Dr. Michael Murphy chats by video about how he sees patients at Central Counties Health Centers in Springfield, Ill. In a new twist on house calls, Murphy, who is immunosuppressed, treats patients from his home via a telehealth procedure to avoid being exposed to the novel coronavirus. (AP Photo/John O'Connor)

Never dreaming three years ago that telehealth would have such a dramatic coming-out party now, I wrote about a California city’s muni broadband and a hospital that were piloting an app that could make a difference in how we fare against COVID-19.

Konrad Bolowich, Loma Linda’s Assistant City Manager said, “One pilot project involves using telemetry [sensors] in hotel rooms where patients can stay while physicians monitor them overnight after surgery or other medical procedure. It’s much cheaper to rent a hotel room than a hospital bed and probably more relaxing. This has a great potential for impacting rural hospitals.”

Don’t expect every Motel 6 to become a quarantine facility. But community broadband and telehealth can fill the role that Loma Linda’s pilot tested for – transforming hotels and motels into facilities that treat accidents, trauma, chronic care, surgery recovery, etc. The technology worked perfectly in pilot testing. 

Regulations are catching up. This week the Centers for Medicare & Medicaid Services (CMS) released additional background on temporary regulatory changes prompted by the pandemic. The announcement said hospitals are no longer restricted to caring for patients within their own buildings.

Under CMS’s temporary new rules, hospitals will be able to transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories, while still receiving hospital payments under Medicare. For example, a healthcare system can use a hotel to take care of patients needing less intensive care while using its inpatient beds for COVID-19 patients.

New York Governor Andrew Cuomo is moving in that direction to close a 40,000-hospital-bed deficit. “How do you create new hospital beds?” asks the governor. “Take people who are in current hospital beds and move them into converted facilities – people who need a lower level of care.” 

He plans to capture 30,000 dormitory rooms, hotels, and former nursing facilities around the state. Telehealth – using broadband to deliver healthcare – can help. 

“Telehealth has been ready years ago,” says Peter Caplan, managing consultant for New York-based eHealth Systems & Solutions. “The technology has been enhanced and refined. It’s the human factor that will need attention.”  

Rural America needs innovative thinking about healthcare delivery. The closure of rural hospitals means there is already a shortage of beds, so the pandemic could cripple healthcare in rural areas. 

Telehealth Can Create Room for More COVID-19 Patients

The test for COVID-19 is often a throat swab and then several days for processing. The Center for Disease Control says COVID-19 also can be diagnosed from a combination of symptoms, risk factors, and a chest CT scan. If a person tests positive but the condition isn’t serious, the doctor or nurse can allow the patient to “self quarantine” in a outpatient treatment environment.

Doctors technically can monitor a patient via a telehealth at home until they are healed or, if things get worse, need hospitalization. 

However, what the governor and others really prefer is to have these alternative facilities house non-COVID-19 patients, leaving hospitals with more capacity to address the pandemic. Communities need to brainstorm the possibilities: post-surgery observation, one- and two-day accident recovery, closely supervised rehab, treatment for chronic ailments, ER triage, and elderly care.

Caplan believes someone has to drive this process of converting facilities, and probably a county public health department is a logical candidate. These folks are nimbler. Speed and competence are what we need now. Community broadband network managers should be involved to ensure that these converted facilities have appropriate broadband resources.

“Are you going to devote a facility to remote monitoring of patients such as those recovering from surgical procedures?” Caplan asks. “That’s probably the easiest to set up and has the least amount of costs. You just need a couple of medical technicians to watch video monitors and data from sensors, and a doctor or nurse to remotely oversee. Techs can escalate patients situation to the nurses if needed.”

As you layer on medical responsibilities that will be taken at the converted facilities, you have to establish different layers of expertise among the medical people. Do patients require blood draws? Will patients require X-rays or MRIs? With temporary radiology operations, the facility will need high broadband bandwidth. Expect high electronic medical records (EMR) traffic. If several communities are served by these facilities, maybe a mini-data center would be in order, especially if the facility will be open for longer than the pandemic. 

Doing What’s Right for Constituents 

Dr. Michael Greiwe is an orthopedic surgeon and CEO of OrthoLive, a telehealth service firm that helps orthopedics physicians grow their practices. Caplan and Dr. Greiwe both believe web-based software (platforms) will help communities convert these facilities more easily.

Dr. Greiwe encourages communities to “select a single platform that can be used with iPhones, Androids, and web devices amongst healthcare providers and patients. Make sure platforms allow for provider-to-provider communication for easy consultation. Telehealth carts with keyboards, two-way video cameras, and various USB-connected devices are great for hospitals, but limit their use in hotels and college dormitories because they are cumbersome there. When carts are necessary, ensure they are used by trained professionals.”

One of the few silver linings of the coronavirus pandemic is that many restrictive rules and regulations about the use of telehealth are rapidly falling by the wayside. Federal and state governments realize our healthcare system will be swamped by the virus, and the only way for the system to survive is if telehealth becomes a force multiplier.

“We are empowering medical providers to serve patients wherever they are during this national public health emergency,” states Roger Severino, director of the Office for Civil Rights (OCR), responsible for overseeing HIPPA compliance at the Department of Health and Human Services. Translation: Throw down wherever you are, and with every date you can bring to the party.

Dr. Greiwe concludes, “In today’s crisis environment, the relaxing of telehealth rules is allowing providers to improve care across all disciplines. In that regard, doing what is right for patients always trumps what is allowed by law. Fortunately, laws are allowing for almost all telemedicine cases to be billed for, and treatment can be rendered for almost all patients.”

Craig Settles is a broadband industry analyst, consultant to local governments, and author.

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