As the public is ordered to stay home to flatten the curve, healthcare systems are tasked to ‘raise the line’ by increasing staffing, adding beds, and moving to a telehealth model to keep patients out of hospitals. Clinicians who are not on the frontlines of the COVID-19 response are being asked to help assist the rest of medicine. During these virtual care visits, it’s critical for these clinicians to utilize clinician decision support software to aid in diagnosis and keep as many patients out of the acute care setting. These software systems can not only help triage cases of COVID-19 but also help quickly and accurately treat patients presenting with other conditions that still require care. Clinical decision support also supplements telehealth services to improve the patient experience, ease patient anxieties, and reduce some administrative burden for providers.
Response from Chris Caulfield, RN, NP-C, co-founder and chief nursing officer, IntelyCare
As a result of COVID-19, demand for healthcare professionals is at an all-time high, with nurses on the front lines providing care to patients in need. In this unprecedented time, nursing and other healthcare professionals need their provider organizations more than ever to support and protect them. One significant aspect of keeping nurses and their patients safe is COVID-19 education. The virus is rapidly evolving and nurses don’t always have time to find and walk through new COVID-19 protocols before each shift. Organizations can offer and promote online learning so that nurses can complete training on their devices and on their own time, and so facilities can ensure the entire workforce is well-equipped to treat and prevent the spread of COVID-19.
Another way to protect facilities, staff, and patients from unnecessary exposure to COVID-19 is the implementation of an online symptom screening that enables workers to remotely verify whether or not they are experiencing COVID-19 symptoms. Nurses that are experiencing COVID-19 symptoms can be removed from the shift without penalty, which can prevent the further spread of the virus to other nurses and the vulnerable populations they’re treating.
Response from Erin Jospe, MD, chief medical officer, Kyruus
With health systems needing to respond nimbly to the rapidly evolving landscape of caring for patients in the midst of a public health crisis, the key, as with any crisis, is to pursue a plan of action with thought and purpose. At a time when the majority of people seek healthcare information and services online, this principle and plan must extend to the role of digital access. The promise of digital technology is to leverage it creatively as a force multiplier, and to do so with an eye toward minimizing friction in care delivery and enabling the safest care possible. In the ambulatory setting, there are three distinct populations we need to think about servicing this way.
The first is the general population needing guidance on safely assessing their health while physically staying in their homes if at all possible. This is best achieved through the interplay of screening tools and virtual assistants with appropriate triaging for 1) those who can safely obtain self-care instruction 2) those who should have additional assessment through a combination of virtual appointments and direction for screening tests if warranted and 3) those who require immediate direction to the closest hospital or care facility. Screening engagement platforms, in conjunction with telemedicine, can decompress call centers, thereby freeing up staff, and help keep more patients safely at home.
In addition, more clinical staff can work remotely to provide virtual visits, maximizing the use of dwindling PPE resources for those who continue to serve on the front lines in direct patient contact. Digital technology can thus similarly benefit this second population, your health system staff and clinicians, by respecting their need for technology that works for and with them, promotes their physical safety, and conserves increasingly limited resources.
The third key population is patients with non-COVID medical needs, who require attention and outreach to help maintain their health. Digital platforms (e.g., telemedicine, automated outreach) can play an important role in keeping these patients well-informed, monitored, and safe, with clear access to information, both static and offered dynamically through real-time interactions when needed. Furthermore, those with chronic conditions that can become increasingly complex if left unchecked and where compliance issues may be exacerbated due to economic pressures, must be supported during this time even in the absence of acute symptoms – for their own well-being and to minimize the need to compete for scarce complex care resources.
While we all struggle to act quickly under these exceptional circumstances, using your digital investments to speak creatively to the needs of these populations is not only possible, it is necessary.
A team of healthcare professionals and evidence-based medical experts at EBSCO Information Services (EBSCO) has launched a COVID-19 portal which aggregates real-time information updates from authoritative sources to provide information on all aspects of the COVID-19 pandemic.
