Pandemic Pushes Telehealth Technology Into Hospitals, Homes

A nurse dressed in full-protective gear gently rolled the doctor into the hospital room of a recovering COVID patient. She literally rolled him into the room on a cart with a video monitor attached.

Kami Krajewski of Grant, Nebraska, watched as the device rolled into position next to her bed. Complications from COVID-19 landed her in isolation at Great Plains Health in North Platte.

Dr. Pushkar Kanade, a nephrologist, appeared on a screen the size of a large laptop computer. He conducted his rounds that morning while remaining socially distanced in an office elsewhere in the hospital.

It was the familiar, cheerful consultation that would have taken place in person but at a safe distance.

It was an unusual experience for the patient.

"When they first told me that they were going to do this, I'm like I was a little confused on how it would all work," Krajewski said.

Dr. Kadian had access to a stethoscope and blood pressure sleeve used to check the woman's vitals. He had the readings on a screen in front of him.

Krajewski was impressed "with how they instantly had the results. It's amazing how technology is developed."

This is the process and equipment known as telehealth. By any measure, it became an essential segment of the medical profession's system for delivering patient care.

In 2020 Great Plains' use of telehealth services jumped 350 percent over spring the previous year.

It was a global trend.

The Centers for Disease Control reported 1.6 million doctors visited with patients using telehealth in the first three months of 2020, just as the pandemic began to move in. That was a 50-percent increase over the same time the previous year.

One New York City hospital saw an 8729-percent increase in video visits in April 2020 compared to the same period in 2019. The four-digit statistic is not a typo.

"We found it very effective, and it worked," said Mel McNea, chief operating officer at Great Plains Health.

Great Plains began expanding its use of telehealth to remote clinic sites before the pandemic. Then, as the coronavirus crisis developed, the hospital recognized expanded use of the technology inside the hospital could help cope with the low supply of personal protective equipment, like masks and gowns. Doctors on rounds had to put on masks and gowns for every patient carrying the virus and then dispose of each set after the visit.

McNea's staff recognized "if they could treat that patient remotely, then they weren't using their masks and gowns in going in the room.

"That was a, just a different level of telehealth that we hadn't used before, but our staff adapted quickly to that."

Some members of the medical team at Great Plains wondered whether increasing the use of telehealth might depersonalize a patient's hospital stay. Dr. Eduardo Freitas, an infectious disease specialist, "was skeptical at first."

"I think most infectious disease doctors rely a lot on their assessment and being there next to the patient and looking for subtle signs that might help you come up with a diagnosis or a treatment."

Once Great Plains put the system into practice, he sympathized with the rationale for using video consultations during the pandemic.

With the small medical staff at Great Plains Health, if the only specialist lands in coronavirus quarantine, it would be a crisis for the level of patient care.

Freitas also found reason to be impressed with how quickly telehealth technology adapted to the level of care needed for critically ill patients. The doctor admired the quality of the video feed from the mobile cart.

During Krajewski's visit, the nurse in the room adjusted the cart's position. At the same time, the doctor controlled the angle of a high-definition camera onboard while zooming in for a closer look when needed.

"I can see actually better (with) the camera than I can with my eyes," Freitas said. "Now the technology is so good."

Telehealth did not win over everyone at Great Plains.

Dr. Renee Engler, co-director of Emergency Medicine, initially used remote video consolations when patients arrived for care.

"We weren't sure how severe it would be and if we would be protected (in) the beginning," Engler said. "A lot of us were doing telehealth because COVID was largely unknown."

The longer the pandemic dragged on, Engler felt something was missing in the use of the technology.

"It's just not a tool that I'm comfortable using," she said. "Emergency medicine is about resuscitation, and it's about stabilization until you can assure yourself that the patient is stable enough."

Being separated from the patient seemed foreign to a doctor who worked to develop personal connections.

"The hardest thing for me to deal with is the patient relationship is essentially gone, and for me, it's about building that relationship, walking in the door of a room, shaking, shaking their hand, and sitting down."

Before COVID, Great Plains Health was among many hospitals using video links for patient check-ups at remote clinics.

"Telemedicine is a wonderful tool in rural Nebraska," McNea said. "It allows a specialist to interact with patients without traveling back and forth."

One survey of patients with telehealth experience found over half would welcome replacing an office visit with an online doctor consultation even after the pandemic clears up.

"A lot of the citizens in western Nebraska are elderly (and) it's hard for them to get a ride to see a specialist," McNea said. "Now, if they can do it through telehealth closer to their home or in some cases right in their home, it's made access to healthcare much more convenient."

Increases in telemedicine's popularity also attracted the attention of hackers interested in stealing data and disrupting computer networks.

Since the pandemic began, hospitals and clinics suffered a rapid increase in computer network attacks with viruses and malware. Up 117 percent, according to a report authored by the cyber-security consulting firm SecurityScorecard.com along with Dark Owl LLC.

"I think it's a targeted category," said Sam Kassoumeh, the co-founder of SecurityScorecard. "It falls into that classification of high, high-risk data (and) high-value data."

SecurityScorecard reported "a drastic spike" in sharing stolen, confidential patient records on the Dark Web where hackers meet online.

Often hackers gain access to hospital records through the digital "back-door" opened by the dozens of devices used in hospitals with internet connections. By design, telehealth hardware may provide a vulnerable point of access requiring heightened security.

"When they have an internet connection, that's another gateway for hackers to go knock on and to open," Kassoumeh said. "The unfortunate reality with digitally-connected devices is security is oftentimes an afterthought."

Before 2017, 8 out of 10 hospitals and clients did not expect most of their patients to be using telemedicine services. However, recent surveys show many health care organizations will expand their availability.

Great Plains Health works with ten satellite clinics in 34 counties with a population of about 130,000. It's an area the hospital claims is roughly the same size as the entire state of Pennsylvania. Using telehealth hook-ups in satellite clinics or on a mobile device at home meant patients need not make lengthy trips to North Platte.

Kami Kajewski, who recovered from her run-in with COVID, was among those who had no problem continuing to use telehealth technology after leaving the hospital. She "wouldn't be opposed" to using video consultations from her home in Grant rather than make the 90-minute drive back to the medical center, "especially if I knew that I could see my provider."

"I was very comfortable with it the whole time. And I didn't feel like I was losing any personal one-to-one contact."

The social media component of this reporting project is part of a special partnership with the PBS science program NOVA, funded by the Corporation for Public Broadcasting.