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Rx for Rural Health Part 3: Technology driving telemedicine explosion

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Rx for Rural Health: Technology driving telemedicine explosion

Robert Inglis/The Daily Item This screen with two cameras, a microphone, and more attached allows doctors to get an up close look at patients while not being in the room at Evangelical Community Hospitals TeleStroke program.

The explosion of telehealth caused by COVID-19, particularly in less-served rural areas, has been aided by a number of new technologies.

A study from the Centers for Disease Control and Prevention found that telehealth appointments were 50 percent higher in the first three months of 2020, over the year before, and then spiked after even more after that.

Telemedicine visits grew by 50 percent nationally in the first quarter of 2020, with 9 in 10 patients seeking care for issues other than COVID-19, according to a study published in October by the Centers for Disease Control and Prevention. The American Medical Association’s coverage of its 2021 state advocacy summit cited a legislative and regulatory advocate who found nearly 25 million Medicare beneficiaries received telehealth services from mid-March through mid-October last year, and another 35 million such services rendered in that same timeframe to beneficiaries of Medicaid and CHIP — a near 3,000 percent surge above 2019.

University Hospitals (UH), which covers sections of northeast Ohio, operates two hospitals in Ashtabula County, covering a mix of rural and urban areas. Dr. Brian D'Anza, Medical Director of Digital Health and Telehealth with UH, said that the COVID-19 pandemic has propelled telehealth technology forward immensely.

"COVID has been one of the biggest sort of revolutionizers of telehealth, I think probably ever," D'Anza said.

UH conducted very few telehealth appointments before the COVID-19 pandemic. "All these things have really expanded in the post-COVID world," D'Anza said.

UH had 10,000 telehealth visits in an entire year before the COVID-19 outbreak. In 2020, UH conducted 400,000 telehealth visits, D'Anza said. "That massive expansion is not uncommon," D'Anza said. "That was seen in a lot of places across the country."

In a meeting with representatives from CNHI’s Pennsylvania newsrooms earlier this year, David Lopatofsky, chief medical director of UPMC Susquehanna of UPMC Susquehanna said systemwide, UPMC was doing about 250 telemedicine appointments a day pre-pandemic. That number exploded to 10,000 a day last April and shows no signs of slowing down.

Starting in early 2020, UPMC's cardiology department started focusing on a bring your own device program, said cardiologist Dr. Eric Dueweke. Previously, UPMC, which covers areas of Pennsylvania and Maryland, had a heart failure monitoring kit, which included a Bluetooth-enabled blood pressure cuff and scale, paired with a tablet, he said. The kit would be used to monitor patients' weight, blood pressure and overall sense of well-being, Dueweke said.

"This would all be fed into a group of nurses that monitored this information, and could make adjustments based on patients feeling more short of breath, or having weight gain or carrying too much fluid," Dueweke said.

Nurses spent a lot of time conducting technical support on the kits, he said. The new system, using patients' smartphones, is simpler.

"It's overall been pretty well received," Dueweke said. "Overall, we've found that we can reach most of the people we could previously reach, and it also decreased a lot of the cost and complexity of the service," he added later.

Smartphones are better than they have ever been, and patients have wearable devices that monitor heart rates and other data, Dueweke said. "In order to meet this force in the market, we have used the patients' own devices, increasingly," he said.

Currently, patients can forward data from their smart devices to the doctor via MyUPMC, the hospital system's messaging system, he said. In the future, Dueweke said he could see more and more consumers using wearable smart devices, instead of some medical devices.

"Patients want to use the technology, they want to be able to reach out in a convenient way, and our physicians are prepared to do that," Dueweke said. "We welcome it, and I think it's an exciting time to be in health care."

UPMC also conducts hospital-to-hospital and hospital-to-clinic telehealth visits, allowing patients to see specialists based in larger hospitals from their own area.

"It goes beyond just a video conference," Dueweke said. "We have electronic stethoscopes and very high-resolution electronic cameras, that we can use to see the patient, listen to their heartbeat, even 60, 70, even 100 miles away."

Pilot programs in place

UH had a number of pilot projects in place before the pandemic, and some of those were expanded in the wake of the pandemic, including a watch-sized device that measures vitals of COVID-19 patients who had left the hospital, and a program that uses artificial intelligence to chat with patients who have been discharged from the hospital.

A lot of the programs that UH was working on were pushed to the forefront by the pandemic, D'Anza said.

"We knew it was a space we wanted to get into, and we knew it could provide value for our patients," D'Anza said. "It was sort of ready for primetime, and then COVID-19, so it was rapidly expanded to include COVID patients," he added later.

UH provides tablets to patients who need them for telehealth purposes. "Some of our recent initiatives are actually around trying to improve the access of those in rural areas, or where they might not have WiFi, improve their ability to (access telemedicine)," D'Anza said. The hospital system received a donation of 1,000 laptops and hotspots to UH from PCs for People, D'Anza said.

"So we're going to be working to get those devices and those hotspots dispersed to the patient population that are most in need, and rural populations are right at the top of that list," D'Anza said.

Daily Item reporter Eric Scicchitano contributed to this story.

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