Stanford Medicine increases use of televisits to help prevent spread of coronavirus

Health care providers at Stanford Medicine have moved a substantial portion of their patient visits to cyberspace, where there’s no chance of spreading COVID-19, the disease caused by the coronavirus. 

Over the past several years, Stanford Medicine has been building its capacity to provide appointments with physicians and other health care professionals via online video and encouraging them to use the technology. The number of such televisits had been slowly growing — cardiovascular health, with its CardioClick program, was in the forefront — but the outbreak of COVID-19 precipitated a spike in virtual appointments. 

At 3,000 per day, televisits now make up 40% of all clinical visits at Stanford Health Care, 50 times higher than prior months. The all-time daily televisit high for Stanford Children’s Health, before COVID-19 hit California, was 35; recently, clinicians conducted 500 in one day. 

“It’s crazy how quickly it’s happened,” said Natalie Pageler, MD, chief medical information officer at Stanford Children’s Health. 

While some patients require office visits — those with broken limbs, for example, or those needing various treatments or tests — clinicians are encouraging virtual office visits, as are patients, whenever possible. 

“Everyone has an awareness that we all need to do our part to stem this pandemic,” said cardiologist Bob Harrington, MD, professor and chair of medicine in the Stanford School of Medicine.

‘They click a button on their app and — boom’ 

To connect with patients virtually, health care providers must be outfitted with computers that protect patient privacy, but patients can use any computer or smartphone. Stanford Health Care patients need to download the MyHealth app. Patients at Stanford Children’s Health, or their parents or guardians, need to download the MyChart app. 

“They click a button on their app and — boom — the doctor pops up and starts talking to them,” said Christopher Sharp, MD, clinical professor of primary care and population health at the medical school and chief medical information officer at Stanford Health Care. Sharp’s team has worked closely with the team led by Eric Yablonka, MBA, chief information officer and associate dean at Stanford Health Care and the School of Medicine, to enhance the technology used for the online clinical visits.  

Sharp said that many of the patients taking part in televisits are worried they have COVID-19. If they are infected but don’t need to be hospitalized, Stanford physicians want to keep them away from the medical center to avoid infecting other patients, he said. If they don’t have COVID-19, it’s better for them to stay away to avoid becoming infected by others. 

Sharp added that just looking at patients can tell him a fair amount about how well they are doing. He can also perform some examinations virtually: For example, he asks patients to take a deep breath and watches whether they start coughing. “I can advise, ‘You sound like it’s possibly coronavirus, so let’s get you to drive-through testing.’ Or, ‘You don’t look well; you need to come to the emergency room.’” 

Follow-ups via televisit

Other patients receive follow-up care via televisit. “Their diabetes doesn’t go away because COVID is happening,” Ian Nelligan, MD, assistant professor of primary medicine and population health, said. “We need to continue their care and do that in the safest way we can.”

For many people — especially the elderly and those with conditions, such as heart disease, that make them vulnerable — that means keeping them away from crowds, he said. 

Clinicians are also using televisits for patients quarantined in the hospital. They can talk with a patient remotely, avoiding transmission of the virus and forgoing the use of protective equipment, which can be saved for nurses and other direct caregivers who need to be in contact with patients. 

Pageler said televisits are especially advantageous for psychologists and social workers. “What they’re doing is talking, so why risk the exposure and waste the personal protective equipment?” she said.

Some health care providers are seeing patients from their homes. They include physicians and staff who have been exposed to the virus and are under quarantine, those who are at high risk for complications due to their age or other conditions, and even those who need to care for young children. Allowing them to work from home helps ease the current high demand for office visits, Sharp said. 

“We have people logging in from home and saying, ‘I’ll take the next patient,’” he said. 

Stanford physicians say they expect the uptick in telemedicine to continue once the COVID-19 threat has run its course. It can save patients from driving long distances and prevent them from having to take a day off work or school.

“This pandemic — while very disruptive and challenging and scary — has provided an incentive to use telemedicine,” Pageler said. “Once people learn how to use it and see the value, I expect they’ll keep using it.” 

Nelligan predicted that once additional remote technology — such as home blood pressure cuffs and stethoscopes that link to medical records, continuous glucose monitors, and scopes patients can place in their ears and throats — becomes commonplace, even more visits will go online. 

“The future is bright in this area of medicine,” he said. “COVID-19 was a shot in the arm. We’re going to see adoption happen much more quickly.” 

A 1:2:1 podcast on telehealth and the surge in televisits at Stanford Medicine features Sharp in conversation with Paul Costello, senior communications strategist and adviser for Stanford Health Care and the School of Medicine.