Unprecedented times call for extraordinary ingenuity. When the coronavirus hit the nation like a tsunami this spring, Delaware’s healthcare workers hit the ground running.
As the number of COVID-19 patients grew exponentially, everyone else still needed care, too, for everything from chronic conditions to minor injuries. Faced with the dilemma of needing to treat patients without risking exposure to the virus, many of Delaware’s healthcare practitioners pivoted to virtual treatment, or telemedicine, almost overnight.
Fortunately for the First State, ChristianaCare was already well prepared with its superconnected CareVio program, which launched in 2012 with a $10 million grant from the Centers of Medicare and Medicaid Innovation.
“When COVID hit, we were able to monitor the patients,” explains Sharon Anderson, MS, BSN, RN, CareVio’s president and chief virtual health officer at ChristianaCare. “The coronavirus is very variable: You may feel fine, just a little bit of a fever in the first three or four days. By day eight, you can hardly breathe.” In one case, someone they were monitoring remotely went into respiratory distress on day nine, but they were able to get an ambulance sent immediately.
“We get a lot of feedback from our patients, because we’re open seven days a week and continuously text them up to three times a day,” she says. Throughout the pandemic, CareVio has exchanged 600,000 texts and monitored 9,000 people.
And there’s no sign it’s letting up, either. Forrester Research predicts the number of virtual healthcare interactions will exceed 1 billion nationally by year-end. That will likely amount to year-over-year growth of 64.3 percent due to COVID-19, according to research from Frost and Sullivan, and a potential sevenfold increase by 2025. By 2026, it could represent a $186 billion market in the United States, Fortune Business Insights reports.
It’s no wonder. According to the American Medical Association, telehealth offers patients numerous benefits, including continuity of care, immediate and after-hours access to help, relief from having to travel, and easing clinician shortages and increasing access, particularly in rural and underserved populations.
While the definition of telemedicine—and its associated regulations and medical billing policies—are in a state of flux, especially now, the term generally encompasses a wide range of methods for delivering treatment. (Anderson dubs it “virtual health.”)
It can include scheduled audio/video visits, plus texting, phone calls, emails or shared images when the need arises, with doctors, nurses, social workers, pharmacists, speech-language pathologists and other clinicians. It can also mean home biometrics with devices that remotely monitor diabetes, blood pressure and other chronic conditions.
“You can do your EKG on your iWatch,” Anderson says. “And there are [digital] otoscopes that are connected from a telemedicine visit. People can look in your ears and your eyes and listen to your heart. If there’s any positive about COVID, it’s that it made virtual care much more of a reality.”
Doctors Ann and Nancy Kim (twin sisters and 2020 “Top Doctors”) specialize in physical medicine and rehabilitation at Christiana Spine Center. Telehealth—like phone calls—has long played some part in their practice, but when the pandemic emerged in March, they moved to nearly all-virtual medicine.
“We could see where things were heading and [our practice manager] was very proactive,” Ann says. “As a team, as a practice, we all got on board, and we were all able to get together to make things happen efficiently and quickly.”
“We contacted all the patients on the schedule who initially scheduled in-office visits and told them how we are transitioning over to telemedicine, and the patients were very responsive to that and very grateful,” she says. “I can’t tell you how many folks said, ‘Thank you so much for continuing our care. We were so scared that there was going to be no answer when we called the office, that nobody was going to be there.‘ …The worst thing would be to leave patients abandoned, so we’re very happy that we could be there for them.”
They did not use televideo—nor were they even set up for it—until the coronavirus started, Nancy adds. “We saw that it was going to be a necessary means to treat our patients, because we certainly didn’t want them to come in when they didn’t feel safe and it really wasn’t safe.”
Although it seems counterintuitive, Ann says several conditions can easily be treated virtually, even things like low back pain.
