“There’s no reason that healthcare has to be delivered in a hospital. In fact, patients are best served in an environment where they are made comfortable. By trusted members of their own community. Hospitals have to go meet patients where they are, not the other way around.”
—Dr. Max Goodwin, Medical Director at the New Amsterdam Medical Center on the TV show New Amsterdam.
The TV show is fiction. The sentiment is reality, especially considering that COVID-19’s epic national crisis is forcing small and large hospitals to declare “No room at the inn.” Traditional hospitals are slammed.
The Atlantic’s COVID Tracking Project reported that 125,379 people were hospitalized with COVID-19 as of December 31. U.S. hospitals are buckling beneath the weight of these patients along with other sick people. In December, a Department of Health and Human Services (HHS) survey of 2,200 counties found that in 126 counties, the average hospital was 90% full. HHS also said that hospitals that serve more than 100 million Americans reported having fewer than 15 percent of intensive care beds available.
It’s time to employ rational thinking about telehealth, so we treat non-COVID patients instead of taking drastic measures such as rationing hospital care, as Arizona is considering. What we perceive a hospital to be often has been dictated by tradition, expediency, and cost—all marinated in the belief that only a corporate hospital can deliver healthcare well. That needs to stop.
It’s not just about video chat with a doctor
Four walls, an internet connection, and a healthcare provider are core ingredients for telehealth medical magic. More than merely being a video chat, telehealth lets healthcare professionals observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care people receive—whether they’re ill, injured, or wanting to stay well.
In April 2020, the city of Boston, the state of Massachusetts, and Boston-based nonprofit Partners HealthCare jointly constructed Boston Hope, a fully working 1000-bed facility in just seven days at the Boston Convention and Exhibition Center. They evoked the full definition of telehealth to treat patients well enough to leave a hospital, but not well enough to go home.
Boston dodged a bullet that many other localities now face with overcrowding. “We had the bed, doctors, nurses, labs, a pharmacy, and even a gym for patients’ therapy to rebuild and regain their strength,” says John Campbell, a CIO at Partners HealthCare. They extended partners’ intranet and data centers to drive the medical IT systems, electronic records management (ERM) and security system. Additionally, Partners trained and equipped 10,000 doctors for telehealth right before Boston Hope opened.
“How do you create new hospital beds?” asked New York Governor Andrew Cuomo last March, as the enormity of the COVID-19 challenge became apparent. “That’s probably the greatest challenge. Take people who are in current hospital beds and move them into converted facilities—people who need a lower level of care.” He directed the National Guard, union builders and private developers to retrofit dorms to prep them for patient care.
“Converting dormitories . . . to handle remote monitoring of patients recovering from surgical procedures is one of the easiest to set up and has the least amount of costs,” says Peter Caplan, managing consultant for New York-based eHealth Systems & Solutions. “You need several medical technicians to watch video monitors and data from sensors, and a doctor or nurse to remotely oversee. Techs can escalate patients’ situation to the nurses if needed.”
In the early days of the pandemic, Tufts University in Massachusetts made hundreds of vacant dorm rooms available for potential patients. Middlebury College in Vermont offering some of its buildings, and New York University asked students who live near campus to clear out their dorm rooms.
Colleges are increasingly adding student telehealth with an emphasis on mental health. Southern Connecticut State University dorms currently are closed for the winter and possibly spring as well. Every residence hall there has telehealth/multipurpose rooms where students can meet with mental health professionals. Every room has a computer, internet access and a desktop. Dorms such as these could be ideal temporary facilities for mental health patients.
Plenty of room at the Hotel California
Hotels have taken a severe hit from COVID-19, which has allowed those empty hotel beds to be repurposed as hospital beds. The state of California negotiated with about 900 hotels to acquire rooms for patients needing hospitalization and for the homeless, a population particularly at risk of contracting COVID-19. In March, Chicago Mayor Lori Lightfoot arranged for 2,000 rooms at five hotels to house asymptomatic people requiring isolation due to COVID-19.
