Telemedicine and Coronavirus

Lisa Bard Levine, M05, explains how remote health care can support primary care providers during the pandemic

A physician on a monitor speaks with a patient in his home. Lisa Bard Levine, M05, explains how remote conferencing can support primary care providers during the pandemic.

In the midst of the COVID-19 pandemic, the U.S. healthcare system is bracing to face a huge wave of new patients. What can we do to ease the burden on our clinics and hospitals? Telemedicine might be one option, says Lisa Bard Levine, M05, who earned her MD and MBA at Tufts University School of Medicine.

She’s the chief executive of the MAVEN Project—the Medical Alumni Volunteer Expert Network—a nonprofit health care organization that uses video conferencing, phone and other remote methods to support primary care providers nationwide. We talked to her about how the same tools we’re using to work from home during the pandemic might be harnessed to improve care.

Tufts Now: How could telemedicine help ease the strain on the healthcare system?

Lisa Bard Levine: Three of the most important challenges that both patients and providers are about to face are finding availability, access, and answers. Many will be related to COVID-19 but others will be related to the management of ongoing chronic medical issues or other unrelated but urgent problems. Telemedicine can help with all of these challenges.

I think one of the key places where it can really help is taking some pressure off primary care providers. Even during the COVID-19 pandemic, other diseases are not so kind as to disappear—in addition to treating patients who are infected, we’ll also need to continue caring for completely unrelated issues like diabetes. Telemedicine gives providers a means of supporting patients’ existing conditions at home, so they don’t have to come into the clinic where possible—which minimizes their risk for contacting COVID-19.

It also frees up capacity within the clinic to triage and treat folks who are infected or who require in-person, hands-on care. But it’s not just about connecting caregivers with patients; it’s also really important for connecting primary care providers, or PCPs, with medical specialists.

What’s the advantage of connecting primary care providers with specialists remotely?

It enables them to consult with an expert quickly and efficiently, which is a powerful way to help treat patients with complex conditions. In the community clinics served by The MAVEN Project, primary care providers are not always doctors. They’re often nurse practitioners or physician assistants. All of those PCPs may be excellent at their jobs but they won't always have specialty expertise needed to manage complex conditions without consultative advice from a specialist.

If a PCP has a patient with complex diabetes, they can consult with an endocrinologist remotely, share information, get advice, and ask specific questions: ‘What could this symptom mean? What should I consider doing?’ The specialist can then advise them if there’s something the patient can do at home so they don't have to come in, or if their condition looks serious enough for an in-person visit.

Telemedicine also allows expertise from one physical location to be used in another. There's no reason a specialist in Massachusetts should only be available locally if people in California need their skills. With a phone call or a video conference, primary care providers can connect with an expert anywhere in the country. It’s really a way of democratizing healthcare

How could those virtual consultations help treat COVID-19 specifically?

In cases of COVID-19, primary care providers could talk directly with an expert in infectious disease, or a pulmonologist, and receive guidance on whether or not to send a patient to the emergency room. They could also potentially make that call while the patient is still at home, which would prevent them from coming in and spreading the virus. That's a big part of the game right now—the more we can prevent people from having to move around, the better. At its most basic level, telemedicine is ideally suited for screening patients at home to help determine whether further exposure at a care facility is warranted.

I imagine that would also help protect the care providers themselves.

Absolutely. Telemedicine can help PCPs stay healthy physically, but also mentally, by offering them access to support so they don’t get burned out. That’s really important, too. It doesn’t matter whether a provider leaves a clinic because of stress, or because of contracting COVID-19 from a patient. Either way, that clinic is now short one provider.

Assuming we do see care providers getting sick or leaving, how could telemedicine reduce the impact of those losses?

In our case, remote consultations actively insert expertise back into the workforce. Many doctors in our volunteer network are retired, or working in industry, so patients wouldn’t normally be able to benefit from their knowledge. By working with us, they can provide their expertise remotely via teleconference in a flexible, effective way. It doesn't take transportation time to help out—they can just flip their computer on and be available to help right then and there before, during, or at the end of their day.

David Levin is freelance science writer based in Boston.

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