Virtual doctors brace for Covid’s new wave


July 28, 2021 8:54 am

Telemedicine didn’t just provide a pandemic lifeline for patients and their doctors. It’s linking rural hospitals with offsite clinicians who consult on patient care and back up on-site doctors and nurses as Covid’s latest surge fills beds once again.

With the highly transmissible Delta variant of Covid-19 now overtaking areas with low vaccination rates, demand for tele-ICU and tele-ER services is on the rise as hospital administrators try to shorten the length of stays and avoid transferring medically frail patients over long distances to higher levels of care. 

Matthew Lyon, service chief of virtual care operations at Augusta University Health, in Georgia, said most hospitals his facility collaborates with remotely monitor one or two Covid patients. A month ago, it was one in every 10 or 12 hospitals.

Kelly Rhone, medical director of outreach and innovation at Avera eCARE, a leading tele-ICU provider in Sioux Falls, S.D., has begun seeing sicker younger patients at facilities her company connects with in the upper Midwest and Great Plains states.

“We don’t know what the future holds with Delta or any other variants that are coming, but we know that this system works to help with that,” Rhone said. 

The fiber optic–connected setup keeps cameras trained on patients. Nurses or board-certified doctors in a command center watch vital signs like heart rates or blood oxygen levels on monitors. A data point change prompts a real-time response, with the virtual care team able to jump in and assist with ordering tests, updating case notes or, in serious cases, putting patients on ventilators. 

Providers say some patients gave the virtual experience high marks, while others’ experience was mixed. Marshall Lee, medical director of the virtual ICU at Oregon Health & Science University, said a number of those hospitalized “wonder what’s going on with the camera,” but have appreciated the attention when hospitals’ in-house staffs are stretched thin. 

Hospitals benefit from keeping more patients in their communities and getting a more predictable revenue stream during a crisis that’s seen many elective procedures and routine care curtailed. Providers like Avera also charge by the cameras in operation, allowing facilities to scale up care without lots of abrupt staffing changes. 

The consultations also reduce the need to shuttle patients to hospitals in big population centers, some of which are experiencing their own Covid crises. A report from Augusta University Health found its tele-ER program cut patient transfers from rural hospitals in Georgia by 81 percent last year. 

With almost 30 million Americans living more than 60 minutes from a trauma center, demand for “teletrauma” could outlast the Delta variant and future Covid surges. Hospitals with limited critical care like KershawHealth Medical Center in Camden, S.C., use hookups with offsite doctors for every patient in the ICU, and had leaned on the tech before the pandemic. The arrangement proved invaluable during the health crisis, when patients were far sicker than normal, said Tallulah Holmstrom, KershawHealth’s chief medical officer. 

Augusta University Health sees future growth in areas like pediatric care and in collaborations with skilled nursing and rehabilitation facilities once patients are discharged. “We think it really helps decrease this rural-urban disparity,” Lyon said.