Telehealth advancements in response to COVID-19 reveal the importance of digital health delivery during outbreaks.
Developments in telehealth and online resources have become vital tools for combatting the novel coronavirus, also known as COVID-19, demonstrating the value of pharmacists and health care providers who take advantage of the benefits these technologies offer.
The current COVID-19 pandemic has sparked a surge in telemedicine and online, publicly available resources by national health institutes, health insurance companies, international corporations, and Congress in order to effectively limit exposure to and spread of COVID-19 in the United States.
At the time of this article’s publication, the United States has surpassed 4000 confirmed cases of COVID-19, and a total of 71 deaths and 17 recoveries from the virus, according to Johns Hopkins University.1
Telemedicine and telehealth services utilize electronic information as well as telecommunication technologies to offer various health-related services remotely; the technologies are particularly useful during outbreaks, especially when health officials recommend implementing social distancing measures.
Blue Cross Blue Shield Association recently announced their commitment to expanding their telehealth services and nurse-provider hotlines, among other pledges, including facilitating patient access to prescription medications in the event of a drug shortage.2
The American Society of Health System Pharmacists (ASHP) has created a COVID-19 resource center, available to the public on their website. The resource center offers myriad links to helpful and updated information addressing diverse coronavirus concerns; among them are an Infection Prevention and Control Checklist and a Drug Shortages Resource Center. The ASHP website additionally has links to other reputable resource sites, including the CDC homepage for COVID-19 information, World Health Organization links, and FDA guidelines. You can view their resources here.3
Eric M. Maroyka, PharmD, BCPS, director of ASHP Center on Pharmacy Practice Advancement, discussed the value of pharmacies incorporating telemedicine into their practice during outbreaks. “Appropriately trained and equipped pharmacists can use telepharmacy to remotely oversee pharmacy operations and provide distributive, clinical, and supervisory services,” he told Drug Topics® in an email.
“A large part of a pharmacist’s role in patient care is education and counseling,” Dr Maroyka added. "With the use of telepharmacy, pharmacists can improve patient access to care, provide credible information and awareness (eg, hand hygiene, cough and sneeze etiquette, remind patients to get influenza vaccine), enable successful comprehensive medication management, provide recommendations for symptom management, and help triage and refer patients to higher levels of care when diagnostic testing is warranted. Telepharmacy has demonstrated value in medication selection, order review, and dispensing; sterile admixture verification; patient counseling and monitoring; and the provision of clinical services.”
Maroyka also pointed to Vice President Pence’s agreement to include telemedicine in health plans. Indeed, Congress recently passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. Division B of the legislation expands the scope of telehealth Medicare requirements during national and public health emergencies. The provisions allow those on Medicare in urban and rural areas–defined as “emergency areas”–to benefit from telemedicine services during the COVID-19 pandemic.4,5
“As we continue to learn about the COVID-19 virus, it’s important for all Americans, and particularly vulnerable populations who are at heightened risk, to be able to access their providers when they feel sick or have questions” said CMS Administrator Seema Verma.6
Bright.md is also an advocate for telehealth services, particularly in rapidly developing emergency situations. In response to the rapidly changing demands of the current pandemic, Bright.md is offering a free COVID-19 evaluation, screening, and escalation tool to all hospitals in the United States. Their Smart Exam technology facilitates the process of diagnosing patients and demonstrates the potential for telehealth services.7
Ray Costantini, MD, co-founder and CEO of Bright.md, explained in an interview how their telehealth system works and the ways in which telemedicine is able to streamline health services for patients and health care providers alike.
When discussing its Smart Exam technology, he said, “An easy way to think about it is as a virtual medical resident; if a patient is sick, and they’re at home, at work, on the bus–really anywhere–they can log in to Smart Exam on their health care delivery system’s patient portal, and that virtual medical resident goes to work using the [electronic medical records system (EMR)] with a chart review, pulling out information like medications, allergies, problem list, visit history, demographic information, and looks at environmental and contextual information like location and seasonality, to drive this dynamic, adaptive, conversational AI platform.”
“It interviews patients for the provider and then it takes all that information, digests it, and gives it to the provider to be able to free them up of all the administrative burden that comes with the process of delivering care. Instead of taking 3 to 5 minutes to interview a patient, and then another 15 to 18 minutes to be able to get documentation, order entry, prescriptions and billing files, we streamline that process for the provider and make it so that they are able to spend their time with their practice.”