The right kiosk can save a lot of time and hassle for people who otherwise would go to an ER or an urgent-care facility.
Interestingly enough, COVID-19 and stay-at-home orders have led to a serious reduction in Emergency Room bed use, with a 42% reduction in ER visits last April compared to 2019. The CDC considers this a double-edged sword. It’s good that there are less non-critical emergency visits, but bad if people who really need the ER are avoiding it because of fear of the virus.
Telehealth kiosks might be the answer to this concern. Often low-income African Americans, other people of color, and immigrants use the ER as primary care. Kiosks can reduce ER overcrowding, provide emergency and general care, and save healthcare facilities money. Patients can go to a kiosk that enables two-way communication and feedback from healthcare professionals who can remotely observe patients.
Local government are placing modified kiosks at food banks, with the potential to do the same at other places where the needy gather. “Counties possibly could set up kiosks in homeless shelters to provide ‘safety net’ free emergency and general health services without patients needing to visit urgent care clinics,” says Eric Haden, president at Drexly Telehealth Solutions. “Many providers could easily be connected to a kiosk network for a wide range of medical issues including various specialty types.”
“Food banks are an ideal spot to address the needs of the most vulnerable among us whether telehealth is delivering mental health or physical health,” adds Emily Fisher, a telehealth doctoral candidate. “The kiosk could be its own ‘health system.’ Different providers can be available during certain hours the kiosk is in use. The health records can be kept in a digital or cloud-based platform. Patients could view their medical records online. Our group uses a palm scanner to create an image that links to the medical record of the patient. Patients don’t need to remember numbers, carry paperwork, or access identification procedures.”
The bottom line is, that the right kiosk can save a lot of time and hassle for people who otherwise would go to an ER or an urgent-care facility. In 2019, USA Today reported that the average cost of an ER visit was $1,389 in 2017. Saving money by deploying kiosks is a given, particularly for public hospitals.
What about the internet connection?
Telehealth’s Achilles’ heel is its total reliance on high-speed internet access. 12 million urban and four million rural homes have no internet at all. Millions more have pathetically inadequate broadband. Some of the people whom telehealth is supposed to help the most can’t even get through the digital door.
Some ISPs such as Comcast limit how much data you can move without paying extra money. Poor people can barely afford a basic connection. Doctors using Zoom to power their telehealth connections can destroy a patient’s smartphone’ data caps. Much attention has been paid to rural America’s broadband issues, but some state and federal government agencies (as well as the media) are not paying attention to the severity of the need in urban areas.
“What happens in the suburban and urban areas amounts to redlining as incumbents’ buildouts, upgrades, and broadband adoption efforts happen in the most profitable areas first,” says Ron Deus, the CEO of regional wireless ISP NetX in Cleveland. “Areas just a mile or two away become broadband deserts. A lot of incumbents are shareholder-driven, so their first concerns are their profits and cherry-picking.”
Broadband providers justify this “cherry picking” as the only way to make a profit. We’re left with an aging broadband infrastructure that providers don’t want to improve and an urban core that is frustrated by the impasse.
COVID-19 is tearing away the fabric of our healthcare systems and won’t let up anytime soon. We’ve got to think differently about hospitals, healthcare, and telehealth. At the same time we need to move quickly to give people the robust broadband they need to embrace telehealth. Fiber infrastructure is the gold standard standard for building broadband networks to last. But in Cleveland and many other urban centers, there are economic considerations that point to fixed wireless infrastructure as a practical and fiscally responsible way to improve broadband. Nothing quite moves as fast wireless deployment.
“Granted, dwindling hospital beds is a crisis that needs to be addressed quickly,” says Cameron Broadnax, Principal at Transcending Healthcare, a telehealth systems integrator. “But these are business operations involving multifaceted projects and multiple technology vendors. Temper the need for speedy decisions with thorough needs assessments.”
Saved from a stroke by telehealth, Craig Settles is paying it forward by uniting community broadband teams and healthcare stakeholders through telehealth initiatives. He’s a community broadband analyst and consultant assisting communities with broadband and telehealth planning.