Tapping Telemedicine for Cardiac Patients During the COVID-19 Pandemic

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Tapping Telemedicine for Cardiac Patients During the COVID-19 Pandemic

Tapping Telemedicine for Cardiac Patients During the COVID-19 Pandemic

The pandemic is pushing health care providers toward the future faster than planned.(GETTY IMAGES)

TELEMEDICINE HAS thrown a lifeline to the U.S. health care system during the coronavirus crisis. An unprecedented number of Americans are now relying on phone and videoconference to receive medical care from their homes, and the federal government has announced plans to expand telehealth services to Medicare recipients.

Atrium Health, my health care system, serves 37,800 patients every day (or nearly one every 2 seconds) across North CarolinaSouth Carolina and Georgia. As 1 in 3 of our patients live in rural communities (compared with 1 in 5 nationally), this would often mean long drives for our patients to access care at one of our locations. Since the coronavirus outbreak, we have rapidly transitioned our care delivery model from one relying predominantly on traditional face-to-face encounters to one fully embracing virtual visits.

Before COVID-19, Atrium Health logged approximately 14,000 virtual care encounters across our system each day. With our primary care services, we have seen our virtual visits increase by more than 500 percent in just a month. We have also launched a new virtual service – a COVID-19 virtual hospital for select patients who test positive for coronavirus, to serve those who don’t need in-hospital care at home.

In general, primary care is seeing the greatest uptick in virtual visits, but specialty care is also ramping up its remote offerings, especially across outpatient clinics that serve patients vulnerable to COVID-19. Addressing the needs of patients with cardiovascular disease without having to rely on face-to-face visits is especially critical during this pandemic, as the risk of mortality from COVID-19 is much higher in these patients.

The pandemic is pushing us toward the future faster than we planned, leading to an evolutionary leap forward for cardiac telemedicine. Out of this international crisis comes an opportunity to permanently alter how we deliver care – for the better.

Laying the Groundwork for Cardiac Virtual Care

Well before COVID-19, we developed several cardiac telehealth programs for patients who have trouble visiting our facilities. For one, we have a team of virtual nurse navigators trained and able to provide invaluable follow-up care to patients after they have a heart attack. These registered nurses all have clinical experience working in cardiovascular care units, and they also have the interpersonal skills to understand and develop bonds with our patients. For 90 days after discharge, navigators call patients throughout the week to advise them and answer their questions. The year after our virtual nurse navigator program began in 2017, hospital readmissions fell from 6.3% to 3.7% of patients, while patient deaths fell by 1.2%.

Two other programs have helped us navigate this new territory in care delivery.

For patients with heart failure, the Heart Success program provides 30 days of virtual transition care to patients immediately following an episode of acute heart failure. A multidisciplinary team manages each patient’s individualized care plan during the high-risk period following hospital admission, and this has reduced the likelihood of repeat hospitalization.

Another effort called Perfect Care (a program funded by The Duke Endowment) assists patients following cardiac surgery. Patients ranging in age from 30 to 80 utilize virtual visits and a digital toolkit – including smartphones/tablets, wearable devices and scales – for monitoring and care from the comfort of their homes. Real-time monitoring of their heart rate, blood pressure, step counts, sleep habits and weight are centrally tracked by our team. This has also led to significant reductions in hospital readmissions.

Less than a year ago, Erika Johnson, 45, of Concord, North Carolina, enrolled in the pilot program after receiving a pacemaker and undergoing valve-replacement surgery. Today, she says she’s “experienced a lot of positive results” and notes that “before my surgery, I was only able to walk for 2 minutes before I was completely out of breath. Now I can walk up to 45 minutes.” We are hoping to see many more results and experiences similar to hers.

Making the Virtual Switch ‘Overnight’

Based on the results of these early initiatives, our Sanger Heart & Vascular Institute was developing a plan to roll out a comprehensive virtual cardiovascular program later this year. But the coronavirus challenged us to both dramatically accelerate our plans and develop a new playbook in just a matter of weeks.

Step one was identifying the patients we needed to see in person versus those who could be safely screened remotely. Our clinicians, knowing the patients best, weighed the risk of possible exposure to COVID-19 with an on-site visit versus possible incomplete evaluation by telehealth.

Next, we piloted virtual cardiac services in one of our offices in Charlotte, North Carolina, incorporating patients and clinician feedback into the process. This allowed us to work through myriad tactical issues – such as how best to connect with the patient or decide who assesses the medications he or she takes – in order to establish a common workflow. This prepared us to scale our telehealth services to 30-plus regional sites and outpatient clinics.

Since the COVID-19 crisis began, Sanger Heart & Vascular Institute has been able to convert approximately 95% of in-office visits to virtual ones via phone or video. Over 500 office visits per day are now delivered through a telehealth platform. As over 60% of our patients are on Medicare, this means that more than 300 patients per day do not have to leave their homes to receive care from their doctors. Our cardiovascular specialists can still pinpoint issues remotely using the results of CT scans, MRIs and other imaging tests patients had received previously in the office.

The coronavirus outbreak has already profoundly impacted all of our lives, and it is too early to know how each aspect of our days will be transformed after we emerge from this pandemic. But with respect to health care, we have already learned that connecting with our patients through telemedicine is not only achievable, but also both clinically effective and greatly accepted by patients and clinicians, according to the early returns.

Our focus is now quickly turning to developing strategies that will allow us to sustain this method of delivering care after we see our way through this crisis. We believe our health care system will be all the better for it.