The portal was created to meet the needs of the healthcare information community in a time when information is released at a rapid rate, from all areas of the knowledge ecosystem. The COVID-19 portal provides researchers and healthcare professionals with consolidated access to real-time, credible information. Librarians and information professionals are also called upon to suggest resources that should be added to the site.
EBSCO Information Services chief medical knowledge officer Brian S. Alper, MD, MSPH, FAAFP, FAMIA, says the portal was developed to provide useful information to many professionals seeking information about COVID-19. “This is a time of massive and rapid information demand.
By creating this portal, we are responding to the needs of many sectors of society by making COVID-19 information available for a diverse set of users. To meet this great need, we have enabled information professionals and others to contribute — to leverage their expertise developing collections and vetting sources — which we’ve made possible through this portal.”
The portal was created in collaboration with EBSCO’s Stacks division. Stacks Founder and EBSCO Information Services vice president of SaaS product and technology Kristin Delwo says the portal is an evolving platform that aims to include all trusted resources to best meet the needs of the online research community. “At its simplest level, the COVID-19 portal is a way to help people share and find information. As experts in clinical content, EBSCO is well positioned to curate a site of this magnitude and to understand the best curators of this valuable content.”
The EBSCO Clinical Decisions division provides clinical decision support resources to healthcare institutions around the world. The COVID-19 portal is one of several ways that EBSCO has made healthcare information accessible during the pandemic. DynaMed, EBSCO’s clinical decision support tool, has made its COVID-19 clinical topic open, offering easy access to evidence-based information related to treatment that is updated daily.
EBSCO has also developed a healthcare resource center to provide open access to the content it provides to medical, nursing and allied health professionals.
The Trump administration temporarily changed the policy for Centers for Medicare & Medicaid Services (CMS) allowing healthcare providers to have phone-only visits with patients, which is a major breakthrough in the industry and one that was not allowed before.
With the coronavirus being spread throughout the United States, the administration understands the importance of social distancing and the pivotal role that telehealth will play in keeping patients healthy. What is necessary to support the amount of patients today is an economically sustainable, scalable and immediate telecare solution that is available to anyone, regardless of income, age, or location.
The way to keep the general population healthy, is in a fight to flatten the curve and protect most specifically older adults and those at-risk from COVID-19. Telehealth is likely the most effective way to provide care to those who need it and minimize exposure to the virus for the both the patient and the doctor. Right now the hospital systems are overwhelmed with the sudden influx of patients from this virus and telecare’s primary role is to treat patients remotely, reducing the pressure being put on the hospital systems.
Another important factor is the effects that social isolation has placed on older adults and how that will impact their overall physical and mental well-being. We created Uniper to provide a familiar service for older adults, right on their TV screens, mobile phone or desktop to have access to life: their communities, friends, family and physicians so that they can obtain much needed care, from a distance.
Uniper is designed to be economically sustainable, scalable, and accessible to anyone that needs it to help them thrive during these unusual times.
With clinical documentation integrity (CDI) professionals playing a key role in efforts to “flatten the curve” of the COVID-19 pandemic, the American Health Information Management Association (AHIMA) has developed tools designed to ease administrative burdens during this difficult time.
AHIMA’s two new COVID-19 CDI query templates will help CDI professionals ensure the integrity and quality of a patient’s health record. With data being such an important element in the fight against COVID-19, the new templates provide a clear guideline of what critical data needs to be obtained to accurately document for the virus. The templates are similar to those CDI professionals use to document other diseases.
“I feel immense pride when I see the important work CDI professionals are doing during this pandemic,” said Wylecia Wiggs Harris, PhD, CAE, AHIMA CEO. “We believe these clear, concise, and compliant templates will make it easier for CDI professionals to document this virus, which in turn gives courageous medical providers more time to focus on patient care.”