“We can get a good history from the patient by asking about their pain location, if they’re having any numbness or tingling or any weakness,” she explains. An exam can also be conducted through telemedicine. “We can ask patients to bend forward, backward—are they having pain? So, we can certainly evaluate low pain and pinched nerves in the back,” as well as neck, hip and shoulder pain issues.
There have been some challenges along the way, however. On Nancy’s very first virtual visit, technical gremlins wreaked havoc.
“The biggest challenge was having a patient understand how to connect. With the electronic medical record and all the HIPAA guidelines, there’s a certain way that you have to connect,” she explains.
First, her patient had to download new telemedicine software. Then the Wi-Fi blipped and they lost their connection. “So then I ended up having to call the patient and then do it through the telephone, and we tried to reconnect again through the televideo, and then we finally connected. By then, a half an hour had passed, but then it went smoothly.”
Michelle Blankenship, MS, CCC, SLP, is director of Outpatient Rehabilitation Therapy Services for Easterseals Delaware & Maryland’s Eastern Shore. She understands the challenges of virtual health all too well, especially since many of the patients her organization sees are “littles”—kids under 3.
“We had a clinician who was treating a child who I guess was [just] done,” Blankenship says. “So he put the phone in his little Playskool barn and said, ‘Bye,’ and shut the door. The therapist was on the phone in a barn, going, “I’m in the barn! I’m in the barn!” so the child’s caregiver would hear her.
Transitioning to telehealth this spring “felt like zero to a hundred,” Blankenship says. Her practice had been looking into telehealth as an option for a while, but regulations precluded its viability. “When COVID came, there were some lifted restrictions related to teletherapy and who could provide it, and where they could provide it,” she says. “So that allowed us to really dig in and provide our expertise with families through a screen.”
Easterseals has locations in all three counties, as well as one in Salisbury, Maryland. Pre-coronavirus, clinicians would travel to work with parents and caregivers on early intervention strategies for children with developmental delays, genetic syndromes and autism, including offering communication therapies. The week they went virtual, they held 600 televisits.
“Telehealth has allowed us to significantly empower our families,” Blankenship says. “In person, we can demonstrate first and then have Mom try, and we can have varying levels of participation,” she adds. “But through telehealth, it really is the therapist teaching Mom. We’ve been able to connect with some parents that we hadn’t been able to connect with as consistently prior to COVID.
“It was a very hard, fast shift, and the team has been amazing,” she continues. “We really were amongst a whole tribe of clinicians who were figuring it out, and I can’t speak enough to their heart and their hustle that enabled us to provide these services to families that otherwise would have gone without support.”
Telehealth can also help ease disparities in access, Anderson says. ChristianaCare received a $714,000 grant from the Federal Communications Commission in late April to support its telehealth services during the pandemic—one of only 17 healthcare providers in the country to get one.
“We’re going to have over 600 iPhones to give out and medical diagnostic equipment to bring into people’s homes, as well as being able to give them minutes and broadband access to connect for telemedicine services,” she says, including at offsite locations like the Latin American Community Center and Kingswood Community Center in Wilmington, where they offer a virtual COVID-19 practice, with testing, symptom checks, televisits and monitoring.
ChristianaCare practices what they preach, too. They’ve offered virtual primary care for their own employees for two years, which now treats 500 people, with in-person visits taking place only 4 percent of the time. Their new telehealth-based program for workplaces to monitor and combat COVID-19 is used by 27 employers across multiple states.
As for what the future holds for telemedicine in Delaware, “We believe that virtual is the future of health care,” Anderson says.
Nancy Kim says their practice will continue with in-person visits, but calls telehealth “a huge game-changer.”
“Had it not been for [virtual visits], none of our patients would have been able to make their way over to get treated. They would have ended up in the emergency room. I think telehealth is amazing. It’s made life easier for our patients. … So for us, it’ll definitely stay.”
“There have been some bright spots that have come out of COVID,” Anderson adds. “People should get health care the way they want it. … Home is our new venue of care, and we need to embrace that, and I think patient satisfaction will soar.”