By Virginia Dean
RUTLAND — Although telemedicine has been practiced since the 1990s, it is needed and being used now more than ever, given the recent and daily difficulties of the coronavirus pandemic.
“Social distancing guidelines make it harder to do many things, including going to doctor’s appointments,” said Peg Bolgioni, marketing and public relations director at Rutland Regional Medical Center. “Telehealth or telemedicine is a great option in these types of situations.”
Sending those who show signs of the coronavirus or Covid-19 to a hospital or clinic not only overwhelms physicians but puts patients and medical staff in danger from those who are infected and need to be diagnosed, monitored and quarantined, Bolgioni related.
With limited surgical masks and personal protective equipment (PPE), reducing hospital admittance is essential in order not to waste valuable resources and risk workers’ health, she added.
As such, telemedicine is rapidly emerging as a viable alternative to keep those with moderate symptoms at home while routing more severe cases to hospitals. But sick patients screened virtually still need in-person testing to determine if they have the coronavirus.
At the Rutland Regional Medical Center, for example, telehealth is a workable option in many types of situations. Clinics inform patients in video chats, for example, with providers who are suitable. After consulting with their doctor, patients can click on a personalized link provided on their cell phones or computers to join them for a video call. All data is secure, private and no information is stored. Most telehealth visits are covered by Medicare, Medicaid, and private pay insurance.
Simply defined, telemedicine is the remote treatment of patients. It has been hailed by many as a solution to such health care problems as long wait times, rural access, and workforce shortages.
“There are so many bad things that have come out of this time, but one of the good things is telemedicine,” said Dr. Rick A. Hildebrant, chief medical information officer and medical director for hospital medicine at RRMC. “While it’s been around for a long time, hospitals have been reluctant to adopt it, but now our hands have been forced and we’ve broadly adopted telemedicine… Some doctors are seeing up to 200 people per week!”
Telemedicine will not go away after this pandemic has, Hildebrant forecasts. “Doctors now understand what a great tool it is to connect with our patients,” he said.
At Dartmouth Hitchcock Medical Center, the goal of telemedicine is to determine if there is a need to come into the office. Telehealth service lines include outpatient virtual visits, TeleEmergency, TelelCN (neonatal), TelelCU (critical care), TeleNeurology, TelePharmacy, TelePsychiatry and TeleUrgent Care.
“Most types of appointments that do not require a doctor to physically touch a patient can be accomplished through telemedicine,” said Lisa Cramb, DHMC spokesperson. “Doctors can evaluate, diagnose and treat patients all remotely through the use of two-way technology such as smart phones, computers/laptops, and tablet.”
In response to the current pandemic, the TeleICU and TelePharmacy programs have expanded substantially, and the outpatient virtual visits have grown exponentially to 2,000 telehealth visits per day in April 2020, Cramb related.
“This allows patients to continue to receive the care they want and need and helps to reduce the risk of potential exposure to the virus for both our patients and providers,” said Cramb.
Medical Director Dr. Kevin Curtis, who oversees telemedicine at DHMC, added that it is vital to the hospital’s strategy to deliver health care to rural patients.
As schools and businesses have shut down during the Covid-19 pandemic, area counselors have also expressed concern about patients who struggle with mental illness or others who have increased anxiety over the sudden and now ongoing lack of normal structure in their lives.
At Gifford Health Care, in Randolph, psychiatric services are available through video conferencing in an effort to improve access to effective mental health treatment. Gifford has partnered with Alpine Telehealth in Brattleboro to bring these services to emergency department patients.
“In terms of telemedicine during Covid-19, Gifford’s Behavioral Health and Primary Care teams visit with their patients via Zoom when appropriate,” said Maryellen Apelquist, communications specialist. “We also provide telemedicine visits for nursing home patients.”
Per the partnership agreement between Gifford and Alpine, which has been in place since the spring of 2019, telepsychiatry services are available at the Gifford ED and hospital inpatient departments 24 hours a day, seven days a week, and 365 days a year, Apelquist explained.
Services are provided using video chat on a web-based platform that is fully secure, encrypted, and Health Insurance Portability and Accountability Act (HIPPA)-compliant.
“We’re discussing additional telemedicine options with a variety of potential partners and will share more information as plans are finalized,” said Apelquist. “In rural areas, telemedicine is one way we can access patient services that we otherwise may not be able to provide here.”
One of the drawbacks of virtual individual or group meetings, however, is the potential inability to access the required technology in addition to the reluctance to make a physical appearance in the doctor’s office, resulting in a shortage of patients, a decrease in cash flow and the potential closing of small, independent practices.
At the Upper Valley Natural Health Center in White River Junction, licensed naturopathic physician Dr. Rebecca Chollet related that telemedicine is used to manage chronic conditions and treat minor acute illnesses and injuries that don’t require a physical exam.
“Conditions that can be treated via TM include anxiety, depression, PMS, menopausal symptoms, seasonal allergies, hypothyroidism, IBS, acid reflux, and arthritis,” said Chollet. “In most cases, we’re able to accept new patients although not for primary care services.”
The Center uses Doxy.me, a simple website platform that doesn’t require downloading or installation of software or applications, Chollet said. It does, however, require that patients have a device with a camera and microphone, either Firefox or Google Chrome browser, and good internet/wifi service. Telephone “visits” are also available.
In Woodstock, the Upper Valley Rehab offers tele-health or tele-rehabilitation for physical or occupational therapy through an internet enabled device with a camera. The visits are live video sessions to diagnose the cause of pain and lost function of joints and muscles.
“It’s 90% of our business right now,” said Josh Roylance, co-owner. “It’s a platform we’ve been sitting on for about a year. There are people in some desolate areas that couldn’t get here. This gives the patient and their family the choice to be treated where they want,” Roylance said. “Patients do not have to visit a clinic to get treatment. Our therapists coach patients and their families every step of the way. Insurance companies have recently acknowledged it. This just turned the light switch on for everyone.”
