the use of telemedicine.

"I think this outbreak is probably the tipping point for telehealth," she told CNHI. "I don't think that the value has been really recognized, until now."

The partnership is a statewide nonprofit that has the network to connect more than 600 providers and receivers of clinical telehealth services across 10 states.

Virtual care is often debated as ineffectual -- critics citing that a screen can't beat seeing a patient in-person. But amid the pandemic, telehealth allows physicians and critical response teams to screen and triage patients with reduced risk of transmission.

Jimmy Lewis is CEO of Hometown Health, a consortium of rural hospitals across Georgia, and serves on the governor's Rural Hospital Stabilization Committee. He said when the committee was formed several years ago, members knew Georgia would one day face an inevitable call for telemedicine.

"It was known that at some point in time, there would be some kind of urgent need for telemedicine to provide access," he told CNHI. "And to keep contaminated patients out of the emergency room and out of the hospital. Then when COVID-19 comes along everybody starts to see the need for it."

Telemedicine allows treatment of the most vulnerable population, he said, without subjecting them to a virus.

"That's critical," he said.

While internet bandwidth in rural areas remains a challenge, Lewis said, telehealth leaders are exploring putting points of access in public facilities.

Robbins said the health system has ramped up expansion of telehealth equipment.

"Without a doubt, we've been deploying equipment on them on a much more urgent basis than we would have in the past," Robbins said. "And it's not just for the sick, it's not just for the doctor who may be sick, it's also allowing us to prevent a doctor from being exposed."

As of Wednesday, patients who show signs of cough, fever or sore throat at Tift Regional Medical Center are immediately quarantined and triaged by doctors in another room using telehealth.

Access to care

The coronavirus pandemic has exposed holes in the health care system across the country and across the world. Toomey told reporters Tuesday that Georgia is experiencing a large shortage in medical supplies -- health officials are actively seeking out respirators, ventilators and other medical equipment.

Kemp said the state has medical supplies on order -- more than 100,000 masks, 10 pallets of medical face shields, 10,000 gloves, 25,000 gowns, 26,000 shoe covers and 1,000 goggles.

Because of the increased need for services, hospitals are seeing a shortage in supplies, beds and doctors, Lewis said. Patients with chronic diseases are facing barriers to regular treatment -- including mental health support. Telemedicine is able to provide a link to care without dwindling a facility's resources.

"There are so many different places that we can interrupt the virus, and we can interrupt the peak curve," Lewis said. "Simply by preventing these patients from having to go and jump into a hospital."

Dr. Jean Sumner, dean of the Mercer School of Medicine, noted years ago when she first encountered telemedicine in her practice, even she was skeptical. But with technology having come so far, a more widespread use of telemedicine to treat patients is critical.

"As physicians and health providers, we built so many walls and between ourselves and our patients that it's really hard for patients to access care," Sumner told CNHI. "We don't have enough providers and certainly rural areas are desperate for care."

Rural doctors are often primary-care physicians who need specialty doctors to lend a second opinion. Telehealth allows patients to connect with speciality doctors miles away, sometimes even from the comfort of their own homes.

"Telemedicine will reduce some barriers for people who are afraid to leave their homes and rightly so," Brewer said.

Sumner said the Georgia Rural Health Innovation Center, established by the university, is working to spread telehealth capabilities to all rural physicians at "little to no cost."

"We think that we will be able to roll this out next week," she said. "So that we can embed it in their practice and see patients from their home."

Nursing homes on lockdown

On March 16, Gov. Brian Kemp, in hand with the Georgia Health Care Association, urged nursing homes and assisted nursing facilities to restrict all visitors, volunteers and non-essential personnel -- except in end-of-life situations.

Health officials have repeatedly stated elderly populations are the most at risk to contract coronavirus.

Two cases of coronavirus in senior care homes have been reported in Georgia. Nursing homes in Seattle have been wracked with cases and deaths -- an epicenter of the outbreak in the state.

Many of Georgia's long-term care facilities have gone into lockdown in hopes of preventing a similar situation.

Robbins, with Tift Regional Medical Center, said nursing homes in its network are already using telemedicine in daily care.

There's always been concern of transporting elderly individuals to a hospital, he said.

"Now we're in this crisis where we definitely don't want to bring the population that is the most susceptible to this virus -- which is the elderly population -- to the hospital. Especially the elderly with underlying chronic health issues," Robbins said.

Sumner worked for a time as a nursing home doctor in rural areas of Georgia and encouraged them to implement telemedicine capabilities.

"When you disrupt the elderly and send them out of a facility, you actually can do harm. It confuses them, it causes pressure areas, they don't stay on their schedule," Sumner said.

Devon Barill, director of communications for the Georgia Health Care Association and Georgia Center for Assisted Living, said that they have sent out notice to all their members on the expanded coverage of telehealth services under Medicare.

"We anticipate nursing centers will utilize these beneficial telehealth services for their residents as appropriate to assist with early intervention if changes in a resident's condition are identified or to assist with matters such as psychiatric consults," Barill said in a statement. "While internet access and bandwidth continues to be a challenge for centers in rural areas when it comes to utilizing telehealth services, GHCA member centers are thankful for the ability to bill for these services in all areas under this revised guidance."

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