CORONAVIRUS

Telehealth demand surges as hospitals cope with coronavirus

'A turning point for how we deliver health care'

Dr. Michael Murphy chats by video Thursday in his new way of seeing patients at Central Counties Health Centers in Sprin
Dr. Michael Murphy chats by video Thursday in his new way of seeing patients at Central Counties Health Centers in Springfield, Ill. (John O’Connor/Associated Press))
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IOWA CITY — They assumed it was the milkshake.

“Ice cream makes her cough,” Cindy Margretz, of Palo, said of her 87-year-old mother, Mary Margretz. “So when she was coughing she said, ‘Oh it’s just the ice cream,’”

But it didn’t stop. While working from home in the dining room, Margretz for the next couple days kept hearing her mother cough.

“I kept checking her temperature and asked, ‘Do you have a sore throat, a headache?’” said Margretz, who is an advertising executive at The Gazette. “Nope, nothing, she said. She just kept saying, ‘I just have a tickle in my throat. Just a tickle.’”

And then it hit. A few days after the cough started, Mary Margretz woke up feeling terrible, unable to get out of bed, and ready to see a doctor. But with the coronavirus spreading through the community, Margretz was advised to see a “virtual doctor” before coming in for a visit.

And that’s become the new coronavirus norm, according to Katie Imborek, clinical associate professor of family medicine with University of Iowa Health Care. As her campus — Iowa’s largest health care system and only academic medical enterprise — prepares and treats an increasing number of COVID-19 patients, it’s become increasingly reliant on telemedicine to sift through cases that don’t warrant a visit and those that do, including potential coronavirus patients.

In the two weeks since UIHC went live with video visits March 10, providers have logged more than 3,310 — averaging 250 to 300 visits a day, surpassing 400 some days, according to Imborek. To handle the load, the hospital has 10 to 15 providers at any one time staffing virtual visits — calculated on an overestimation of 500 patients a day.

Many of those providers come from UIHC quick care and urgent care offices, but they also include family medicine doctors, advanced practice providers, specialists, emergency room physicians and pediatricians.

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“So we have folks across the board who have stepped up and are doing some of these videos to help us out,” Imborek said.

Not only do virtual visits keep patients who don’t require in-person care out of the clinics and emergency rooms, they help the hospitals prepare for potential COVID-19 patients, allowing staff to properly protect themselves and others before the possibly infectious patients arrive.

UIHC isn’t the only local hospital ramping up its virtual visits and telemedicine.

Mercy Medical Center in Cedar Rapids earlier this month expanded its use of telemedicine “to offer patients video visits with more local providers at more local locations.”

Unity Point-St. Luke’s Hospital likewise has been directing more patients into its virtual waiting room, which is where Margretz and her mom landed after calling their provider with the concerning symptoms.

“I had never done it before, but they put you in a virtual waiting room, and there are different doctors that you can see, with their photos and their names,” Margretz said.

Each doctor’s image shows how many patients are waiting to see him or her, and patients can chose any or whichever provider is available first. Margretz chose the first-available option, but that still took more than two hours.

Other hospital processes vary, with UIHC asking patients to pick a time to call back.

When the doctor “came in” for Margretz’ virtual visit, she talked with both mom and daughter — asking about travel history and symptoms, both of which were concerning, as Cindy Margretz had just returned from Mexico.

“My mom was kind of in and out of sleep, so I did a lot of the talking,” Margretz said. “But then she wanted to see her, so I just had her kind of sit up in bed so she could see my mom’s face on the screen, and she had me do different things, like put your ear up near her mouth and listen to her breathing.”

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In the end, the doctor advised they visit urgent care to check her lungs and her oxygen levels. At urgent care, they put a mask on Mary Margretz and checked her for influenza. She was negative and went home — with the advisement to call back if her symptoms worsen. They did, and the next morning they went to the emergency room, where they were promptly rushed into a negative-pressure room with masked nurses and doctors running tests and making preparations to admit her.

Although she had no fever, Margretz “kept coughing and coughing” and the staff eventually decided to test her for COVID-19.

“That’s when it got real for me,” Cindy Margretz said. “And I just wanted to cry. Like, if she has it, this is on me. I’m the one who traveled out of the country.”

A day later, she learned her mom’s test had come back negative, and she was sent home. But she praised the health care process in getting her that diagnosis, including its virtual beginnings.

“If we could do that all the time, that would make life easy,” Margretz said, noting her mom typically hates leaving the house. “And she really hates going to the doctor, so I could see her asking for this every time.”

The idea that this massive event could forever change not only the patient view of telehealth, but the provider and wider political and public view, is one potential positive, according to Imborek.

“I think that this is going to be a turning point for how we deliver health care from here on out,” she said, acknowledging some impromptu policy changes have made telehealth more palatable, including reimbursement levels and approvals, for example.

“And, just to be clear, the university decided and moved forward with this long before we were promised any sort of reimbursement things because we know that it’s the right thing to do,” she said. “This is the way to actually flatten the curve — to keep people at home and out of our waiting rooms where either they didn’t have it and they got it or they did have it and they just gave it to others.”

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But this health care emergency is propelling telehealth further, Imborek said, noting UIHC has been transitioning standard follow-up care to its virtual platforms.

“This is great,” she said, “And I think that we need to continue to be thinking about how do we provide care in innovative ways that is convenient for our patients and removes barriers to access.”

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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