By Deborah Borfitz
June 23, 2020 | In the wake of COVID-19, a telehealth revolution has greatly expanded the universe of tools and platforms available to a tech-ready healthcare marketplace and prompted creative repurposing of some existing technologies. Patients in hospital isolation units and nursing homes, those requiring post-discharge care and individuals having their virus-related symptoms monitored from home—or simply wanting to avoid a risky in-person visit with their provider—are among the beneficiaries.
When the pandemic hit Charlottesville, the University of Virginia (UVA) Health System turned a homegrown telemedicine setup developed to battle Ebola into a means of improving the care of patients hospitalized with COVID-19. The Isolation Communication Management System (iSOCOMS), recently described in an article published in the Annals of the American Thoracic Society, allows doctors to provide personal, high-quality care while conserving vital personal protective equipment (PPE) and reducing infection risks.
The total equipment cost for iSOCOMS was “not prohibitive” at approximately $34,250, UVA's epidemiology and telehealth leaders report in the paper. They’re now urging their healthcare colleagues to consider telemedicine as a relatively low-cost way to improve COVID-19 care.
“One of the few bright spots of the COVID-19 crisis is that it's shown us how remarkably powerful and versatile telemedicine can be during outbreaks of novel contagious diseases,” says UVA Health epidemiologist Costi Sifri, M.D. "It’s importance in helping us care for patients in their home while sheltering in place is clear. What we show here is that telemedicine solutions can also be used within the walls of hospitals, emergency rooms and clinics to help provide enhanced, more efficient and safer patient care for those potentially infected with high-risk pathogens.”
iSOCOMS was designed to provide remote treatment, guidance and supervision for a special pathogens unit and biocontainment room in the emergency department, UVA Health reports, but those capabilities have since expanded to rooms in a new South Tower. The secure system includes visual and audio connections allowing care providers to monitor and communicate with patients in isolation without layers of PPE separating them, and to communicate with care providers inside the room.
The setup allows members of the care team to continually visualize patients and their IV medications and, importantly, family members and spiritual advisers outside the hospital to connect with their loves ones via video calls, notes Kendall Barger, RN, a nurse in UVA's medical intensive care unit.
“We have cared for over 100 patients using this technology with several thousand hours of video interactions with patients and assisting providers in the room with care,” says Kyle Enfield, M.D., a critical care medical specialist at UVA Health. “The experience is similar to our experience with Ebola, but even more dramatic due to the number of patients and the extended duration of illness for these patients.”
Monitoring Via Text
Wilmington, Delaware-based ChristianaCare was one of the first healthcare providers to receive grant funding from the Federal Communication Commission’s COVID-19 Telehealth Program (part of the recently enacted CARES Act) to support telehealth services during the pandemic. A portion of the $714,000 award is being used to expand a COVID-19 virtual provider visit and interactive telehealth program for individuals who have coronavirus symptoms or for those who have already tested positive and are symptomatic.
A key component of the initiative is secure text messaging via ChristianaCare’s CareVio care management program. This ongoing monitoring connects patients with a registered nurse who monitors the condition of patients several times per day and, if it begins to deteriorate, schedules a provider telemedicine visit, explains Chief Virtual Health Officer Sharon Anderson, RN. An initial provider visit in most cases will initiate the program.
Since the crisis began, CareVio has monitored more than 2,300 patients and more than 2,000 patients have had a telemedicine visit with the COVID-19 practice, she says. CareVio has also called more than 12,400 patients following COVID-19 testing, ensuring they have a primary care provider and answering questions.
ChristianaCare’s COVID-19 care model also includes providing broadband telehealth services to disconnected, vulnerable patients, and neighborhoods, notes Anderson. The provision of devices and data plans will ease the current burden of COVID-19 while building a “telemedicine foundation” to address disparities in access to care for other health conditions.
Faculty members at the University of Louisville (UofL) Department of Family & Geriatric Medicine are piloting web-connected Vuzix M400 smart glasses allowing specialized medical providers and behavioral health experts to provide remote video consults, and they’ve identified long-term care facilities and emergency departments as two areas that could reap the greatest benefit during the pandemic.
Vuzix is one of a string of smart glass companies that have emerged since Google brought a lot of attention to the space in 2014, says R. Brent Wright, M.D., associate dean for rural health innovation at the UofL School of Medicine.
