Berks County Medical Society Medical Record Summer 2020 - 32

Coronavirus Chronicles: Berks Responds
M e d i c a l R ec o r d F e a t u r e

THE DOCTOR WILL SEE YOU NOW, FROM ANYWHERE:

COVID-19 AND TELEHEALTH
by Kyle D. Fistner, DO
System Telehealth Program Coordinator - Tower Health

H

ealthcare is
constantly
evolving in
an endless endeavor
to improve patient
care. In recent years,
this development has
come in the form of
new technological
advancements to decrease healthcare cost and improve accessibility.
Telehealth is the latest concept in such advances at health systems,
such as Penn State and Tower Health, which enables the use of
telecommunication modalities to safely and securely provide a
multitude of healthcare services to benefit patients from a distance.
With TeleNeurology and TelePsychiatry programs becoming
relatively commonplace, Telehealth has been slowly emerging for
many years but has undergone a rapid nationwide expansion in
response to the COVID-19 Pandemic. During this time, patients
have been asked to stay at home and remain socially distant to
slow the spread of disease. However, this also includes avoiding
close contact with healthcare professionals. The drastic need to
extend care to patients remotely escalated Telehealth into a realm of
prominence.
Fortuitously, much of the technology was already available
with most difficulty stemming from the integration of video
conferencing capabilities into the Electronic Health Record
environment. Another major consideration came in the form
of careful consideration of these projects from a medicolegal
standpoint, requiring creation of new consent forms. However,
once a strong foundation was built, similar processes began to be
spread throughout health systems as appropriate.
	 Among these contributions are Video Visits where patients
can be connected to healthcare professionals in a variety of ways
from their mobile devices. Appointments are scheduled with
Primary Care Physicians to preserve continuity of care. Patients can
monitor their existing disease processes with medication refills and
adjustments. Diagnostic testing can be ordered and results made
available with secure online accounts.
	 Conversely, should a patient require urgent consultation,
mobile applications are available to immediately connect to a
Provider. Many common conditions can be diagnosed and treated
over video conference. Recommendations can be made and
prescriptions delivered to Pharmacies. All of this is performed from
the comfort of the patient's home, limiting unnecessary exposure to
possible infection.
	 For those patients who require further observation, there is
Remote Patient Monitoring. At risk patients receive blue tooth

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devices that transmit patient vital signs for professional monitoring
from the safety of their own home. These devices generate alerts for
both patients and Providers if any abnormalities occur and further
evaluation becomes necessary.
	 Finally, Virtual ICU Monitoring offers a process by which
access to specialized Intensivists becomes more readily available.
This process allows for Intensive Care patients to be virtually
observed through a sophisticated monitoring dashboard at multiple
hospitals from a central ICU command center. This hybrid process
has already been shown to decrease patient mortality and ICU
length of stay, and will become more nationally utilized by hospital
systems.
	 Unfortunately, as with all great progress, difficulties are
encountered along the way. Adoption of Telehealth processes is not
always universally welcomed, and not all providers are keen on the
idea of virtually treating patients. Though the immediate benefit is
recognized, uncertainty circulates around viability of longstanding
implementation of new treatment technologies and reimbursement
for providing these services. However, with time and further
understanding of Telehealth applications, the utility will become
more apparent for individual practices as benefits to patient care
become realized.
Also, many Telehealth applications have been installed in haste
in response to an immediate predicament. Therefore, providers
have been discouraged by preliminary "bugs" inherent to the new
programs. However, these struggles leave room for technological
improvement and individual practice specialization. Processes will
continue to transform as challenges are identified and solutions
created. These initial drawbacks will allow Telehealth to develop
and be uniquely tailored to allow for enduring modifications.	
Perhaps the most prevalent hindrance to adoption has been
concerns surrounding the performance of a physical examination.
Many providers feel strongly that even a basic physical exam cannot
be performed utilizing a video conferencing platform. In fact, the
entire idea is often dismissed at the notion that no auscultation
is possible for any body system. However, there already exists
documentation at Tower Health, and across the nation, regarding
techniques to allow for a thorough 10-point physical examination.
While the exam may look different from what providers are
accustomed to, and employ the assistance of the patient with
instruction, it can provide much needed information regarding
the current disease process. There also exist Bluetooth stethoscopes
capable of recording and sharing heart, lung, and abdominal sounds
which can similarly be used to obtain individual 1-lead EKG
findings. The process provides hope for the future as technology
continues to evolve and be developed.
The goals are not to replace in-person visits, but to provide an
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