House calls: ‘Tele­health’ doc­tor vis­its a help­ful tool even beyond pan­demic

Re­mote health care ap­point­ments a prac­tice ex­perts say will live on beyond coro­n­avirus cri­sis

Chicago Sun-Times - - FRONT PAGE - BRETT CHASE

Bring­ing her 14-year-old son, Alessan­dro, into Chicago for doc­tor’s vis­its has been a heavy bur­den on Ra­mona Gon­za­lez.

As a baby, Alessan­dro’s brain was de­prived of oxy­gen and, as a re­sult, he needs a ven­ti­la­tor to breathe, a feed­ing tube to eat, he’s deaf and blind. In re­cent years, Gon­za­lez has had to bring her son from Mat­te­son to La Rabida Chil­dren’s Hospi­tal on the South Side, which spe­cial­izes in car­ing for med­i­cally com­plex chron­i­cally ill chil­dren. Some­times, she has to load him in an am­bu­lance along with his med­i­cal sup­plies and equip­ment.

“It’s a lot,” she said.

But over the past few months, Alessan­dro was able to see six doc­tors from La Rabida in three ex­ams con­ducted over video. It was a god­send for Gon­za­lez dur­ing a pan­demic she feared would en­dan­ger her son’s life.

“It was re­ally good,” she said. “I don’t want to risk him get­ting any disease.”

One of the many things the pan­demic has changed is the way peo­ple see their doc­tors. Al­most overnight, pa­tients be­gan switch­ing to so-called tele­health vis­its, a trend that’s ex­pected to last.

“We went from do­ing zero tele­health … to within a week, we were do­ing 80% tele­health,” said La Rabida Chief Med­i­cal Of­fi­cer David Soglin. “Over time, we’ll find the right bal­ance. For some of these com­plex kids, maybe we do two per­sonal and two tele­health vis­its a year. We’re still learn­ing.”

In­sur­ers largely didn’t cover tele­health vis­its un­til March as the pan­demic forced new prac­tices. In Illi­nois, Gov. J.B. Pritzker called for an ex­pan­sion. Around the same time, the fed­eral agency that runs Medi­care and Med­i­caid and pri­vate in­sur­ers agreed to re­im­burse doc­tors for such vis­its as they would for of­fice ap­point­ments, some­thing they weren’t will­ing to do in the past. Doc­tors in­ter­viewed say telemedici­ne will ex­pand as long as in­sur­ers pay. Mul­ti­ple bills in Congress en­cour­age it.

In a state­ment, Blue Cross and Blue Shield of Illi­nois, the dom­i­nant pri­vate in­surer in Chicago, said it views “tele­health as a mode of de­liv­er­ing health care that will re­main a part of our health care land­scape.”

More fre­quent con­tact

Pro­po­nents say tele­health cre­ates op­por­tu­ni­ties for doc­tors and pa­tients to stay in con­tact more fre­quently. Fed­eral health of­fi­cials cite tele­health as a tool to help pre­vent heart at­tacks, strokes and other con­di­tions.

Still, doc­tors stress that video and phone ex­ams have their lim­i­ta­tions, and pa­tients are of­ten asked to come in for per­sonal vis­its to avoid mis­takes. Med­i­cal er­rors al­ready lead to tens of thou­sands of U.S. deaths a year, re­search shows.

Many vis­its to spe­cial­ists, such as gy­ne­col­o­gists or oph­thal­mol­o­gists, can only be done in per­son.

Ad­vo­cates for chil­dren with a broad ar­ray of spe­cial health needs point to lim­i­ta­tions as some in­tense ther­a­pies can­not be done vir­tu­ally. And im­mu­niza­tions and early care re­quire in-of­fice ex­ams.

“It works for some. It doesn’t work for oth­ers,” said Faye Manaster, a pro­ject direc­tor in Mo­kena with The Arc of Illi­nois Fam­ily to Fam­ily Health In­for­ma­tion Cen­ter.

In ad­di­tion to phone calls, as doc­tors and hos­pi­tals across Chicago worked to re­duce the num­ber of peo­ple coming in for ap­point­ments in re­cent months, they be­gan of­fer­ing video, or even drive-up op­tions.

On Wed­nes­days, ev­ery pa­tient seen by Dr. Sachin Shah is over video or by phone.

