NHPCO NewsLine Summer 2020 - 12

continued

The panel reflected a diversity of
experiences, locations, and
discipline perspectives. Not all
members of the interdisciplinary
team are reflected in the following
excerpts but a number of NHPCO
COVID-19 focused webinars and
chats have been provided in recent
months that can be found at
nhpco.org/coronavirus and within
the MyNHPCO e-community for
members.

Joe Rotella, MD, MBA,
HMDC, FAAHPM
Joe Rotella is a Palliative Care
Physician and Chief Medical
Officer for AAHPM.
With telehealth, we need to think
about having different
approaches for different
problems. We must think about
how we can include the patient
and family more in this
partnership in their care. And
COVID-19 has added an increased
dimension to this because it's not
just the burden for the patient
and the family to travel, but it's
the fear they might have that you

12

Newsline / Summer 2020

would introduce infection if you
come into their home.
There is also the fact that you
would have to use personal
protective equipment that might
be better used in other instances.

What We Hope For...
We hope that we will see less
actual spread of COVID-19 by
utilizing telehealth. By not making
any more in-person visits than are
necessary we are helping with the
distancing that is going to flatten
the curve for everyone and we
can conserve our limited supply of
personal protective equipment.
Hopefully, this results in fewer
hospitalizations and emergency
department visits. We hope that we
can improve quality through more
timely intervention and see a high
level of patient and family
satisfaction. We hope to find that
telehealth can improve access,
particularly for people that are hard
to get to and/or in remote rural
areas, and that we can maximize
cost efficiencies by eliminating
things like windshield time, allowing
us to spend most of our time doing
what clinically matters.

Effective Visits
When we think about what
makes an effective virtual visit,
the ideal is to use both the audio
and visual components. There is
something you gain from being
able to see the patient, to see
them in their environment, to
read body language and there is
something they gain from being

able to see us. Whenever possible,
adding the visual component
means you are going to have
more rich flow and exchange of
information; however, there may
be times when that is limited due
to connectivity issues or the
availability of equipment.
The seriously ill population is a
particularly good target for virtual
visits because of the burden they
feel in having to travel to a
physician's office or a hospital,
having to wait in a crowded
doctor's office which increases their
risk of exposure, and increased
fatigue from travel. These burdens
are much higher for the seriously ill.

What Triggers an
Interaction
If you were to think about what
might trigger a home visit or
what might trigger a telehealth
intervention, there is a broad
number of things that could be
the trigger. We can begin with
just a simple acute issue. The
patient has a new symptom, or in
the COVID era, that symptom
might be cough or infection,
delirium might be a tip off that
the person is coming down with
COVID-19. COVID-19 screening
can go all the way from the
person who says, "I think I was
exposed," to the person who says,
"I think I have symptoms," to the
person who says, "I'm very ill."
We can think about advance care
planning and goals of care
discussions in general for anyone
with serious illness, but also in the
http://www.nhpco.org/coronavirus
NHPCO NewsLine Summer 2020

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