Dr Costantini also identified how telehealth services are applicable to outbreak situations such as the COVID-19 pandemic, in which hospitals and providers are experiencing a dramatic influx of patients. “We’re seeing roughly a doubling of patients every week who are concerned about coronavirus symptoms and exposure. We’ve so far screened about 11,000 patients who have had concerns about coronavirus; we’ve been able to treat all of those patients, and almost all of them have had benign upper respiratory tract infections. We’ve also identified 21 patients out of 11,000 who were at heightened risk for coronavirus exposure, and then were able to escalate those patients for additional testing and evaluation.”
“A typical provider can see about 100 patients a week in an in-person setting, so 11,000 visits in a month would take a massive number of providers. We’re helping our delivery systems do that with just a handful of providers in much less time because of the efficiency we’ve introduced. It frees up the clinicians’ capacity to be able to go and take care of all of these other rising needs that are out there.”
Online resources from CVS, the CDC, and Johns Hopkins University and Medicine are all available to the public and are thoroughly updated to keep up with the rapid development of COVID-19. CVS is also offering all telemedicine visits and diagnostic testing with no co-pay and waiving home delivery fees of prescription medications, in order to align with CDC recommendations of those with heightened risk for COVID-19 to stay home and follow social distancing measures.1,8,9,10
When asked about what is likely to happen with COVID-19 in the United States over the next few weeks, Dr Costantini said, “The United States is entering into the exponential growth phase, which is where you would expect to be seeing substantial increases in new incidents. I’m hopeful that some of the more recent developments around social distancing and people’s awareness of the importance of hand hygiene–things that can really help reduce the spread of viral illnesses–can reduce that exponential growth rate and keep it from peaking at a level that’s higher than our health care system’s capacity to be able to manage. Our goal as a company has been to help lift that level and give them more capacity so that peak can be better navigated; but really important actions that patients, health care consumers, and the general population can do will help reduce the height of that peak of new cases.”
1. Coronavirus Resources Center. Johns Hopkins University & Medicine’s website. https://coronavirus.jhu.edu/map.html. Accessed March 12, 2020.
2. McGrail S. Industry Leans on Telehealth to Tackle COVID-19 Outbreak. mHealth Intelligence’s website. https://mhealthintelligence.com/news/industry-leans-on-telehealth-to-tackle-covid-19-outbreak. Published March 10, 2020. Accessed March 12, 2020.
3. Coronavirus Disease 2019 (COVID-19). ASHP’s website. https://www.ashp.org/Pharmacy-Practice/Resource-Centers/Coronavirus?loc=ashphero3-covid19-03092020. Accessed March 12, 2020. Coronavirus (COVID-19). CDC’s website. https://www.cdc.gov/coronavirus/2019-ncov/index.html. Accessed March 12, 2020.
4. Coronavirus (COVID-19): new telehealth rules and procedure codes for testing. AAFP’s website. https://www.aafp.org/journals/fpm/blogs/gettingpaid/entry/coronavirus_testing_telehealth.html. Accessed March 12, 2020.
5. Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020. Congress’ website. https://www.congress.gov/bill/116th-congress/house-bill/6074/text?q=%7B%22search%22%3A%5B%22Coronavirus+Preparedness+and+Response+Supplemental+Appropriations+Act%22%5D%7D&r=1&s=1. Accessed March 12, 2020.
6. Telehealth Benefits in Medicare are a Lifeline for Patients During Coronavirus Outbreak [news release].CMS’ website. https://www.cms.gov/newsroom/press-releases/telehealth-benefits-medicare-are-lifeline-patients-during-coronavirus-outbreak
7. Bright.md Offers Free Coronavirus Screening Tool to Hospitals [news release]. https://www.bright.md/press-release/bright-md-offers-free-coronavirus-sc...
8. Coronavirus (COVID-19). CDC’s website. https://www.cdc.gov/coronavirus/2019-ncov/index.html. Accessed March 12, 2020.
9, CVS Health announces additional COVID-19 resources focused on patient access [news release]. https://cvshealth.com/newsroom/press-releases/cvs-health-announces-additional-covid-19-resources-focused-patient-access
10. What you need to know about the COVID-19 outbreak. CVS Health website. https://cvshealth.com/newsroom/articles/what-you-need-know-about-new-coronavirus-outbreak. Accessed March 13, 2020.
11. Wicklund, E. Breaking: Telehealth Coverage Included in Coronavirus Spending Bill. mHealth Intelligence’s website. https://mhealthintelligence.com/news/breaking-telehealth-coverage-included-in-coronavirus-spending-bill. Published March 4, 2020. Accessed March 12, 2020.