A new kind of house call: Coronavirus leads to increased telemedicine use

Monadnock Community Hospital is working towards creating a path for patients to see their doctors remotely, as response to the COVID-19 outbreak has opened up new avenues for accessing care remotely.

Telehealth visits use a video and audio connection from doctor to patient, and allow the patient to access medical care without leaving their home. It can be used by doctors, therapists, and other health care workers.

Monadnock Community Hospital has already begun the process of doctors consulting with patients via video, and is on track to be able to provide greater access to that service – on a limited basis – within two weeks.

Dr. Greg Neilley, an internist and geriatrician at Monadnock Internal Medicine, said he’s been able to meet with several patients so far using a video call. While telehealth consultations aren’t always appropriate – there is no way to run certain tests, or physically listen to a patient’s lungs or heart, for example, and most critical emergencies will still require an Emergency Room visit. But for many patients, they can receive a similar level of care as if they were in the same room as their doctor.

“I’ve been pleasantly surprised at how seamless it is, how efficient it is, and how much you can do with a video connection,” Neilley said.

Neilley said the hospital is working to be able to provide more regular care through telehealth services.

“We’re expecting to expand this in the weeks ahead. We need to figure out how to continue to provide routine care, say for patients with a chronic issue, such as diabetes. Now, of all times, we want to keep them healthy and out of the hospital,” Neilley said.

For Monadnock Community Hospital, patients who want to access telehealth services must connect to the hospital online through their patient portal and have a computer or laptop with a web camera, or a phone or tablet with a camera. On a computer, they can access a video conference with their doctor through an emailed link. With a phone or tablet, they can connect through an app.

For those that don’t have access to a camera on their computer or phone, a telephone visit can be arranged.

Susan Howard of Peterborough is one of the patients who has been able to take advantage of Monadnock Community’s telehealth offering. She said she was having issues with vertigo.

“I didn’t want to go in, but I wanted to check in and see what I should be watching out for,” Howard said. She said she wasn’t expecting to have a video conference with a doctor, and didn’t have much experience with video chat, but hospital employees walked her through the process, and within hours, she was able to connect to Neilley and have a consultation.

“It was great. It saved me from traveling and exposing myself to the virus, but allowed me to access a doctor. It made me feel like I had more access to medical care,” Howard said.

Neilley said early studies of telemedicine visits have shown that patients are as satisfied or more satisfied with their visits than patients visiting in person.

“Patients find this very convenient,” Neilley said.

Monadnock Community Hospital isn’t the only medical provider ramping up its telemedicine offering. The Concord Monitor reports the Concord Hospital Medical Group has suspended regular office visits. Instead, it has performed over 1,100 telephone visits.

Dartmouth-Hitchcock Medical Center already had a remote visits available for patients in several specialty units, according to the monitor, and was already using it for about half of its outpatient visits prior to the outbreak of COVID-19, according to the Concord Monitor.

Other health services, such as optometrists and dentists, have been reduced to seeing patients in emergency-only situations. They, too, have been relying on making initial contact with their patients either through video, phone calls, and photographs.

Dr. Michael Gordon, a Peterborough optometrist, said he’s only had to examine a small number of patients face-to-face. He’s speaking to patients by phone, and receiving photographs of eye issues for emergencies.

Dr. Marilynn Acker, of Jaffrey Eye Care, said she’s been dealing with emergency situations similarly. She’s had similar interactions with patients in the past, and it’s not a service she charges for, she said.

Acker said she’s not adding any additional telehealth services, other than what she already provides, due to patient confidentiality concerns, and what she hopes is only a temporary situation.

Dr. Zane Broome, of Monadnock Dental Associates, however, said his office is fully embracing the potential benefits of adding telehealth consultations as a way to initially connect with patients and determine if they have need of an emergency consultation.

“We’re able to have a conversation. They can take pictures of what’s going on, so we can get a handle on the situation. Sometimes, it’s just over the phone, or they can take a picture and text it, or we can have a video call using something like Zoom or FaceTime to determine the best course of action,” Broome said.

Neilley said hospitals haven’t been fully utilizing technology available to them prior to the outbreak of coronavirus, mainly because most insurance companies didn’t have a mechanism in place to reimburse hospitals for them. Government mandates implemented during the COVID-19 emergency have made it possible.

Governor Chris Sununu, in one of his emergency orders, required all health insurance carriers regulated by the New Hampshire Insurance Department, benefit plans authorized under RSA 5-B and all New Hampshire Medicaid coverage to allow in-network providers to provide telehealth services.

The federal government has also temporarily loosened some of the rules restricting telemedicine, including allowing doctors to treat patients from other states, as long as that state agrees, requiring health insurance to cover telemedicine, and to allow telemedicine visits to take place over public video chat channels, instead of being confined to more dedicated and secure channels, a rule designed to align with medical privacy laws.

Neilley said the current state of medical care may push the use of the technology forward permanently.

“That may be a silver lining in this terrible illness,” Neilley said.

Broome said he too, would like to see telemedicine here to stay.

“It may actually end up changing how we do individual consults,” Broome said. “We can establish a treatment plan with the patient, even give them financial arrangements, and we can do it virtually. It limits the amount of exposure people have in the office, and it can be more efficient in getting people in and out and maintaining sterilization.”

Broome said whether telehealth visits are here to stay is dependant upon whether insurance companies permanently sign on to the concept. He said he’s hopeful they will.

“There's a lot of things changing right now, and that's  one of them,” Broome said.