Telemedicine in Disaster Medicine pt. 1
- Zeel Shah MD
- Apr 11, 2020
- 4 min read
Population-Level Interest and Telehealth Capacity of US Hospitals in Response to COVID-19: Cross-Sectional Analysis of Google Search and National Hospital Survey Data.
Hong YR, Lawrence J, Williams D Jr, Mainous Iii A
doi: 10.2196/18961
Disclaimer: This is a summary of the highlights of this article, I do not own any or endorse any of the findings within this article. This is for educational purposes only and a full link for further review is included.
Bite-Sized Take Away:
As the number of COVID19 cases increase, there is an increase in the national population’s interest in telehealth. However, this increase in population interest did not correlate with the proportion of hospitals providing telehealth services.
Key Points:
Introduction:
As COVID19 spreads, the Centers for Medicare and Medicaid Services (CMS) have expanded Telehealth services for all Medicare beneficiaries.
Almost all electronic communications between patients and providers real-time communication can be paid at the same rate as in-person visits.
Purpose: is to alleviate the overload on the healthcare capacity by providing care for initial screening of symptomatic patients (ie. forward triage) –> Keep these patients away from the hospitals.
They investigated:
Relationship of the population-level internet search volume for telehealth (to work as an indictor of population interest and demand for telehealth services)
Number of new COVID19 cases and proportion of the hospitals that adopted the telehealth system (to work as an indicator of the telehealth capacity in the United States)
Due to the large concern that COVID19 cases will potentially need ICU beds and ventilators – they identified the telemedicine ICU capacity of US hospitals
Tele-ICU: technology-enabled care delivered from off-site locations that was developed to address the increasingly complex patients and the insufficient number of intensivists.
Its possible that as COVID19 cases increase, tele-ICU might be able to help remotely and ease some of the capacity constraints.
Methods:
Used Google Trends to obtain internet search volume data to represent a national interest in telehealth.
Used “telehealth” and “telemedicine” since these terms are often used interchangeably.
Data was obtained between Jan 21, 2020 – March 18, 2020 to gauge population interest.
Relative Search Volume (RSV) Index was used. RSV ranges from 0-100. 100 indicates the peak of search volume. So if RSV is 80, then 80% of the highest search volume is recorded based on the search period, geographic area, and population size.
Johns Hopkins Coronavirus Resource Center was used to obtain data on COVID19 cases in the United States.
Data about a hospital’s telehealth service capacity, data from the 2018 American Hospital Associate Annual Survey (AHAAS) and the AHAAS Information Technology (IT) Supplement was used.
The proportion of hospitals that use the telehealth system and the tele-ICU capacity was estimated based on positive responses to the AHAAS survey and IT supplement questions.
Biostatistical Methods:
Pearson Correlation to examine association between the population search volume for telehealth/telemedicine (RSV score) with the cumulative number of COVID19 cases in the United States and the proportion of hospital-level telehealth and tele-ICU capacities
Results:
Please refer to full article for details, diagrams, and charts.
Strong correlation between population interest in telehealth as the number of COVID19 cases reported – as the number of cases increased, population interest also increased (r=0.948, P <0.001)
Of the 6146 hospitals that were included, 60.8% had telehealth and 13.4% had tele-ICU capabilities.
A higher population interest in telehealth was noted in the Northeast and West census regions while the proportion of hospitals with the telehealth capabilities was higher in the Midwest region.
No significant association between population interest and the proportion of hospitals that adopted telehealth.
No significant association between population interest and the proportion of hospitals that adopted tele-ICU.
Discussion:
As the number of COVID19 cases increase, there is an increase in the national population’s interest in telehealth. However, this increase in population interest did not correlate with the proportion of hospitals providing telehealth services.
This raises the question – do hospitals and health care systems have the capacity to meet the increasing health care demand in their service area?
Telehealth can help to improve triage and coordination of case for patients with COVID19.
It is possible that the telecommunications infrastructures in US hospitals might not have the capability to address the ongoing needs of patients with other health conditions.
This study has relevant findings to help flatten the transmission curve overall but hospitals may not have the capacity to handle the surge in telehealth and remote critical patient care.
Uncertainty if hospitals can actively expand their telehealth platforms or implement a new system if they have not previously adapted them because the CMS waiver only extends until the end of the COVID19 emergency.
For those that weren’t using telehealth to optimum capacity – there may be a need to have structured guidelines to stimulate effective implementation.
Expansion of tele-ICU capability could be a promising strategy during this pandemic especially in light of the shortfalls of ICU beds in rural hospitals and growing number of patients in need of intensive care.
Hope for future studies:
Explore how expanding telehealth services might influence the scope of practice and patient outcomes.
Limitations:
Using the internet search data might not actually reflect true population interest.
Studies have demonstrated the utility of Google Trends to be representative of US population.
Limited to the hospitals that actually responded to the AHAAS
Definition of telecapacity was limited to the hospitals and provision of nonhospital teleservices weren’t identified.
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