Caregivers make use of phone, interactive video and secure messaging
By Anna Wilde Mathews and Melanie Evans
March 4, 2020
Hospitals and doctors have a message for patients who want to come in because of fears they might be infected by the novel coronavirus: Try the phone first.
Doctor groups, hospitals and health insurers are increasingly steering people with mild or no symptoms toward initial visits conducted by phone, interactive video or secure messaging. They are also starting to use the technology to care remotely for people with suspected or confirmed cases of Covid-19, the respiratory disease caused by the virus.
The number of coronavirus cases in the U.S. crossed 100 Tuesday, with a growing outbreak in Washington and new cases scattered across states from New York to Arizona. As the fast-moving virus spreads, hospitals and doctors say they fear a surge of patients into waiting rooms could further spread the disease.
If a patient is potentially infected, “we don’t want them coming into a doctor’s office or urgent care or emergency room to sit in a waiting room and potentially infect other patients,” said Robert Wyllie, chief of medical operations at the Cleveland Clinic. The Cleveland Clinic is suggesting that patients call, setting up a video visit with a doctor who can decide whether the patient needs to come in for an examination.
Hospitals are also seeking to conserve beds for the sickest patients, should a large outbreak occur. Critically ill coronavirus cases could stress the capacity of hospitals, infectious-disease experts say. In the Seattle area, where a nursing home is at the epicenter of new cases, officials announced plans to buy a hotel to house Covid-19 patients as they recover.
“We want to do everything we can so that only people with severe illness are going to the hospital,” said Jenna Mandel-Ricci, who is heading emergency preparations for the Greater New York Hospital Association, a trade group.
The Centers for Disease Control and Prevention has urged doctors and hospitals to first assess potentially infected patients remotely. The agency is also suggesting that patients with mild symptoms from Covid-19 can be cared for at home when possible, but monitored closely using virtual check-ins.
Companies that provide telehealth services say they have seen an uptick in recent days. “The evidence of community spread, that was a big game-changer,” said Ian Tong, chief medical officer of Doctor on Demand Inc., a telemedicine company. “People are on high alert.”
American Well Corp., which offers doctor visits primarily by video, had seen an 11% higher-than-expected volume leading into Monday, and expects further growth, said Peter Antall, chief medical officer. Part of the increase is from people worried about Covid-19, but the surge was also driven by patients with other conditions seeking to avoid being exposed.
American Well has had two patients who met CDC guidelines for testing, and it referred them to hospitals, Dr. Antall said Monday. The company reaches out to let the hospitals know of patients’ arrival, and tells patients to remain in their cars until hospital personnel meet them, he said. It also makes sure local public-health officials are contacted and follows up to make sure the patients got treated.
“It would be irresponsible for us to just send patients off and say, ‘go to your local emergency room,’” Dr. Antall said.
Providence—which operates eight hospitals in the Seattle area—plans to start steering patients initially using a chatbot, a computer program designed to take questions and provide answers.
The system, which operates 51 hospitals and 1,000 clinics across seven states, consulted CDC guidelines and its own doctors about criteria by which patients should be triaged to nurses, said Todd Czartoski, telehealth chief executive for Providence. “We literally spent 48 hours going back and forth about where do you draw the line?” he said.
The chatbot, built in-house two years ago, will be found online on a Providence webpage for Covid-19 information.
Anyone with clear exposure—such as contact with someone potentially infected or having made recent travel in areas with outbreaks—will be directed to call Providence nurses, Dr. Czartoski said. The chatbot will also steer those with flulike symptoms and trouble breathing to nurses, as well as those with mild symptoms who are at higher risk, such as seniors or those with heart disease.
Kaiser Permanente, the big integrated health-care provider and insurer based in California, says it is using telehealth to care for members who are quarantining at home. Patients are staying in touch with doctors via video, phone and text-style messaging, said Patrick Courneya, Kaiser Permanente’s chief medical officer.
“The ability to stay connected with people remotely and follow them over time is very powerful,” said Dr. Courneya.
Kaiser is also issuing laptops to more doctors, who can do visits from home during late hours or should they be isolated due to potential infection, he said.
Intermountain Healthcare, a large Utah hospital system, is using video visits for a coronavirus-infected patient who is in one of its hospitals. The patient, who was a passenger on the cruise ship Diamond Princess, is in an isolated room where nurses care for him in person, but doctors see him via a live video feed, said Todd Vento, medical director for Intermountain’s infectious-disease telehealth program.
“You can get a really good assessment through the camera,” said Dr. Vento, who said the technology allows him to zoom in if needed. The patient currently has no symptoms of Covid-19, he said.
Telehealth services have grown rapidly in recent years. A 2019 Kaiser Family Foundation survey found 82% of big employers included such a service in their biggest health plan, up from 27% in 2015.
But the services haven’t always proved popular. A Kaiser foundation analysis of 2016 data found uptake by consumers was low.
Telehealth providers are lobbying for Congress to include in coronavirus-related legislation a provision to allow for Medicare to loosen tight limits on paying for remote visits during an emergency.