Stanford Health Care has ramped up its use of telemedicine and online tools to examine patients — not just outside of the hospital but inside as well — during the COVID-19 crisis. As a result, it's keeping medical caregivers from getting sick and saving on thousands of sets of personal protective equipment that doctors and staff would otherwise need to wear when treating patients in person, according to hospital staff.
The medical center has for some time integrated telemedicine — online and video office visits and in-hospital consultations via video and iPad — in its medical settings. But the COVID-19 epidemic in the Bay Area has forced a rapid mainstreaming of virtual tools at the hospitals with a fast expansion within weeks of the outbreak, said Eric Yablonka, Stanford Health Care chief information officer, by phone on Wednesday.
For those people concerned that they have COVID-19, the telemedicine approach starts when the person arrives at the hospital. Dr. Sam Shen, an emergency department physician and clinical associate professor of emergency medicine at Stanford Medicine, said that patients — if referred to have a COVID-19 test — go to a drive-thru testing area where they are screened for the virus.
Patients who meet the criteria are referred to a triage area inside the hospital parking garage adjacent to the emergency room. A photo is taken of the patient's driver's license and their identifying information is digitally sent to the registration clerk.
Driving into the garage, the patient encounters a nurse and a technician who check the patient's oxygen level and heart rate. They swab the patient's nasal cavity for the virus. Using a two-way camera, a physician in the emergency department examines the patient while they are still in their car. The doctor interviews the patient and checks for signs such as the sound and frequency of a cough, the patient's appearance and other symptoms.
Most patients are sent home with instructions for their care and to await the test results. Patients with a negative COVID-19 test receive an email of their result; those with a positive result receive a phone call, Shen said.
Patients who are sick enough to need possible hospital admission are taken in through a door to an isolation room or enclosed, negative-pressure room from which air does not circulate through the rest of the building. There, a telemedicine cart with an iPad allows a physician to communicate with and further examine the patient remotely. When a patient is admitted to the hospital, the admitting physician can do an assessment and reassessments without going into the room.
Dr. Christopher Sharp, clinical professor of primary care and population health at the medical school and chief medical information officer at Stanford Health Care, said that many patients taking part in televisits are worried they have COVID-19. If they are infected but don't need to be hospitalized, Stanford physicians want to keep them away from the medical center to prevent them from infecting other patients.
Sharp said he can tell a fair amount about how well patients are doing just by looking at them. He can also perform some examinations virtually: He asks patients to take a deep breath and watches whether they start coughing.
"I can advise, 'You sound like it's possibly coronavirus, so let's get you to drive-thru testing.' Or, 'You don't look well; you need to come to the emergency room,'" he said.
Another benefit to telemedicine is that thousands of pieces of personal protective equipment — gowns, masks, gloves, eye protection and the like — don't have to be used by health care workers, which is especially important given the current critical shortage of the gear.
Each time a doctor, nurse, technician or staff member comes into the patient room, they must don new equipment to prevent contamination and spreading the virus. At the Stanford emergency room alone, staff and doctors can shed up to 10 sets of protective items per patient during the course of an examination and treatment, Shen said.
When all telehealth visits are taken into account — not just those to the ER but more routine visits for conditions such as diabetes and heart disease — the savings on protective gear in one day alone can reach into the hundreds or thousands. On Wednesday, the hospital clocked 3,100 video visits for that day; televisits now make up about 40% of all clinical visits throughout the entire Stanford Health Care system, 50 times higher than in prior months, according to the hospital.
Telehealth is also helping keep staffing levels more stable during the virus outbreak. Some doctors and staff who were exposed to the virus and are in quarantine are seeing patients from their homes, Sharp said.
"We have people logging in from home and saying, 'I'll take the next patient,'" he said.
Although it is some months away, Stanford is looking at attaching other technological tools to telehealth visits, such as an electronic stethoscope, home blood pressure cuffs, continuous glucose monitors and scopes that patients can place in their ears and throats.
Until recently, hospitals had encountered some friction with sources of reimbursement regarding patient telecare, Yablonka said, but the crisis has erased much of the problem. COVID-19 has necessitated more recognition of the continuity of care needed to address the crisis, he said.
Telemedicine also received a big boost on Monday when Federal Communications Commission Chairman Ajit Pai announced a plan for the COVID-19 Telehealth Program, which if adopted would support health care providers responding to the coronavirus pandemic.
Congress appropriated $200 million to the FCC as part of the CARES Act to support telehealth services in combating the pandemic. If adopted by the FCC, the funding would help eligible health care providers purchase telecommunications services, broadband connectivity and devices for telehealth.
Correction: A previous version of this story mistakenly stated that Eric Yablonka is an MD.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.