Inpatient Telemedicine for COVID-19

Tweetchat Summary

#TelemedNow Twitter Chat Wednesday, March 25 – 8 PM ET Introduction & Welcome: Helen Burstin (@Hele Burstin) – Moderator

Q1: To our friends and experts, during the #COVID19 crisis, how have you modified patient evals and assessment in hospitals and EDs to minimize risk to patients? A1 Notable Responses: V.G. Press (@vgpress13) I direct our COPD Readmissions Reduction Program. During COVID our APN inpatient consults and outpatient visits changed to phone-based calls and have held our pharmacist-led med rec and inhaler teaching currently- need #TelemedNow options to provide this care. V.G. Press (@vgpress13) One option for inhaler education, could be extended to other COPD related interventions: Dr. Andrew Watson (@awrmd) I “tele-round” using video carts in the hospital. Have done about 180 and patients love it. #TelemedNow. Have occasional technical issues but really it means I can round from anywhere ! Jamey Edwards (@jameyedwards) Using our platform to create clinical distancing in #hospitals to protect our frontline #healthcare workers from infection and help us save on #PPE supplies. Also launched tool for home visits to decompress ER's and keep people home. @CloudbreakHLTH Ritu Thamman (@iamritu) Mostly a favorable response as long as it’s not an acute problem ,easier for patients & their families to know they can still get care while adhering to #SocialDistancing Andrew Dunn (@andrewdunn111) Agreed. Using patient cell or room phone often. Allows more frequent virtual touches. Q2: Given #COVID19, how have telehealth and tech innovations been used to help keep clinicians safer? A2 Notable Reponses: Dave Foster (@HWInsider) Telecommunicating with the public and with patients is critical in being proactive and helping flatten the curve. Telehealth enables safe and effective treatment to accomplish this vital public health goal. Especially safety for clinicians Andrew Dunn (@andrewdunn111) Can use telehealth to keep #COVID patients safer too. The abruptness of deterioration has been startling. Need to leverage telehealth for early warning. Using now for more frequent sx and O2 sat checks via central monitoring or remote camera. Dr. Ami Bhatt (@AmiBhattMD) at this time, using what we have (phone, stand-alone) is fine. But longer term, integrated platforms allow for easier scheduling and tracking. Jamey Edwards (@jameyedwards) Treat #telehealth calls like an in-office visit w/ similar pacing & breaks. Maintain openings for the “real-time” needs of #patients in more of an on-call model so you can tackle urgent situations as they arise. Jamey Edwards (@jameyedwards) Video is the ultimate #interoperability tool. No need to build interfaces when you can aim the camera at the monitor :) Julie Reisetter (@juliereisetter) LOTS of opportunity to improve here! Right now - more manual than integrated Face with rolling eyes. We need to worry about getting the job to done - right NOW! Dr. Andrew Watson (@awrmd) ER telemedicine can be truly impacted. Based on this think of the impact on PPE and bilateral #Covid19 exposure. #TelemedNow Dr. Andrew Watson (@awrmd) Hard to know what is the most precious resource, MDs / nurses / Apps or PPE. They are so co-dependent hard to think through this.... Dr. Andrew Watson (@awrmd) #TelemedNow A more generic white paper but still very good! @aafp #TelemedNow Covers some of the issues we are discussing here.

Q3: Next question. Has telehealth in ED and hospital impacted your need for PPE? A3 Notable Responses: Ritu Thamman (@iamritu) Since #PPE is in such short supply , doing more via #Telemedicine will help alleviate some of that supply demand mismatch & hopefully reduce #COVID19 transmission rates to healthcare worker. Ritu Thamman (@iamritu) keep exposure down & limit transmission by planning ahead & relying on #Telemedicine to do as much as possible #TelemedNow. Nicholas Morrissey (@nickmorrisseymd) I think for inpatient visits it can be especially helpful in the covid era. We have so many covid + patients. what are the guidelines for this? similar to outpatient ? Reply to @nickmorrisseymd:

Ritu Thamman (@iamritu) #Covid19 patients are usually divided into moderate or severe/critical in the hospital & can use #Telerounding to pre round on the moderate Pts & even telephone into the room to conserve #PPE & Downwards arrowtransmission risk.

Dr. Ami Bhatt (@AmiBhattMD) #Covid19 patients in the ICU will also have many invasive and noninvasive assessments to help manage care. Use clinical judgement to establish how many exams a day are needed.

Ritu Thamman (@iamritu) points symbol keep exposure down & limit transmission by planning ahead & relying on #Telemedicine to do as much as possible #TelemedNow Matthew D. Neal, MD (@macky_neal) My N=1 experience is yes. My #TelemedNow outpatient general surgery clinic today required 0 masks. Then rounded in the hospital - different story. Andrew Dunn (@andrewdunn111) Definitely. Leveraging any means to avoid unnecessary room entrances. One non-telehealth tip: align med times. Give 6am, 8am, 10am meds all at 8am. Dr. Ami Bhatt (@AmiBhattMD) #TelemedNow keeps clinicians safe by allowing them to stay remote and saving #PPE. Helps patients similarly but also by ensuring we have the workforce to replace one another when people get quarantined. Dr. Ami Bhatt (@AmiBhattMD) The sooner you can launch it the fewer exposures, quarantines and illnesses you may incur. Teams need to be taught how and of course use clinical judgement. #TelemedNow Jamey Edwards (@jameyedwards) A good diagnosis is built on great communication, testing is usually confirmatory of a great HPI and Family History. #Telemedicine shines here. #Healthcare #TelemedNow Helen Burstin (@HelenBurstin) Our people are always most important, but they need PPEs! @futuredocs, any thoughts about telehealth strategies are affecting teaching and residents?