With the help of a med­i­cal as­sis­tant, pa­tients are prepped much like they would be for a visit to the of­fice, though they are re­port­ing their own weight, blood pres­sure, pulse or ad­di­tional in­for­ma­tion. Pa­tients get a check­list in ad­vance.

Prior to March, Shah, a pri­mary care doc­tor and as­so­ciate pro­fes­sor at Uni­ver­sity of

Chicago, saw his pa­tients in the of­fice. But the pan­demic and the re­sult­ing stay-home or­ders changed all that.

Now he’s telling a pa­tient on a video screen to “push on your belly” and “show me where you have dis­com­fort.”

In-per­son changes

For pa­tients who do go to the doc­tor, they’re asked to come alone so not to crowd the wait­ing room. If a per­son is more than 10 min­utes early, that pa­tient has to wait in the car. Vis­i­tors are en­cour­aged to use a mo­bile app to make ap­point­ments and check in, a sort of OpenTable for health care, Shah said.

Uni­ver­sity of Chicago and other hos­pi­tals are ex­per­i­ment­ing with curb­side ser­vices, in­clud­ing blood draws for lab work and po­ten­tially vac­ci­na­tions. Drive-up shots may be key to han­dling flu sea­son while doc­tors and hos­pi­tals brace for an­other wave of coro­n­avirus cases.

“Med­i­cal providers have been ready to do this for some time,” Shah said, re­fer­ring to vir­tual vis­its.

Doc­tors at John H. Stroger Jr. Hospi­tal of Cook County had to make the switch to tele­health, with the ma­jor­ity of vis­its from April through early June done over the phone or video, said Dr. Clau­dia Fe­gan, chief med­i­cal of­fi­cer of Cook County Health.

“Medicine was try­ing for years to get to tele­health, and this dra­mat­i­cally ac­cel­er­ated it,” Fe­gan said of the pan­demic.

The vast ma­jor­ity of those us­ing tele­health were largely on gov­ern­ment in­sur­ance plans or unin­sured, mir­ror­ing the Cook County Health sys­tem’s over­all pa­tient pro­file, Fe­gan said.

In ad­di­tion to Stroger, the sys­tem in­cludes 17 health clin­ics, Prov­i­dent Hospi­tal and Cer­mak Health Ser­vices, which treats county jail de­tainees.

The ini­tial re­sponse from pa­tients seen at Cook County was en­cour­ag­ing, Fe­gan said. While many pa­tients don’t have per­sonal com­put­ers or lap­tops, many have phones with video, she said.

“More peo­ple have smart­phones than com­put­ers,” Fe­gan said. “That’s their way to ac­cess.”

In all, more than 85,000 tele­health vis­its took place at Cook County Health, ac­cord­ing to health sys­tem fig­ures.

At Uni­ver­sity of Chicago, the num­ber of video and phone vis­its this year is around 90,000, con­ducted by about 1,000 doc­tors, nurse prac­ti­tion­ers, so­cial work­ers and other providers.

Ad­vo­cate Health Care, the state’s largest health sys­tem with 10 Illi­nois hos­pi­tals and 350 health cen­ters, has logged 325,000 tele­health vis­its this year, spokesman Mike Riopell said.

At Rush Uni­ver­sity Med­i­cal Cen­ter, video ex­ams have been ex­panded to in­clude thou­sands of ur­gent care con­sul­ta­tions, al­most 11,000 since March.

One big hope is tele­health can en­cour­age more peo­ple to seek treat­ment early, the­o­ret­i­cally keep­ing them out of the emer­gency rooms, said Dr. Meeta Shah, an emer­gency medicine doc­tor and as­so­ciate chief med­i­cal in­for­mat­ics of­fi­cer at Rush Uni­ver­sity Med­i­cal Cen­ter.

“This is a good op­por­tu­nity for pre­ven­ta­tive care,” she said. “Pre­ven­ta­tive care is also im­por­tant for keep­ing emer­gency rooms from be­com­ing over­whelmed.”

Dr. Meeta Shah speaks with a pa­tient via a video chat at Rush Hospi­tal in early Au­gust. AN­THONY VAZQUEZ/SUN-TIMES

Dr. Sachin Shah is do­ing video and phone vis­its with his pa­tients at Uni­ver­sity of Chicago Hospi­tal.

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