The new templates are designed to capture high-quality documentation to support the continuum of care in this complicated healthcare environment. Clinical documentation integrity is critical during the pandemic because it can impact research efforts to curb COVID-19 and provides government and healthcare leaders with key information for their decision-making processes.
The American Hospital Association (AHA) and AVIA are reaching out to all AHA members with a new tool for rapid, critical support to deal with COVID-19. The nationwide roll out of the COVID-19 Digital Response Pulse to all 5,000 members of the AHA provides a free online tool that allows hospitals and health systems to immediately assess critical digital capabilities they will need to meet the challenges of COVID-19 over the weeks and months ahead, and links directly to further information about how members can access and implement the solutions they select.
Members face immediate challenges to stand up a virtual approach for screening, testing, triage, primary care, and specialty care for worried, anxious patients in their communities – all to avoid being at the hospital unless absolutely necessary. These solutions need to leverage scarce clinician resources and build trust and confidence in doing so.
The COVID-19 Pulse shows members where they have gaps in these capabilities and offers specific steps that can be taken now to prevent the spread of the virus, allocate resources, care for the sick, and protect clinicians.
“We don’t have in-house experts and large teams to figure all this out, and we all wear so many hats, so we need partners to help us,” said Liz Dean, executive director of strategy and business development at Riverwood Healthcare in Aitkin, Minnesota. “The COVID-19 Pulse helped us quickly identify virtual health solutions. We gained insights on best practices, resources and reassurance that we were on the right track. Because we used this tool, we were able to implement virtual solutions very quickly and efficiently.”
The AHA formed a strategic alliance in October 2019 with AVIA, the leading digital transformation partner for healthcare organizations across the country. Since then, AHA and AVIA have worked together to create tools that help the industry accelerate digital transformation. The COVID-19 Pulse is an important and timely development for AHA members and their communities and is accessible for any healthcare organization with an AHA member account.
The COVID-19 Pulse contains a framework of 13 critical capabilities identified by AVIA and its Network members, including screening and triage, remote workforce, and addressing social needs for COVID-19, that can effectively be supported by high-value digital solutions. Upon completion, hospitals and health systems receive aggregated data-driven insights into how their organization compares to peers that are also responding to COVID-19. This information will also jumpstart new connections across the AVIA Network, so that hospitals and health systems can share emerging best practices and foster real-time learning.
“In this moment of crisis, there is so much noise when health systems need focus and clarity. The COVID-19 Pulse allows our 5,000 members to identify where they can take rapid action on the front lines to best serve their communities,” said Andy Shin, COO AHA Center for Health Innovation. “In partnership with AVIA, we can allow health systems and hospitals across the country to leverage their existing tools for COVID-19 response and rapidly implement new ones.”
“AVIA was founded on the idea that digital is imperative to catalyze meaningful and quick benefits for healthcare,” said Bruce Brandes, General Manager, Digital & Partner Network at AVIA. “We can move faster if we work together, especially during this crisis. The COVID-19 Pulse powers up knowledge sharing and collaboration needed to simplify and scale care across the country during such a critical time in healthcare.”
Using interactive virtual reality technology, the new Febris educational module incorporates the latest Centers for Disease Control and World Health Organization guidelines and recommendations. The online module includes information about proper hand hygiene procedures as well as best practices regarding personal protective equipment (PPE), including disposable gowns, face shields, respirators, gloves and face masks.
“Our goal is to help new nurses incorporate current guidelines regarding personal protective equipment as they collect diagnostic respiratory specimens and work directly with patients throughout the COVID-19 pandemic,” said Febris founder and CEO Kirkland Brooks. “We are planning to roll out additional educational modules in the coming months, but we are focused on providing free coronavirus PPE training because this topic is urgent, timely and extremely important to help keep nurses and medical staff as safe as possible.”
Hospitals across the United States are currently facing a growing need for nurses amid the coronavirus pandemic. Given the expected surge in COVID-19 patients expected in the coming weeks, many U.S. healthcare facilities are trying to fill crisis-based nursing jobs, particularly in intensive care units and emergency rooms.