Reply to @HelenBurstin: V.G. Press (@vgpress13) Fundamental shift in any type of teaching right now- zoom morning reports and conferences are the norm. obviously traditional #meded has depended on in-person conf so this is sea change #TelemedNow Dr. Ami Bhatt (@AmiBhattMD Zoom conferencing also encourages hospitals and practices to share across state lines. Listened to MGH and UCSF grand rounds in one day! #TelemedNow

Q4: Any insights from patient and family responses to these social distancing changes? A4 Notable Responses: Andrew Dunn (@andrewdunn111) Heard suggestion: #physicaldistancing. Love that. We can still be highly social. Patients and families like the virtual touch. They still get a daily in-person visit but now get connected via phone or tablet several times per day. Does not need to be anti-social. #TelemedNow Dr. Andrew Watson (@awrmd) I hope we can make “3-way rounding” easier, with patient in bed and family at home #TelemedNow. And with translation services as needed. I watch them do this in our @UPMCnews ICUs, round with families. Is impressive

Reply to @awrdmd: Helen Burstin (@Helen Burstin) Especially with visitor exclusions during #COVID19, this technology would be very appreciated by families #TelemedNow

Dr. Ami Bhatt (@AmiBhattMD) Visitor policies are appropriately stringent now, #TelemedNow allows for us to bring families to patients and update them. Even for those who are in the ICU and intubated. Much better for fearful family members to see an MDs face than receive a phone call.

Jamey Edwards (@jameyedwards) Multiparty calling is available now on multiple platforms. We have implemented before. A whole continuum of care including family can be tied to together in one call. Jamey Edwards (@jameyedwards) Imagine being able to setup #PrecisionCareTeams with providers from multiple health systems with expertise in specific co-morbidities. A nationwide care team surrounding a patient with everything they need to thrive. That's our dream :)

Q5: Any other good tricks for remote physical exam? A5 Notable Responses: Dr. Ami Bhatt (@AmiBhattMD) Remote physical exam with single lead ekg is great, but low tech: have the person feel their radial pulse and say "now" when they feel it. Afib is suprisingly obvious. #TelemedNow Dr. Andrew Watson (@awrmd) Alas, to just have to deal will one organ ! Winking face hard to draw a parallel as a colorectal surgeon. Other questions/comments in the chat: Participant question – 1 Michelle J Nickolaus (@mjnickolaus) #TelemedNow question for you all as to what platforms you are using Geisinger has EMR Epic and InTouch as telemed platform... going to attempt some televideo visits On Friday Dr. Ami Bhatt (@amibhattmd) we use Epic and intouch @MassGeneralNews as well .. you will like it. Happy to share tip sheets. Ritu Thamman (@iamritu) All consults are #Telemednow with video using @zoom_us. Patients love it. Jamey Edwards (@jameyedwards) Both Epic and @InTouchHealth are great platforms. What really changes between settings is #workflow for specific use case. Ideally #hospitals move to one unified platform for all #telemedicine specialties so #doctors just need to learn one interface. Jamey Edwards (@jameyedwards) Always good to try and select "open" platforms that work on open standards so calls can interact and be #interoperable with other systems. #collaboration within and beyond the hospital walls becomes possible. Monica Lypson (@mlypson) #TelemedNow hello...interested in the topic...I see many familiar faces . Interim Division Director for Endocrine..having docs handle consults in this way would reduce PPE. Helen Burstin (@Helen Burstin) Next question. Has telehealth in ED and hospital impacted your need for PPE? Andrew Dunn (@andrewdunn111) Definitely. Leveraging any means to avoid unnecessary room entrances. One non-telehealth tip: align med times. Give 6am, 8am, 10am meds all at 8am. #TelemedNow

Participant question – 2 Michelle J Nickolaus (@mjnickolaus) My question is how are folks using #TelemedNow and in corporate physical exam heart sounds and EKG. Jamey Edwards (@jameyedwards) Bluetooth stethoscopes by @TytoCare and others are useful. Can also do remote EKG's now with smaller devices. Dr. Andrew Watson (@awrmd) That is an amazing peripheral, @TytoCare, I do hope we can perfect telerounds, especially with #Covid19 and the need for education (@iamritu thank you for the Pitt Med course you are standing up). Ritu Thamman (@iamritu) Yes even #education is different w #COVID19 & #TelemedNow & @Twitter education will be taught & used! Getting these 3rd &4th years ready for the new world @PittHealthSci Michelle J Nickolaus (@mjnickolaus) So true, not to mention education of the patient -@AmiBhattMDI am thinking about our ACHD program outreach and how I set up our transition clinics for teens and this is going to be a game changer. #TelemedNow Dr. Ami Bhatt (@amibhattmd) And think of how "cool" the transitioning teens will think you are! #TelemedNow will also make it easier for patients, parents and their physicians to trust the transition from CHD to ACHD which we know is paramount to successful transfer! @ACHA_Heart Participant question – 3 Ryan K. Louie, MD, PhD (@ryanlouie) I have a question about when to launch #telemedicine for inpatient units. Is it for just backup in case physicians go under quarantine? Or is it to be launched asap? Thanks everyone. #TelemedNow Helen Burstin (@helenburstin) Thanks @jameyedwards. Any suggestions for how to best use teleconsults, especially when some specialties overextended like ID during #COVID19? Andrew Dunn (@andrewdunn111) Will decrease unnecessary room entries, facilitate communication, and enhance monitoring. #TelemedNow

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