By Jeni Miller

As telemedicine use increases, case management professionals can harness its benefits to improve outcomes and provide a better experience for patients and physicians. According to McKinsey, healthcare providers saw 50 to 175 times more patients via telemedicine visits in 2020 compared to previous years.1 COVID-19 played a large part in the increase as providers worked to minimize exposure to the virus. However, many patients still need proper monitoring.

Leaders at the University of Miami Health System launched the UHealth Televigilance program, which was developed to monitor symptoms remotely in patients with COVID-19.

“The UHealth Televigilance Program arms specific patients discharged from the ED [emergency department] or inpatient service with TytoCare devices,” says Sabrina Taldone, MD, medical director of the UHealth Televigilance program in Miami.

These home health devices allow patients and their caregivers to electronically monitor and transmit health data to their provider and the patient’s electronic medical record, Taldone says. But it does not just end there.

“The physician reviews the data, and if there are concerning vital signs, then the provider follows up with a telemedicine visit,” Taldone says. “The provider can remotely conduct a thorough physical examination by having the patient or caregiver use the device’s adapters, which allow the provider to examine the patient’s heart, lungs, mouth, ears, and skin.”

Some issues can be managed further via telemedicine, while those who need higher levels of care enter the triage process.

Taldone says the program’s goal is to improve transitions of care for patients with COVID-19 infection who were discharged home from the ED or inpatient service, as well as prevent repeat ED visits and readmissions.

As of December 2020, more than 60 patients have participated in the program. Taldone and her team will analyze hospitalization length of stay, readmissions, and mortality outcomes.

This information could be valuable to case managers at other facilities, especially those in hospitals serving a large population of patients with COVID-19. In those cases, every bed freed up for another sick patient counts.

“For monitoring symptoms of COVID-19, this tool is fabulous — it’s an outstanding extension of healthcare,” says Mindy Owen, RN, CRRN, CCM, principal of Phoenix HealthCare Associates in Coral Springs, FL. “Some patients with flu-like symptoms can easily be treated at home, while some will need acute care through the ICU [intensive care unit]. For patients who can be managed in their own home environment, monitored by a physician, this tool is a true advantage.”

Having the results directly feed into the patient’s health record also helps make the connection with case management, Owen says.

“The tool helps give the case manager another valuable view of the patient,” she explains. “The case manager can then do oversight regarding which resources are needed in the home environment for the patient to stay there. It’s easier to identify the specific tools for activities of daily living when it’s obvious what the patient’s symptoms are. It is also then possible for case management to follow up and make sure all is working well in that home.”

In addition to providing more detail to the case manager, the program also allows other healthcare team members, like respiratory therapists or pharmacists, to consult easier.

“Bringing other members of the team to the table is critical in these situations,” Owen says. “The tool is not just to monitor, but an opportunity to bring the team together. The great thing is that case management gets a clear understanding of what the physician is monitoring and what might change in the care plan depending on that. Ultimately, it’s for the good of the patient.”

“We aim to improve the quality of patient care in transitioning patients to the outpatient setting,” Taldone says. “Patients with COVID-19 and their caregivers have tremendous fear about what will happen to them when they return home, so patient education plays a crucial role.”

Using telemedicine and remote monitoring to its fullest extent is a group effort that requires a high level of quality communication.

“Launching a patient monitoring program like the UHealth Televigilance program requires interdisciplinary team efforts,” Taldone says. “Effective communication facilitates patient education and the opportunity to improve the patient experience.”

Even as the results of the UHealth Televigilance program are assessed in the coming months, Taldone says expansion of the program is certainly possible.

“Various departments have met with our team, and they are considering expanding the UHealth Televigilance program in their areas of patient care, from cancer to surgery,” Taldone says.

Owen agrees and hopes this will be the case.

“After COVID, I hope this program doesn’t go away, but rather shows itself as an opportunity for patients and providers to stay connected through telemedicine, especially for those with chronic conditions,” Owen says. “Of course, it will only be stable if Medicare continues to keep the rules and regulations in place for the reimbursement of telemedicine.

“COVID-19 has brought to the forefront much more in telemedicine than we’ve ever experienced before,” Owen continues. “It’s been out there, but there hasn’t been a push for reimbursement for telemedicine to the extent that there is today. With COVID-19, CMS took an in-depth look at reimbursing [telemedicine] activities at a much higher rate because professionals were telling people to stay home, yet we have to take care not to exacerbate a patient’s other comorbidities.”

When the patient’s main symptoms and comorbidities are under control, home often is the best place for recovery. “For both patient and family, there isn’t anyone out there who says, ‘Oh, I want to go to the hospital,’” says Owen. “Going in typically increases the stress level for the family as well as the patient. During COVID-19, the family often can’t even accompany the patient at all. Telemedicine options can reduce stress for the patient and family.”

Owen says this is an essential part of recovery for many patients whose health is negatively affected by stress.

“That can’t be minimized,” she says. “A tool such as this is a blessing to be able to offer as a service to allow patients and family a less stressful situation — or even give them an option when it’s not possible to find a bed in a hospital situation.”

Hospital case managers and other healthcare professionals should continue to monitor the developments in telemedicine programs, and consult with their team regarding best practices for making the best use of it throughout the case management process.

REFERENCE

  1. Bestsennyy O, Gilbert G, Harris A, et al. Telehealth: A quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company. May 29, 2020. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality