125,379 people nationwide were hospitalized with Covid-19 as of December 31.
“This is about the total collapse of the healthcare system if we have another spike [of Covid-19],” Dr. Brad Spellberg, Chief Medical Officer at the Los Angeles County-University of Southern California Medical Center told CNN Health.
Health and Human Services’ survey of 2,200 counties found that 126 hospitals are 90% full. The size of the hospital doesn’t seem to matter. In Texas, both the Memorial Hermann Hospital System, with its 250 beds, and the Hereford Regional Medical Center, with its 31 beds, were above 90%.
In Albuquerque, there were zero beds available.
The numbers of seriously sick people with Covid-19 aren’t going to let up, it seems. Maybe it’s time to think differently. It may be that telehealth will save embattled hospitals.
It helps to look at the full definition of telehealth: using intranets and Internet networks to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care people receive when ill, injured or wanting to stay well.
Looking at that definition, it seems telehealth, four walls, an Internet connection, and a healthcare provider are core ingredients for practical solutions.
No Beds? Adapt and Perform
“Our hospitals ran several broadband-assisted pilot projects at a local hotel that has great potential for impacting rural hospitals,” said Konrad Bolowich, Loma Linda’s Assistant City Manager. “One tested how well robots can assist with monitoring and other routine non-critical medical tasks, and other uses of telemetry to monitor patients post-surgery.”
A small college in North Carolina rented a block of rooms at a nearby local hotel for students who have contracted Covid-19 but are not showing any symptoms. “Since their dorms are open to students the hotel made sense,” said Kim Almkuist, who manages the telehealth program for Wilson County, North Carolina, Department of Health. “A school manager keeps tabs on the quarantined students, the school health center keeps track of the students’ conditions, and if there are drastic changes in their condition the students can be rushed to the nearby hospital.”
College and university dormitories have been emptied out in a lot of states because of Covid-19, and almost all of these have Wi-Fi and some amount of fiber infrastructure. Early in the pandemic, Tufts University in Massachusetts made hundreds of vacant dorm rooms available for potential patients. Middlebury College in Vermont offered some of its buildings, and New York University asked students who live near campus to clear out their dorm rooms.
Southern Connecticut State University dorms are currently closed for the Winter and possibly Spring as well. Every residence hall has Telehealth/Multipurpose rooms where students can meet with mental health professionals. Every room has a computer, internet access, and a desktop. Dorms such as these could be ideal temporary facilities for mental health patients.
“Using colleges and even hotels as temporary hospital facilities is a great idea!” Almkuist said. “But while telehealth works perfectly, many healthcare facilities have a shortage of doctors and staff. As the pandemic grew, we lost more as medical personnel got infected with Covid-19. Telehealth makes healthcare delivery more effective yet still we can be overwhelmed with the work.”
Loma Linda University Health’s hospital blog concurs in its assessment of tele-mental health. “One of two issues (and possibly both) is happening. Either the demand/need for care is increasing faster than it was prior to Covid-19, or the resources [i.e.healthcare staff] available. for behavioral health are decreasing.”
ER Bed Availability Is Increasing – and That’s Bad
Intensive Care Units (ICU) are in short supply, but the opposite is happening with ER beds. The U.S. Centers for Disease Control and Prevention (CDC) reported that ER visits were 42% fewer last year than in 2019. This is a big problem because many low-income individuals use the ER as their primary care physicians.
CDC fears a lot of the drop-off in visits is from fear of the virus. Telehealth kiosks potentially could lower those numbers further without Covid scaring people away from needed emergency care.
Kiosks are increasingly popular and being deployed in places such as pharmacies, supermarkets, and business complexes. Resembling airport check-in kiosks, these units enable two-way audio and video contact with healthcare professionals who can exam people visually and send prescriptions to patients’ local pharmacies. Optionally, assistants also can be assigned to kiosks to use digital otoscopes and stethoscopes, and sensors with patients.
“Privacy is big, especially when people need to consult with their doctor or receive behavioral health services,” said Eric Haden, President at Drexly Telehealth Solutions.“Counties possibly could set up kiosks in homeless shelters to provide ‘safety net’ free emergency and general health services without patients needing to go to urgent care clinics.”
“Many kiosks are used for populations that do not have insurance or primary care providers,” added Peter Caplan, the managing consultant for New York-based eHealth Systems & Solutions. ”They have been in community rec centers, churches, government offices, or have been mobile circulating between schools, libraries, and homeless shelters.”
Haden, Caplan, and others who consult with medical practices believe it’s important that these kiosk programs need to be developed for the immediate crisis and with a long-term business strategy along with an outreach program to both patients and providers.
For example, is it the case that they save money for public hospitals? USA Today reported that the average cost of an ER visit was $1,389 in 2017.
“Many local providers could easily be connected to a kiosk network for a wide range of medical disciplines,” Haden said. “Assess specialists that patients can access who they otherwise would have to drive a long way to see. J.D. Power has done some very robust consumer satisfaction surveys on telehealth, and they should be a part of your research.”
Cameron Broadnax, Principal at Transcending Healthcare, a telehealth systems integrator, understands the urgency of addressing the bed shortage crisis. However, he has some words of caution when it comes to implementing telehealth solutions.
“These are business operations involving multifaceted projects and multiple technology vendors,” said Broadnax. “Be careful vendors don’t start thinking we know everything a community’s going to need.’ And they don’t really because it’s a rush job and they haven’t communicated with the community well enough.”
Temper the need for speedy decisions with needs assessments.
Craig Settles, saved from a stroke by telehealth, pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth initiatives.