A New Frontier of Telehealth Care

After her eye bothered her for days, Kelly Pollock realized she needed to get it checked out. But as with many things during the COVID-19 crisis, doing that wouldn’t be easy.

But with the help of her laptop, some close-up iPhone photos of her irritated eye and a video conference with her Duke doctor, Pollock didn’t leave home to get a diagnosis, a prescription for an anti-biotic ointment or a first step toward relief.

“It worked out well,” said Pollock, associate general counsel for Duke’s Private Diagnostic Clinic. “I thought it was great. I’d absolutely do it again.”

For Duke Health, increasing the amount of available options for telehealth – which unites patients and caregivers by telephone or video – has been a long-term goal. But with the outbreak of COVID-19 and social distancing measures, Duke worked quickly to expand its ability to deliver care remotely.

In one day last week, Duke Health did around 1,030 video visits and 3,400 telephone consultations – up from around 100 visits per month prior to the COVID-19 outbreak.

“Over the last five years we’ve had some level of telehealth, but it’s really been accelerated,” said Simon Curtis, vice president for Ambulatory Services with Duke’s Private Diagnostic Clinic, which includes most of Duke’s specialty physicians.

The growing importance of telehealth is reflected in a recent expansion to health plans offered to Duke employees. In late March, Duke announced that, for the remainder of 2020, virtual healthcare visits would be covered with a regular copay for all covered staff, faculty and family members.

As the Duke community responds to the unprecedented challenge of COVID-19, here’s how Duke’s healthcare providers are using telehealth to maintain their commitment to patient care.

The Front Lines

For Dr. Mony Mehrotra, medical director for telehealth at Duke Primary Care, which encompasses most of Duke’s family, internal and urgent care clinics, the COVID-19 outbreak was a call to action.

She’d overseen Duke Urgent Care’s existing telehealth option, which uses an outside provider. But with COVID-19 creating a greater need for virtual visits, Mehrotra led a whirlwind effort to drastically increase Duke Urgent Care’s telehealth capacity.

“In a matter of a few days, we mobilized technology, our people and our workflows to begin doing telehealth visits,” Mehrotra said.

Starting on March 17, patients with mild COVID-19 symptoms could consult with a Duke Urgent Care provider by phone or video to assess their symptoms and schedule a test. And by using a drive-up testing site, a patient with COVID-19 could be assessed and diagnosed without ever stepping foot in a clinic.

“It was a lot of work, but what it says about us is that we’ll do what we need to do in order to get done what needs to get done,” Mehrotra said. “It was the right thing for the patients, it was the right thing for the community, our colleagues and our system. We’ll always be adaptable and open to new and innovative ideas, especially during these challenging times.”

Expanding the Reach

While the first wave of Duke Primary Care’s telehealth expansion addressed the immediate needs created by the COVID-19 crisis, a broader movement to equip the rest of the organization’s roughly 330 caregivers with telehealth capabilities is taking shape.

“We’ve been talking about these things as part of our future, but the environment we find ourselves in today has pushed it to the present,” said Chayla Handley, Duke Primary Care regional director of operations for Wake County.

In recent weeks, a small group of Duke Primary Care providers has been conducting virtual patient visits unrelated to COVID-19. As more providers get comfortable with using the technology and the system for ensuring a smooth and successful patient experience is fine-tuned, the number of providers offering virtual visits will expand. The goal is to have telehealth options available across all of Duke Primary Care later this spring.

“Our providers are doing a good job of being thoughtful about the idea that, with the state that were in with COVID right now, we need to push a lot of visits out of our office,” said Tabitha Smith, Duke Primary Care’s regional director of operations for pediatrics. “Instead of indefinitely delaying visits, we’re looking for ways to care for our patients through this platform.”

Learning for the Future

Prior to the outbreak of COVID-19, a handful caregivers in Duke’s Private Diagnostic Clinic (PDC) had telehealth experience. It was mostly used for low-risk consultations where distance was a factor.

Now, virtual visits are an option for patients of nearly all of the PDC’s roughly 1,850 physician members in around 110 outpatient clinics.

“It is literally across the board, nearly every specialty is now using telemedicine to deliver care to certain patients,” said the PDC’s Simon Curtis.

This follows a robust push in recent weeks to build technological infrastructure and train clinicians to engage in virtual visits. 

Across Duke, around 2,500 providers now have telehealth training.

Now, the question facing Duke’s telehealth caregivers isn’t how they can pull it off, but how well it’s working.

Curtis said the PDC is constantly gathering feedback from patients and providers to gauge the effectiveness of the telehealth experience. The goal is to learn how to deliver the highest quality care remotely and understand which kinds of visits work well in the virtual setting.

“A good thing that might come from this terrible situation is a new understanding of when and where telemedicine makes sense,” Curtis said.

Help us share the proactive and extensive work being done by all Duke community members during the COVID-19 outbreak. Send ideas, shout-outs and photographs here or write us at working@duke.edu.