Coronavirus has forced practices nationwide to undertake dramatic changes in how they practice medicine. But whatever the means we use to deliver care, there is still nothing as dramatic as saving a life.
Although I had been thinking about and planning to use telehealth for about a year, the sudden arrival of the COVID-19 pandemic left me with no choice. I recognized that there was no way to safeguard my patients or staff if I kept my office open.
I still had some reservations. Would patients use telehealth technology? Would they accept it? Most importantly, would telehealth allow me to deliver the same quality as an in-person office visit?
The answers came quickly and clearly. With healow TeleVisits from eClinicalWorks, getting started was simple and easy for my staff. Patients were thrilled to have a way to receive care without having to risk exposure to the coronavirus by traveling to my office. We transformed our more than 20 daily in-office visits to more than 20 televisits in just 10 days.
Saving a patient’s life via telehealth
And my remaining doubts about the efficacy and quality of remote care were erased in a single encounter.
I was meeting with a new patient who was complaining about vomiting, diarrhea, and abdominal pain. When I asked him to show me what the vomit looked like, he placed a jar containing black vomit in front of the camera.
I immediately knew that he was suffering internal bleeding and instructed him to get to a hospital. His wife ended the call and took him to the ER, where he was admitted. The bleeding was stopped and he received a transfusion.
Five days later, we had a follow-up televisit. He was in good spirits and told me that his life had been saved because of that first televisit.
Updox, a telehealth platform, experienced a significant spike in demand throughout March, onboarding more than 10,000 new customer users to its HIPAA-compliant telehealth solution in just two weeks. Today, the company facilitates more than 45,000 telehealth visits per day between patients and their doctors, with that number increasing rapidly.
More than 300 million Americans are currently under orders to shelter-in-place as public health officials and providers work to contain and mitigate the coronavirus. Updox experienced a sharp increase in the demand for telehealth from mid-March, when more states began issuing stay-at-home orders and physicians needed a safe and secure way to connect with their patients.
Unlike some first-generation telehealth solutions, Updox allows patients to connect with their own physicians instead of someone unfamiliar to them. Likewise, rather than competing with physicians, the Updox platform supports practices to maintain revenue, protect staff and deliver care safely to their patients. Studies show that patients prefer receiving treatment from their own physicians, with whom they’ve developed strong, trusted relationships. In fact, according to a recent survey by Sharecare, 60% of Americans noted they would want to “access care with their primary physician if they experienced COVID-19 symptoms.”
The Mount Sinai Health System has partnered with Sana Labs to launch Project Florence, a personalized learning platform to enhance the skills of nurses treating COVID-19 patients in New York City. The group, facilitated by the New York Academy of Sciences, is also making the platform available for free to hospitals around the world to improve medical response and care during the pandemic.
The virtual training platform, available through Sana Labs, provides a curriculum developed by Mount Sinai that includes the latest on industry resources and policies from organizations including the American Association of Critical Care Nurses.
After users complete an AI-powered adaptive assessment that measures their knowledge, the platform recommends personalized content in real time to address individual skills gaps. It can be accessed from any internet-connected device including phones, tablets, laptops, and desktop computers. The project was officially launched at the Mount Sinai Health System on Monday, April 13.
“The profound shortage of intensive care nurses and respiratory therapists will be one of the most significant hurdles facing U.S. hospitals treating critically ill COVID-19 patients,” said Jane Maksoud, RN, MPA, senior vice president and chief human resources officer, Mount Sinai Health System. “Project Florence will be a great benefit to staff preparing to care for critically ill patients. We are grateful for the partnership we have developed with Sana Labs and the work we have done together to assist our nurses on the front line.”
A projected 4.8 million Americans will be hospitalized for COVID-19, according to the American Hospital Association. Of those hospitalized, an estimated 40 percent or nearly 2 million patients will require admittance to the ICU. While there are currently about 550,000 critical care nurses in the United States, tens of thousands of nurses will be in demand in the coming months.
“I’m very excited to bring this innovative approach to Mount Sinai hospitals to help advance the skill set of our nurses,” said Diane Adams, MS, Chief Learning Officer of Mount Sinai Health System. “Not only are we advancing the essential skills of our staff, but we are also meeting the needs of our community during a particularly critical time across New York City, the United States, and the rest of the world.”
As hospitals shift priorities from other departments to ICUs, the two-day curriculum is tailored to each individual and suitable for nurses, as well as other medical professionals who are called to assist and may require an update on their understanding of ICU equipment and procedures.
The Centers for Medicare & Medicaid Services (CMS) has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.