“With states fast-tracking medical permits and universities graduating healthcare students early to work the front lines, creative solutions like Febris’s virtual reality COVID-19 nurse’s training module will help ensure that lack of experience doesn’t lead to greater risk for both patients and medical personnel,” said Jennifer Bonnett, executive director of The Creative Coast. “It’s great to see Febris stepping up and innovating quickly to help our community — and the world — in this time of crisis.”
Maven, the largest telemedicine provider for women’s and family health, announced a new partnership with MassHealth, the Massachusetts, Medicaid and the Children’s Health Insurance Program. MassHealth will provide free telemedicine appointments for members with COVID-19 symptoms with Maven’s network obstetric/gynecologists, maternal fetal medicine specialist, pediatricians, family physicians, and general practitioners for women and families in Massachusetts.
MassHealth members will be connected through an online navigation tool to Maven providers through on-demand chat and video appointments 24 hours a day through the use of any web-enabled device.
“During the COVID-19 emergency, MassHealth has made unprecedented efforts to eliminate barriers to health care access, including expansive coverage of telehealth services,” said Acting Medicaid Director Amanda Cassel Kraft. “We are excited to announce this partnership with Maven ?to provide medical support to our members seeking guidance on COVID-19 symptoms or risk factors.”
In the wake of COVID-19, women and families are dealing with a myriad of health concerns, from managing conditions related to a high risk pregnancy to being discharged from hospitals soon after giving birth to caring for a newborn. Telehealth now plays an essential role in giving these women and families the support and care they need from the safety of their own homes.
“This pandemic has raised serious concerns for millions of women who are pregnant or have just given birth,” said Kate Ryder, founder and CEO of Maven. “We have doctors available around the clock to support MassHealth members and alleviate the burden on the healthcare system during this public health crisis. Massachusetts has long been a leader in healthcare and other states should look to their innovative response to this crisis as a model.”
With the incredible demand for care, trusted clinical data and information, and resources around COVID-19, Maven has developed dedicated COVID-19 resources. This includes:
Ongoing webinar series led by healthcare professionals to provide clinical updates on the rapidly evolving COVID-19 pandemic, answer member questions and address topics including pregnancy, fertility, anxiety and pediatrics. The next webinar will be held on Thursday, April 2 at 1:30 p.m. EST. Please register here.
Covid-19 support section in our member app for those looking to connect with specific providers.
Specific Maven provider in-app resources with the most up-to-date information regarding COVID-19.
Elsevier, a global leader in information analytics specializing in science and health, today introduces Veridata EDC, a secure, compliant and user-friendly platform to capture patient data for clinical research.
Veridata EDC is a next-generation version of Elsevier’s MACRO, a solution that has been proven in commercial and not-for-profit clinical research for more than 20 years.
To assist researchers working to develop vaccines and other therapies for COVID-19, Elsevier has pledged to make Veridata EDC available for free. Interested clinical researchers can contact Elsevier customer support via e-mail at firstname.lastname@example.org and apply for a demo account. Following the necessary compliance training, they will receive a free 12-month license.
“As researchers around the globe unite to fight COVID-19, they urgently need ways to streamline data collection and facilitate workflows in their studies,” said Olaf Lodbrok, Senior Vice President for Precision Medicine, Global Clinical Solutions, Elsevier. “Veridata EDC is a platform that optimizes data to help them find untold insights faster and more easily.
“COVID-19 is perhaps the biggest challenge in healthcare today. Elsevier is proud to offer clinical researchers a free solution that can transform data points into knowledge to improve clinician collaboration and hopefully patient outcomes.”
Veridata EDC provides clinical researchers with secure and compliant electronic data capture to ensure that the rights, safety and well-being of clinical trial participants are protected. Its intuitive user interface means researchers can quickly input, monitor and run reports to collect accurate and reliable subject data for analysis.
