The COVID-19 pandemic accelerated the use, value and importance of telehealth and remote patient monitoring services. But there were obvious limitations in the ability to obtain certain physical exam findings that are necessary to providing accurate diagnoses.

THE PROBLEM

"While video capabilities allowed visualization of certain skin concerns and the general appearance and wellbeing of patients, it was not possible to listen to heart and lung sounds," Dr. Nadim Ilbawi, physician director for innovation and care models, and vice chair for clinical affairs and engagement at the department of family medicine at NorthShore University HealthSystem.

"Clinicians also were not able to examine the eardrum and throat or obtain vital signs," he noted. "Clinicians oftentimes can rely on the patient's reported history to make accurate diagnoses. However, certain diagnoses only can be made with a comprehensive physical exam. Many of these diagnoses requiring a physical exam are pediatric in nature."

For example, the diagnosis of an ear infection cannot safely or accurately be made without looking directly at the eardrum. Similarly, a diagnosis of pneumonia or an asthma exacerbation is best made with a physical exam.

PROPOSAL

To solve the problem, NorthShore University HealthSystem went with telemedicine technology from vendor TytoCare.

"New technology can be shiny and enticing. However, if not paired with the appropriate workflows and support with the driving force of doing what is best for patients, it will fail."

Dr. Nadim Ilbawi, NorthShore University HealthSystem

"Their product is a very unique and impressive technology that allows for a remote physical examination and the ability to take vital signs," Ilbawi explained. "This small, handheld device allows clinicians to listen to the heart and lungs. It also provides the ability to visualize the throat, eardrum and skin.

"Vital signs can be obtained including heart rate, respiratory rate and temperature," he continued. "The device comes with certain peripherals or add-on pieces that convert it into a stethoscope, to listen to the heart and lungs; an otoscope, to look at the ear canal and the eardrum; and a device to be used as a tongue depressor to look in the mouth and throat."

MARKETPLACE

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MEETING THE CHALLENGE

The health system initially provided this tool to its employees. It used its online patient platform to facilitate patients scheduling urgent and immediate-care visits for acute symptoms such as red eyes, rash, ear pain and many others.

"Our immediate care clinicians supported this work by providing care to our employees who purchased the device," Ilbawi said. "These patients/employees used the technology for acute concerns for themselves and their kids. Telehealth visits linked to this technology allowed our immediate care clinicians to make accurate diagnoses like otitis media [ear infection] and prescribe the appropriate treatment and plan of action.

"Our patient portal, NorthShoreConnect, linked the technology to our Epic electronic health record," he added. "This technology and the associated workflows have created a very streamlined and effective process that makes possible a telehealth visit with remote physical exam findings leading to accurate diagnoses and thorough treatment plans."

RESULTS

NorthShore University HealthSystem has been successful in implementing a technology that saves patients and their families the need to take time off work or school or leave home to obtain medical care for certain acute symptoms.

"Continued metrics of success will include utilization, timeliness and ease of access to urgent/immediate care services," Ilbawi said of the organization's ongoing effort to collect success metrics. "We will continue to measure patient satisfaction with the care they receive through this service offering."

ADVICE FOR OTHERS

"New technology can be shiny and enticing. However, if not paired with the appropriate workflows and support with the driving force of doing what is best for patients, it will fail," Ilbawi cautioned. "Our guiding principle with any new technology is to make sure we are solving for a need that provides better care.

"In our case, it was essential that we were able to pair this technology to our existing EHR," he continued. "This was necessary for both an improved and streamlined process for patients and clinicians alike. Our ability to integrate scheduling for this service to our patient portal also was key."

Creating a pool of dedicated clinicians to support caring for patients through this technology also is important, he advised.

"We engaged physician leaders in both primary care and immediate care to make sure this service was aligned and consistent with the care we provide in other settings," he concluded. "We also created a quality review process to ensure that the technology reinforced what we consider standard of care in treating patients of all ages for acute symptoms."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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