One of the strategic priorities for Harris County Public Health in Houston is to identify potential uses of emerging technologies and adopt tools that are appropriate to maximize resources. Video-based telemedicine is one tool the department thought would help it meet the needs of its patients and help its Tuberculosis Elimination Program to maximize its resources.

In 2014, a team was formed to research the technology and identify vendors that could most effectively and successfully offer such a tool. Telehealth consults, the provider concluded, can help reduce the stigma of TB, increase the ease of medication adherence and self-efficiency of patients and reduce overall costs.

When Hurricane Harvey hit Texas in 2017, Harris County Public Health was prepared to ensure TB did not spread in the disastrous aftereffects of the storm, thanks to its telehealth investment. 

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"TB is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs," explained Dana Wiltz-Beckham, tuberculosis elimination program manager, disease control and clinical prevention at Harris County Public Health. "It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.”

People diagnosed with TB are placed on a treatment regimen that can range from six to nine months or longer. Interruption of the treatment regime can prolong the treatment as well as possibly create TB bacteria that are resistant to medications.

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"With any incident that can interrupt the continuity of care for TB patients, our Tuberculosis Elimination Program activates established protocols for providing patients with medications to take on their own, verify and obtain additional contact information in case the patient becomes displaced, and monitor patients after the incident," Wiltz-Beckham said. "Especially in the case of the storm, it was vital to determine which patients missed taking their medication and which patients needed clinical follow-up."

During the hurricane and its aftermath, the county staff reached out to TB patients via mobile phone, landline or pushing text messages to patients via its telemedicine app from telehealth technology vendor emocha. Patients were connected through the app to their provider.

Or, if a patient was managed by an outside provider, a nurse case manager would reach out to the outside provider to ensure that continuity of care was being carried out during post-storm activities.

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"Prior to the storm, all telemedicine patients were contacted and given a month's worth of medication," Wiltz-Beckham said. "Instructions were given to the patient to continue to video record themselves taking their medication, and in turn, a trained staff member would view the videos. If the patient encountered any issues – medical or technical issues – they would contact their nurse case manager and outreach worker immediately."

Ninety-seven percent of the 61 patients in the program took their TB meds, Wiltz-Beckham reported noting that compliance, under the extreme circumstances, was remarkable. Wiltz-Beckham added that the 97 percent of patients remained 100 percent medication-adherent through the storm event.

"This was achieved by building trust with the patient, implementing a process that worked for patient and Harris County Public Health staff to carry out the core TB activities in order to protect the public's health," Wiltz-Beckham said. "Telemedicine has not only proven beneficial for patient compliance and cost savings, but also an added layer of resource to continue to operate during and after storm activities."

"It helped us keep a direct pulse on the patient," said Wiltz-Beckham. "We were able to see which patients were submitting videos, communicate with them through the push texts feature on the app, and actually place eyes on them by viewing their videos. This was important to determine if there needed to be an intervention and connect them to medical care immediately."

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com