“Veridata EDC breaks down the barriers to research for COVID-19 and beyond. We believe the long legacy of Veridata EDC, combined with its sophisticated functionality, provides the research community with a solution they can trust to further medical discovery,” said Dr. John Danaher, president of global clinical solutions, Elsevier. “Along with Elsevier’s Novel Coronavirus Information Center, our one-stop access to the latest medical and scientific information on coronavirus from across Elsevier’s journals and clinical resources, we are pleased to be a company helping clinicians and clinical researchers on the front lines of fighting this outbreak.”
The HIPAA waiver issued for telemedicine during COVID-19 is a game-changer for physicians now that CMS says virtual visits are reimbursable.
And now, telehealth is emerging as an effective and sustainable solution for precaution, prevention, and treatment to stem the spread of COVIS-19. But what do the new HIPAA waiver and CMS rule about telemedicine during COVID-19 mean?
According to Dr. Neil Baum, chief medical advisor at Vanguard Communications, professor of Clinical Urology at Tulane Medical School, and in clinical practice for 40+ years, the glass is half full.
“Telemedicine is a great opportunity for us to fill our glass and engage our patients in a way we never have before. We’re still able to practice good medicine without having to be face to face or touching a patient,” says Dr. Baum.
Telehealth is bridging the gap between people, physicians, and health systems, enabling everyone, primarily symptomatic patients, to stay at home and communicate with physicians through virtual channels, helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines.
For healthcare professionals, this news means that CMS now allows providers to be reimbursed for the vast majority of virtual visits using telemedicine during the COVID-19 pandemic. (Only a small number qualified for reimbursements as recently as March 14.)
Plus, no special software or extra expense for healthcare-specific hardware and software is needed. The tools are free and easy to use.
Below is a chart of the popular apps approved for telemedicine during COVID-19.
Dr. Baum says telemedicine will go a long way to enhancing a physician’s connection with patients and providing access to care but stresses the importance of documenting virtual visits and video conversations just as you would an in-office appointment.
“If you didn’t document, then you didn’t do it, and then you don’t get paid for it,” says Dr. Baum.
“Every day, heroic nurses, doctors, and other healthcare workers are dedicating long hours to their patients. This means sacrificing time with their families and risking their very lives to care for coronavirus patients,” said CMS Administrator Seema Verma. “Front line healthcare providers need to be able to focus on patient care in the most flexible and innovative ways possible. This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly.”
Other temporary CMS waivers and rule changes dramatically lessen administrative burdens, knowing that front line providers will be operating with high volumes and under extraordinary system stresses.
CMS recently approved hundreds of waiver requests from healthcare providers, state governments, and state hospital associations in the following states: Ohio; Tennessee; Virginia; Missouri; Michigan; New Hampshire; Oregon; California; Washington; Illinois; Iowa; South Dakota; Texas; New Jersey; and North Carolina. With today’s announcement of blanket waivers, other states and providers do not need to apply for these waivers and can begin using the flexibilities immediately.
Administrator Verma added that she applauds the Mar. 23, 2020, pledge by America’s Health Insurance Plans (AHIP) to match CMS’s waivers for Medicare beneficiaries in areas where in-patient capacity is under strain. “It’s a terrific example of public-private partnership and will expand the impact of Medicare’s changes,” Verma said.
CMS’s temporary actions announced today empower local hospitals and healthcare systems to:
Increase Hospital Capacity – CMS Hospitals Without Walls:
CMS will allow communities to take advantage of local ambulatory surgery centers that have canceled elective surgeries, per federal recommendations. Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan. The new flexibilities will also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries.
CMS will now temporarily permit non-hospital buildings and spaces to be used for patient care and quarantine sites, provided that the location is approved by the State and ensures the safety and comfort of patients and staff. This will expand the capacity of communities to develop a system of care that safely treats patients without COVID-19, and isolate and treat patients with COVID-19.