“Healthcare providers are making massive financial sacrifices to care for the influx of coronavirus patients,” said CMS Administrator Seema Verma. “Many are rightly complying with federal recommendations to delay non-essential elective surgeries to preserve capacity and personal protective equipment. They shouldn’t be penalized for doing the right thing. Amid a public health storm of unprecedented fury, these payments are helping providers and suppliers – so critical to defeating this terrible virus – stay afloat.”
The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks. In a little over a week, CMS has received over 25,000 requests from health care providers and suppliers for accelerated and advance payments and have already approved over 17,000 of those requests in the last week. Prior to COVID-19, CMS had approved just over 100 total requests in the past five years, with most being tied to natural disasters such as hurricanes.
The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.
The CMS Accelerated and Advance Payment Program is funded from the Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) trust funds, which are the same fund used to pay out Medicare claims each day. The advance and accelerated payments are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement.
The majority of hospitals including inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals will have up to one year from the date the accelerated payment was made to repay the balance. All other Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively.
The coronavirus (COVID-19) has had a significant impact on healthcare at home providers’ ability to see or care for patients, and the much-publicized lack of personal protective equipment (PPE) is a very real issue, according to findings of a survey conducted by healthcare technology leader Axxess.
More than 80 percent of respondents said the virus has had an impact on their organization’s ability to see or care for patients, and three-fourths of respondents said they do not have adequate PPE for staff.
The survey of thousands of home-based care providers from organizations of all sizes from March 25-30 confirmed that agencies have a critical need for PPE, including N95 masks, gloves, face masks, gowns and hand sanitizer.”
In addition, billing or cash flow has been interrupted for nearly 60 percent of respondents’ organizations, and more than half of respondents indicated their organization has experienced staffing challenges as an impact of the virus.
“Understanding how challenged providers are at this uncertain time, we appreciate everyone who took the time to help provide visibility into the needs of the industry,” said John Olajide, founder and CEO of Axxess. “Our brief survey was designed to give a voice to our heroes on the frontlines of caring for those most vulnerable to coronavirus.”
The survey, which included respondents from all levels of organizations, including management and caregivers directly working with patients and clients, showed nearly half of respondents have a negative view of coronavirus’ (COVID-19) eventual impact on their business.
The long-term impact of coronavirus (COVID-19) on the industry is less certain, with about a third of respondents feeling it would ultimately be positive, a third feeling it would be negative and about a third having neutral feelings.
“I am incredibly proud to be part of such a caring community,” Olajide said. “We can’t know how long this crisis will last, but it should be reassuring to all of us that we are all working together and demonstrating leadership, providing expertise, displaying innovation and sharing resources.”
The full survey report is available in the Axxess COVID-19 Resource Center.
By Julie Pursley Dooling, MSHI, RHIA, CHDA, FAHIMA, director of HIM practice excellence; AHIMA.
Release of patient information during COVID-19
What insiders have long known has become clear during the COVID-19 pandemic: health data is a vital element of health care, including efforts to curb the pandemic. Of course, that data is important to patients, providers, and healthcare staff. And even during COVID-19, if a patient wants to access their data, release of information services (ROI) teams must comply with a strict set of processes set forth by the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). These regulations ensure that patients retain safe and secure control of their personal health information and record requests are timely, accurate, and complete.
So, what should providers and patients expect during this time? For years, patients have been able to walk into a provider’s office or a health records office and request a copy of their records. During a stay at home order, however, that’s not such a good idea.
The American Health Information Management Association (AHIMA) recommends that organizations temporarily suspend walk-in access for medical records inquiries during COVID-19. Organizations should work closely with their ROI vendor (if they have one) to ensure continuity, while also displaying signage on doors and windows to redirect patients and families to alternative resources. In addition, it would be prudent to post process changes to the organization’s website and through automated messaging systems, while alerting the patient access staff.
It’s important for organizations to provide patients and their families with alternate record request options during COVID-19. All requests via phone should be authorized by health information staff who witness and document it in the patient’s record. And voicemails should be directed to a patient portal so they can be returned.
And just how can a health professional be assured they’re talking to a patient or one of their relatives? They should ask the caller to verify their patient demographic data such as a date of birth, home address or the last four digits of a social security number (if applicable). Other examples of data may include cell phone numbers, nicknames or another reliable data source that is consistently collected.
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.
Updox
The Mount Sinai Health System has partnered with Sana Labs to launch 
The Centers for Medicare & Medicaid Services (CMS) has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.
The coronavirus (COVID-19) has had a significant impact on healthcare at home providers’ ability to see or care for patients, and the much-publicized lack of personal protective equipment (PPE) is a very real issue, according to findings of a survey conducted by healthcare technology leader Axxess.
By Julie Pursley Dooling, MSHI, RHIA, CHDA, FAHIMA, director of HIM practice excellence;