COVID-19 Pandemic Pushes NJ to Step Up Reliance on Telemedicine

Gov. Murphy signs bill lifting restrictions on telehealth services, but can they slow seemingly inexorable spread of deadly coronavirus?
Credit: Courtesy of RWJ University Hospital New Brunswick
The triage video tent at the Robert Wood Johnson University Hospital in New Brunswick. (The person on the left is not a real patient.)

For years New Jersey has been a reluctant player in the field of telehealth, dabbling but not committing to use the evolving technology to treat patients remotely. But as the COVID-19 virus spread in recent weeks, and the death toll spiked, government officials and health care providers here and across the United States had no choice but to jump feet first into the world of virtual health care.

First, Congress included $500 million for the use of telemedicine services in its emergency COVID-19 aid package earlier this month. Then the Trump administration lifted restrictions on Medicare reimbursement for telehealth services, which immediately allowed telephone and videoconferencing between doctors and patients.

Gov. Phil Murphy soon followed suit, signing into law temporary measures that removed a number of regulations that have long kept health care providers from practicing telemedicine. Private insurers also climbed on board, waiving copays and out-of-pocket fees, as Medicare had already done.

Extending remote care to more practitioners

On Sunday, Murphy directed several state departments to bolster the commitment to remote care, specifically adding mental health and behavioral health providers, physical therapists, occupational therapists and speech therapists to the mix of those who can engage in remote patient management.

“This crisis shows the absolute need for alternative ways for patients to connect with health care providers,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute. “One positive element is that regulators at the federal and state level have moved aside the many bureaucratic barriers that previously stymied the growth of this important part of the continuum of care.”

State Sen. Joseph Vitale, the chief sponsor of the bill, has been calling for new telehealth laws in New Jersey long before the coronavirus arrived. For the Woodbridge Democrat, it was a no-brainer. Telehealth, he argued, would address a growing shortage of clinicians and an increase in demand in an aging population with more chronic diseases, requiring more care.

Suddenly, his advocacy took on an urgent currency, and his bill became law.

“This now allows our seniors to stay home and remain in touch with their doctors,” Vitale said. “It protects them and it protects our doctors. It’s just smart policy … It will easily demonstrate its effectiveness.”

The results of the new law were immediate and wide-ranging.

For starters, it allows for remote diagnoses and advice for those experiencing suspected COVID-19 symptoms, protecting both patients and health care officials from contact with the deadly virus. It also allows for the routine care and protection of non-COVID-19 patients.

Now that our hospitals are expected to be inundated in the very near future, the health of the state’s care providers is obviously critical. New Jersey doctors, in particular, tend to be older — 60 and beyond — and thus at higher risk. (Italy suffered tremendously from doctors becoming infected.) And with medical masks and gowns in short supply, virtual visits will help preserve the precious inventory until sufficient supplies can be manufactured.

Remote triage

Family doctors are now using a number of platforms — like Facetime, Skype and Zoom for Physicians — to interface with their patients by phone. This allows them to first, verify their patients’ identities before inspecting wounds, rashes and other symptoms on live video. Many of the software providers are waiving subscription fees for six months. More importantly, it allows them to triage patients by phone before setting up office visits.

Hackensack Meridian Health, which runs Hackensack University Medical Center, and Jersey Shore University Medical Center, started dabbling in telehealth a year ago, according Dr. Thomas Bader, vice president of Medical Quality. They bought a software platform, Convenient Care Now, dedicated some resources, but it never really took off. On average, they performed 300 video consultations per month, he said.

In early February, as the pandemic started to take hold, they decided to ramp up the operation, adding doctors and other resources. Now, they are doing 100 consultations a day. People are receiving prompt medical attention, which is helping them keep their emergency-room beds available for critical patients.

In order to reduce risk, Holy Name Medical Center in Teaneck, the hardest hit area in the state, is now transmitting video of a single doctor’s examination to a team of offsite physicians, according to  Lawrence Downs, CEO of the Medical Society of New Jersey and executive director of the Institute of Medicine & Public Health of New Jersey.

Robert Wood Johnson University Hospital in New Brunswick takes it another step. Last Wednesday, it erected two tents outside its emergency room, according to Dr. Robert Eisenstein, chief of emergency care, who explains the operation like this:

In the first tent, all people seeking ER access are screened. Those with non-COVID-19 symptoms are sent into the ER. Those with severe COVID-19 symptoms are immediately admitted to an isolated ER tent. Those with minor symptoms are given a mask and sent to the other tent.

There they are further screened by a nurse, who is fully dressed in a protective hazmat suit, who takes and records the patient’s vital signs. Also in the tent is a “video robot” that transmits a video to a physician inside the emergency room for further interviewing. If the doctor wants to hear the patients breathing, an electronic stethoscope on the robot takes care of the request. That doctor then makes a determination about whether the patient needs to be admitted and tested for the virus. Some with mild symptoms are sent home with instructions for self-quarantine.

The goal is to protect the emergency room patients and the medical personnel.

“It’s working quite well,” says Eisenstein. “We’re seeing about 40 patients a day” via video in the second tent.

Asian advances in telehealth

As innovative as RWJ’s triage tent may be, it pales in comparison to the remarkable telehealth advances in Asia, where China and South Korea are rewriting the rules and practices of medical care.

In recent years, China has launched over 150 so-called internet hospitals.

Last month, Chinese officials opened the Smart Field Hospital in Wuhan, China, where the pandemic began. It is the latest of more than 150 internet hospitals they have launched in recent years. From an outsider’s perspective, the facility approaches sci-fi status.

It can handle 2,000 patients, and all care is performed by robots and other computer-driven devices. Admitted patients are connected to 5G thermometers, which alert staff of anyone with a fever. They are also given smart bracelets and rings that provide their vital signs, including temperature, heart rate and blood-oxygen levels. Other robots provide food, drinks and medicine to patients, while autonomous droids spray disinfectant and clean the floors.

South Korea, which has emerged as the global model for fighting the pandemic, is also aggressive with technology. Citizens are sent emergency alerts to their cellphones as soon as new cases are discovered in their neighborhoods. There are websites and phone apps that provide detailed timelines, methods and routes of infected people’s travel. Offices, hotels and other large buildings use thermal-image cameras to identify people with fevers.

People ordered into self-quarantine are required to download another app, which alerts officials if a patient ventures out of isolation and subjects them to heavy fines. Privacy is clearly less of concern in South Korea than here.

“There are lessons to be learned from these Asian countries,” according to Dr.  Soumitra Bhuyan, an assistant professor at the Edward J. Bloustein School of Planning and Public Policy at Rutgers. “I believe there is a need to better leverage technology in tracking contacts and understanding community spread. (But) some cultural differences exist, which make it harder to replicate here in the US.”

While telehealth today is a temporary measure in New Jersey, many believe that the way America delivers health care is transforming before our eyes.

“This will produce a profound change in the way medicine is practiced,” said MSNJ’s Downs. “The system wasn’t ready, but now it is being forced to adjust.”

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