CMS will also allow hospitals, laboratories, and other entities to perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital. This will both increase access to testing and reduce risks of exposure. The new guidance allows healthcare systems, hospitals, and communities to set up testing sites exclusively for the purpose of identifying COVID-19-positive patients in a safe environment.
In addition, CMS will allow hospital emergency departments to test and screen patients for COVID-19 at drive-through and off-campus test sites.
During the public health emergency, ambulances can transport patients to a wider range of locations when other transportation is not medically appropriate. These destinations include community mental health centers, federally qualified health centers (FQHCs), physician’s offices, urgent care facilities, ambulatory surgery centers, and any locations furnishing dialysis services when an ESRD facility is not available.
Physician-owned hospitals can temporarily increase the number of their licensed beds, operating rooms, and procedure rooms. For example, a physician-owned hospital may temporarily convert observation beds to inpatient beds to accommodate patient surge during the public health emergency.
In addition, hospitals can bill for services provided outside their four walls. Emergency departments of hospitals can use telehealth services to quickly assess patients to determine the most appropriate site of care, freeing emergency space for those that need it most. New rules ensure that patients can be screened at alternate treatment and testing sites which are not subject to the Emergency Medical Labor and Treatment Act (EMTALA) as long as the national emergency remains in force. This will allow hospitals, psychiatric hospitals, and critical access hospitals (CAHs) to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19.
Rapidly Expand the Healthcare Workforce:
Local private practice clinicians and their trained staff may be available for temporary employment since nonessential medical and surgical services are postponed during the public health emergency. CMS’s temporary requirements allow hospitals and healthcare systems to increase their workforce capacity by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community as well as those licensed from other states without violating Medicare rules.
These healthcare workers can then perform the functions they are qualified and licensed for, while awaiting completion of federal paperwork requirements.
CMS is issuing waivers so that hospitals can use other practitioners, such as physician assistants and nurse practitioners, to the fullest extent possible, in accordance with a state’s emergency preparedness or pandemic plan. These clinicians can perform services such as order tests and medications that may have previously required a physician’s order where this is permitted under state law.
CMS is waiving the requirements that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician. This will allow CRNAs to function to the fullest extent allowed by the state, and free up physicians from the supervisory requirement and expand the capacity of both CRNAs and physicians.
CMS also is issuing a blanket waiver to allow hospitals to provide benefits and support to their medical staffs, such as multiple daily meals, laundry service for personal clothing, or child care services while the physicians and other staff are at the hospital and engaging in activities that benefit the hospital and its patients.
CMS will also allow healthcare providers (clinicians, hospitals and other institutional providers, and suppliers) to enroll in Medicare temporarily to provide care during the public health emergency.
Put Patients over Paperwork:
CMS is temporarily eliminating paperwork requirements and allowing clinicians to spend more time with patients. Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously Medicare only covered them under certain circumstances.
During the public health emergency, hospitals will not be required to have written policies on processes and visitation of patients who are in COVID-19 isolation. Hospitals will also have more time to provide patients a copy of their medical record.
CMS is providing temporary relief from many audit and reporting requirements so that providers, healthcare facilities, Medicare Advantage health plans, Medicare Part D prescription drug plans, and states can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.
This is being done by extending reporting deadlines and suspending documentation requests which would take time away from patient care.
Further Promote Telehealth in Medicare:
Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only.
These temporary changes will ensure that patients have access to physicians and other providers while remaining safely at home.
Providers can bill for telehealth visits at the same rate as in-person visits. Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth. New as well as established patients now may stay at home and have a telehealth visit with their provider.
CMS is allowing telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health.
CMS is making it clear that clinicians can provide remote patient monitoring services to patients with acute and chronic conditions, and can be provided for patients with only one disease. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.
In addition, CMS is allowing physicians to supervise their clinical staff using virtual technologies when appropriate, instead of requiring in-person presence.
These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.