Over the past three weeks, Massachusetts General Hospital has undergone a transformation. Like most US hospitals these days, a palpable tension hangs over the building. The halls are quiet and devoid of visitors, isolation wards are filling with patients, and staff are dressed in extensive protective gear. There’s an unusual stillness in the air.
The usual daily gaggles of doctors and residents moving from bed to bed to conduct rounds has been replaced by a lone physician, clad in protective equipment, escorting a laptop on a cart around the hospital. Doctors participate virtually through an app the hospital has configured to facilitate medical care while limiting potential exposure by staff. Some doctors join virtual rounds from a sanitized conference room down the hall where they sit 6 feet apart, others from their homes.
In the isolation wards, Covid-19 patients rest in rooms equipped with iPads mounted to IV poles using a gizmo designed to secure tablets to boats. The iPads include software that makes them virtual extensions of Mass General’s 2,000 nurses. Nurses can use the devices to check on and communicate with patients without donning masks, gloves, and other precious protective gear, and risk exposing themselves to the virus.
In the three weeks since the system was deployed, Mass General says its use of personal protective equipment, or PPE, has fallen by half, helping the hospital cope with a nationwide shortage. It has also converted longtime opponents of telemedicine in hospitals into fierce advocates of the technology.
As the pandemic worsens, hospitals from California to Texas to New York are hastily building virtual care systems using tablets and smartphones, with similarly promising results. Many began as slapdash efforts to provide patients with high-quality care and access to the outside world amid visitor restrictions and supply shortages, but hospital officials say they have been surprised by the programs’ impact.
“This digital surge that is preceding the actual Covid-19 patient surge is going to transform health care permanently in the United States,” said Dr. Lee Schwamm, who leads Mass General’s Center for TeleHealth.
At SUNY Downstate Medical Center, a hospital in Brooklyn that is transitioning to exclusively house Covid-19 patients, staff use a limited supply of donated iPads and smartphones to help isolated patients connect with their loved ones. Another five iPads on carts are used for video interpretation services in multiple languages, including sign language.
The adoption of inpatient telemedicine has also helped with staffing, by allowing more providers to participate in care, says Jordan, at Saint Francis. Immunocompromised and other at-risk providers who had been kept away from patients to protect themselves can now weigh in remotely. Doctors who feel healthy but are quarantined because of Covid-19 exposures are also now able to contribute, Jordan says, which has helped the hospital avoid dire personnel shortages.
“Change is difficult in medicine. Historically, telehealth has been an exercise in pushing so that people begin to see how technology can make a difference,” says Estrada. “These last three weeks, we are not really pushing. We are being pulled. This huge community of providers is clamoring for these solutions now. It’s amazing.”