As the coronavirus continues to spread around the world, Washington State has emerged as ground zero for the epidemic in the United States. Currently, the CDC is reporting that the state has 267 cases. 

"It's probably not all that surprising since we are based on the West Coast that we ended up with patient one here in the U.S.," Dr. Amy Compton-Phillips, chief clinical officer for Providence St. Joseph Health, said during a HIMSS webinar yesterday. 

Not only did Providence treat the first patient, it has also been a front-runner in implementing new technologies to address triaging and caring for patients with the condition. 

On January 19, a patient came into one of the Providence facilities' urgent care centers presenting with a cough, and reported recently returning from Wuhan, China. The nurse practitioner treating the patient called the CDC for next steps and tested the patient for the coronavirus. One day later the patient was admitted to the hospital with a positive case of COVID-19, marking the first case in the U.S. 

While this was the first case of the virus in the U.S., Providence St. Joseph Health had taken steps to prepare for the event, building off its experience during the SARs and Ebola epidemics. 

"We had an infrastructure we built we never threw out," she said. 

The system included group-communication channels for specialists and specialized outbreak alerts. 

"Our IT team sprung into action and took the shell of the EHR alert we had built previously, and updated the content with everything to do with coronavirus, and implemented that within eight hours of starting," Compton-Philips said. 

As the team's efforts to care for patients with the virus progressed, it broke up its efforts into three buckets: triage, test and treat. 

Triage

Across the country, panic and anxiety around the virus has led to the increase of patients' questions and concerns. Historically during this time of year, doctors already have packed schedules, according to Compton-Phillips. One way that Providence decided to ease this supply-and-demand burden was through tech. 

"As we are thinking about triaging we started asking questions. If you are a person who has a question about your health and your care, you don't necessarily want to go into a doctor's office. What are the tools we can use otherwise?" Compton-Phillips said. "So we worked with our digital innovation group and Microsoft to build a chatbot to help people go online and work through: Are you 'worried well,' and you just want to learn the symptoms of coronavirus? Or do you have a cough and fever and might need to get seen? So you can do self-service and triage yourself for what care you need, which has been an incredibly helpful tool." 

The chatbot is also linked to an on-demand patient-care visit where the user can get in touch with a clinician, usually a nurse practitioner, and go through symptoms. Through this tool patients can also get connected to a nurse line. 

Compton-Phillips said that the first day the tool was release it had over 500,000 visitors and has continued to see use since its launch. 

This isn't the only chatbot addressing the outbreak. Buoy added new feature providing patients with information about the condition. When people are using Buoy’s symptom tracker, it may also be listed as a possible condition for certain patients – based on travel history and other factors. Digital health companies 98.6 and BrightMD have also introduced coronavirus screenings as part of their algorithms.

Testing 

Getting tested for the virus in the U.S. has been notoriously difficult thus far, however Providence is looking for ways to test a broader swath of patients in a speedier way. 

"It has been a continuously evolving and frustrating experience for everybody. Because of the very stringent criteria we had initially, we could only get people tested if they had travel [history] and all three symptoms: shortness of breath, fever and cough. It was incredibly frustrating even for caregivers who thought they might have been exposed and had two out of the three symptoms. We couldn't get them tested. Since the emergency-use authorization on February 29, the opportunities have opened up, and we think the pipeline will improve so we can significantly improve our testing capacity."

The organization has been working on bringing the testing to more patients, however, there are other hurdles. 

"We developed our own test internally," Compton-Phillips said. "We have yet to be able to get reagents to run it because the reagents are made in Europe. So we are continuously working on that."

Providence plans on following the lead of South Korea and opening up drive-thru testing units. Compton-Phillips said that the tents are ready to be deployed as soon as the capacity for testing increases. 

Treatment

The treatment of the coronavirus is continually evolving as more information about the disease is gathered. 

"We know from statistics coming from abroad about 80% of people are OK with this condition. About 15% could qualify for hospitalization, and about 5% [are] needing respirator support or ICU care," Compton-Phillips said. 

This means the bulk of patients can be treated from home – with the support of technology. 

"We worked very closely with our telehealth group, and they were able to create at capacity to give patients seen in the ED a thermometer and a pulse oximeter, and have them monitor at home using our telehealth capacity to be able to say how are you doing, and are you safe to stay at home, and are you going the wrong way? It's one of the things we've seen with this particular germ that patients can be OK for a while then decompensated rapidly."

For those patients who do have to go into the hospital, there are strict protocols prohibiting visitors.

"It's incredibly isolating, particularly for the older patients getting admitted. That kind of isolation is just another contributor to delirium and all kinds of bad things that happen. So we started deploying iPads to our facilities to make sure we break that down and people keep that connection to stay sane while undergoing acute therapy."

In addition to just in-hospital initiatives, Providence has been connecting with lawmakers and other hospitals in an attempt come up with the best solution for caregivers and patients.  

"The big thing for us is, what is the right thing for us, for our nurses and respiratory therapists, and everyone touching patients?" 

The Reducing Unnecessary Senior Hospitalizations (RUSH) Act of 2020, bipartisan legislation introduced in both the House and Senate, aims to enable more widespread use of telehealth in skilled nursing facilities.

WHY IT MATTERS

The RUSH Act – introduced in companion bills from Sens. John Thune, R-South Dakota, and Ben Cardin, D-Maryland, and from Reps. Adrian Smith, R-Nebraska, and Ann Kuster, D-New Hampshire – would allow Medicare to enter into voluntary, value-based arrangements with medical groups to provide acute care to patients in skilled nursing facilities using a combination of telehealth and on-site staff.

The aim, say the bills' sponsors, is to enable better care coordination and avoid more costly patient transfer to hospital emergency departments.

If the model generates savings, they would be shared between the medical group and the skilled nursing facility, according to the legislation. Skilled nursing facilities with a star rating of less than three would be eligible to participate in the model, but would not be eligible for shared savings until they successfully achieve a three-star rating.

Facilities in the Medicare Special Focus Facility program would be ineligible to participate; if the program is shown not to save money over time, Medicare would be required to end it.

THE LARGER TREND

The critical value of telehealth is evident as the coronavirus spreads worldwide. Earlier this month, after urging from the American Telemedicine Association, HIMSS and other groups, Congress voted to waive some restrictions for Medicare telehealth coverage as part of its new COVID-19 supplemental funding package. As hospitals prepare themselves to be overwhelmed by a surge of new coronavirus cases, any technology enabling remote care can help.

THE LARGER TREND

"Greater use of telehealth in skilled nursing facilities will benefit patients and doctors, reducing expensive and unnecessary hospital visits,” said Sen. Cardin. “I’m proud to be a partner on the bipartisan RUSH Act that will continue to increase the availability of telehealth through Medicare and help deliver better health outcomes across the country.”

"The RUSH Act brings needed innovation to Medicare, lifts burdensome regulations, and will ultimately benefit patients,” said Rep. Smith. “This legislation builds on new technologies and improved connectivity to use telehealth in skilled nursing facilities, allowing patients to be treated in place rather than transferring them to a hospital. This bipartisan bill will help transform rural health care and improve lives."