A ‘seismic shift’ moves medicine online during COVID-19 crisis through telehealth technology
STEAMBOAT SPRINGS — Never before has so much medicine been practiced over a computer screen or a phone call.
From pediatrics to emergency medicine, doctors and nurses around Routt County are fielding a higher than average number of calls and, in most cases, a lower than average number of in-person visits.
Some health care providers have sophisticated telehealth systems, which involve a secure screen-to-screen conversation with features that put patient information directly onto virtual charts.
There are also a lot of less formal visual options being utilized, like Facetime or Zoom. And of course, a lot can be done simply over the good old-fashioned telephone.
All strategies fall under the category of telehealth, which is defined as “the provision of health care remotely by means of telecommunications technology.”
But while people are being advised to remain home if they are not suffering a medical emergency, the doctors, nurses and medical assistants on the other end of the line must strike a careful balance between keeping people at home who genuinely don’t need immediate medical intervention and identifying when people must get medical care.
Keeping people home keeps them safe from potentially becoming exposed to COVID-19 at the doctor’s office or hospital, and it keeps the staff and patients who have to be at the hospital from potentially being exposed. As more health care workers fall sick and even die, the need to protect the frontline is increasingly critical.
Being scared right now when any kind of new symptoms are present is understandable, said Steamboat Emergency Center doctor Matthew Freeman.
It also should be reassuring that 80% of people who get COVID-19 recover without any medical intervention, he noted.
“It’s still an appropriate response to be fearful, but within reason — fear without panic,” Freeman said.
Freeman said a big part of his role right now is to provide education and reassurance.
“If I can do that over the phone — right now — that’s the best way I can do it,” he said.
He and his colleagues are helping people understand whether their symptoms are mild or severe and what might trigger the need to come in.
“There is still a great deal we do not know about this infection,” Freeman said about COVID-19 concerns.
And the fact that so many COVID-19 symptoms mimic influenza makes it even more challenging.
“We find ourselves in a very unique dilemma in that we don’t have the capacity to test,” he said. “We have to assume people are positive. We have to assume it is present without the ability to test.”
Freeman said Steamboat Emergency Center is continuing to build and improve its telehealth capabilities and has seen a significant increase in phone calls in recent weeks.
At South Routt Medical Center in Oak Creek, District Manager Ken Rogers said his staff started talking about expanding telehealth capabilities about three weeks ago. Before that, there just wasn’t much of a demand, he said.
“People like coming in,” he added.
In addition, there are many areas of South Routt with limited internet and cell phone access.
After choosing a system and getting everything hooked up last week, the South Routt center launched its telehealth platform Monday.
And they use the phone — a lot. They are discouraging walk-ins at this time and encouraging everyone to call first. Before anyone comes in, they first go through a phone screening with basic questions. Then, if they do come in, they must put on a mask and get their temperature checked — and that goes for the entire staff as well.
The center is also accepting all patients regardless of ability to pay.
“We know people will be going through financial hardships in the weeks and months to come, and we don’t want anyone’s health care to be compromised,” Rogers said.
Dr. Chris Davis is the medical director for virtual health at UCHealth. Davis said the UCHealth system, which includes the Yampa Valley Medical Center in Steamboat Springs, has been building telehealth capabilities for years.
Today, it is proving an effective way to deliver and receive care through social distancing, according to Davis.
In the past three weeks, UCHealth’s virtual urgent care has increased 1,000%.
It’s been a “seismic shift in health care,” David said.
In early March, UCHealth was handling about 20 virtual visits a day across the entire system, which serves about four million patients. Now, there are more than 200 virtual visits daily. They’ve trained about 100 additional providers to work in the virtual realm, Davis said.
They are also “crowdsourcing,” Davis said, recruiting doctors and other medical professionals who aren’t as busy because of the reduction of things like elective surgeries. People are volunteering, he said, and eager to help.
“This pandemic accelerated (our telehealth infrastructure) exponentially,” Davis said. “We made three years of progress in three weeks.”
Every one of UCHealth’s 700 clinics turned on their telehealth capabilities in a span of three days, he said.
There is a lot that can’t be done over a screen, Davis acknowledged, but there is still a lot that can be done.
“So much of health care decisions are based around patient discussions,” Davis said.
In about 10 seconds, providers can make a determination of how sick a patient is, Davis said. They can see if a patient is having difficulty breathing, see the color of their skin, assess posture and look into their eyes.
They can get a good sense of whether that patient should immediately go to a hospital, he said. Or, with everyone on high alert, concerned patients can get to the right place at the right time. That’s what flattening the curve is all about, he said — identifying what needs to be seen immediately and what can wait.
At Pediatrics of Steamboat, Dr. Dana Fitzgerald said their call volume has doubled — even tripled — on some days. More than ever, people aren’t sure if they should come in. Fitzgerald is advising anyone with children with mild cold or flu symptoms to keep them at home and, of course, call with any questions. It’s also been a relatively heavy year for influenza, she said, and cases are still going around.
“If the child is healthy otherwise and it seems like a regular cold, we recommend you stay home,” she said.
With kids, what they can’t do with their telehealth system is check vital signs, listen to the lungs and check ears. They can renew prescriptions for kids with depression and anxiety and check out things like rashes.
If kids are breathing really fast, have a bad cough that is getting worse or a high fever for more than three days, they should come in, Fitzgerald said. It is important to check oxygen levels and make sure kids aren’t in any respiratory distress.
“We really encourage parents to call if you aren’t sure,” she said.
At this time, Fitzgerald’s office is scheduling wellness checks in the mornings and sick visits in the afternoon.
Yampa Valley Medical Associates joined the EPIC electronic medical record system last year, which has been “huge” for their telehealth system, said Dr. Jennifer Kempers. Her practice went live with telehealth in October.
Kempers admits she was a little skeptical. She prefers in-person medicine, and the demand wasn’t really there. Telehealth got off to a slow start, she said, until about two weeks ago.
Now, it’s playing a crucial role. And patients — some who were also skeptical — are figuring it out and embracing it, she said.
And, as with everyone else, doctors are fully aware of the limits. They can’t check vital signs, but they can do a lot. They can ask patients to push on certain places and see what hurts. Doctors can see distress, anxiety and evaluate breathing.
Kempers’ practice is also doing a lot over the phone and talking people through their symptoms and fears.
And her primary message is, “Don’t drop in — but call us. We are here for you. We are here for you every step of the way.”
Bottom line, if it is an emergency, call 9-1-1. If it isn’t, call your primary health care provider. They know what to do.
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