The testing team represents UofL Trager Institute, emergency medicine and psychiatry. A handful of Kentucky nursing homes (Presbyterian Homes of Louisville, Treyton Oak Towers, NHC Healthcare Glasgow, and Episcopal Church Home) as well as the UofL emergency department will participate in the study, says Wright. Each site has received a pair of the smart glasses so individuals can receive direct care from physicians who neither have to enter the facilities nor expose themselves and other patients to COVID-19.
An advanced practice nurse practitioner or other facility-based healthcare professional will put on the glasses and dial in with an attending physician through the Zoom conference platform. A camera and microphone are attached to the glasses, and the technology has the potential to display and obtain information for the physician to access remotely. The physician can see and interact directly with patients, providing immediate consultation and evaluation.
It’s a hands-free experience for the on-site provider, an advantage over current standard telehealth delivery that requires computers and monitors to be transported from bed to bed on large carts. Data gets input into medical records by voice commands.
Usability and effectiveness of the Vuzix M400 smart glasses are being evaluated to see how well they fit into the current workflow, says Wright. If findings are promising, the study will be extended. The Vuzix product will also be evaluated against several other types of smart glasses.
Google Glass captured a lot of media attention with its introduction of Explorer Glass Edition, says Wright, adding that he and his colleagues were part of the Explorer program and utilized the glass in long-term care settings with a HIPAA-compliant software program in early 2015. While the results were promising, the smart glass space was actively changing as well as the business model for their usage.
The team had been establishing connections with different companies in early 2020, he says, but the pandemic “accelerated work in assessing smart glass usage as a means to deliver telemedicine.”
Self-Sampling of Moles
Proof-of-concept research has demonstrated that patients can reliably perform remote self-sampling of concerning moles using the DermTech Pigmented Lesion Assay (PLA) under physician supervision via telemedicine. Data from 211 eligible melanoma survivors using the non-invasive adhesive skin collection kit published in SKIN, the official journal of the National Society for Cutaneous Medicine.
Among participants in the study, seven had cases of self-identified concerning lesions confirmed by a clinician to be suspicious of melanoma and conducted supervised sample collection. Melanoma was objectively ruled out in all cases—findings in line with sample collection results by licensed providers.
In addition, survey findings indicated that anxiety around skin self-examination increased during COVID-19 due to a lack of in-person physician access. High-risk patients expressed interest in accurate melanoma detection options for circumstances such as this.
DermaTech PLA “allows me to offer quick and accurate results with this easy-to-use, trusted and validated test, which helps to determine if an office visit is necessary to surgically biopsy a mole that looks suspicious clinically,” says the study’s lead author June K. Robinson, M.D., research professor of dermatology at the Northwestern University Feinberg School of Medicine. “In over 90% of cases, the PLA helps to avoid an unnecessary surgical biopsy.”
The adhesive patch technology collects skin cells from the surface of a lesion, leaving it intact to offer dermatologists the option for further analysis if necessary, explains Burkhard Jansen, M.D., chief medical officer of DermTech. The extracted skin cells are then analyzed for gene expression associated with melanoma. DermTech PLA has 91% sensitivity and a less than a 1% chance of missing a melanoma.
Since its launch in 2016, DermTech PLA has been used to assess more than 50,000 lesions and remains the only non-invasive gene expression test in dermatology.
At-Home Pulmonary Rehab
Just last month, digital therapy provider SWORD Health launched a fully remote pulmonary rehabilitation program—most immediately, for COVID-19 patients. The first-of-its-kind program pairs physical therapists with wearable, medical-grade technology so patients can recover from the comfort and safety of home.
Many patients with moderate to severe symptoms of COVID-19 need to continue pulmonary rehab following hospital discharge to avoid developing chronic lung issues. Unfortunately, it remains largely inaccessible and expensive in the U.S., with risks of contagion worsening what was already a difficult-to-access treatment, says SWORD Health CEO Virgilio Bento.
When the pandemic hit, the company accelerated development of its digital therapy program and made it available to all U.S. employers and health plans. Essential businesses have access to the program at no cost to their employees.
The program extends SWORD’s musculoskeletal therapy solution for back, joint and muscle pain, which the company reports as being 30% more effective and having a 54% higher retention rate than in-person therapy. It features a wearable-based biofeedback system that can track the slightest errors in movement and ensures patients do their exercises correctly from home.
Artificial intelligence on the back end synthesizes data from wearables to suggest changes in treatment plans, such as the addition of a pulse oximeter. Treatment is highly personalized by SWORD physical therapists based on the gold standard defined by the American Thoracic Society: exercise training, education, and behavior change.