When the COVID-19 pandemic hit, many people were concerned about their access to health care. But 15-year-old Elly LeCursi knew that visits with her doctor would be business as usual.

She was diagnosed with PCD, or primary ciliary dyskinesia, five years ago and has been a virtual patient at Michigan Medicine since then. The cilia throughout her respiratory system does not function properly, making it difficult for her to produce mucus. LeCursi is immunocompromised and regularly sees a pediatric pulmonologist.

Elly, a patient of Dr. Tom Saba, at her home in Saline, MI. Image credit: Eric Bronson, Michigan Photography

“My doctor, Thomas Saba, is really good about communicating with me through email when I can’t see him in person,” LeCursi said. “And during the quarantine, I got sick and we emailed back and forth to figure out the best way for me to get better.”

She says their email exchange eventually led to a video visit where Saba could determine the best path forward for her health.

“I’ve always liked using virtual care because it’s easier to work around my school schedule and extracurricular activities. I can also be home when I need to be home—I’ve even had visits with Dr. Saba from our car,” LeCursi said. “Also, it’s a lot healthier given everything that’s going on right now with the pandemic.”

According to Saba, when COVID-19 cases ramped up in March, Michigan Medicine’s doctors, nurses and other health care professionals were naturally focused on managing the disease. Personal protective equipment and logistics regarding a potential field hospital were top of mind.

Dr. Tom Saba is a pediatric pulmonologist at Michigan Medicine. He has moved 50% of his appointments to video and phone calls. Image credit: Eric Bronson, Michigan Photography

There was also an incredible amount of effort around maintaining sufficient access to care for the academic medical center’s existing and future patients.

“We had a commitment to our patients and wanted to continue providing them with the level of care that they were used to,” Saba said. “That’s why a massive amount of work went into training thousands and thousands of our employees in telemedicine, a platform that has existed for many years.”

Video visits have been available to Michigan Medicine patients in a slowly increasing number of ambulatory clinics since 2016, and e-visits have been offered to primary care patients since 2017. But it took several key policy shifts at the federal level in response to the pandemic to enable the recent rapid surge of telehealth.

“The No. 1 thing that made it possible was making people’s homes as a site where patients can connect and receive telemedicine,” said Chad Ellimoottil, assistant professor of urology and director of the U-M Institute for Healthcare Policy and Innovation’s Telehealth Research Incubator.

Dr. Chad Ellimoottil at the North Campus Research Complex in Ann Arbor, MI. Dr. Ellimoottil is the director of the Telehealth Research Incubator. Image credit: Eric Bronson, Michigan Photography

Up until March 2020, the Medicare program did not allow patients to connect using their smart phones from home. But as the pandemic began to unfold and shelter-in-place measures were instituted across the country, Medicare not only allowed patients to connect with clinicians from home, it allowed for the use of non-HIPAA-compliant equipment and the practice of medicine across state lines.

Before these moves, providers couldn’t be sure whether a patient would get stuck with a large bill for a telehealth visit, Ellimoottil says. Now, Medicare considers a video visit equivalent to an office visit.

With these barriers removed, providers were able to respond to the rapidly growing interest in telehealth visits by streamlining operations and quickly training more providers. To date, Michigan Medicine has conducted more than 350,000 video and phone visits since the pandemic started.

For patients leaving the hospital that still need care, Karen Neeb, a nurse practitioner at Michigan Medicine, provides them with home monitoring kits. Image credit: Eric Bronson, Michigan Photography

For patients leaving the hospital that still need care, Karen Neeb, a nurse practitioner at Michigan Medicine, provides them with home monitoring kits. The readouts are automatically sent to a team that operates 24 hours a day, seven days a week.

“We treat people who have left the hospital but still need care, whether at a subacute rehab center or in their own homes,” Neeb said. “We also go to several nursing homes in the surrounding area to care for Michigan Medicine patients.”

Neeb says that when the pandemic started, the patient monitoring at-home service was created to serve as a bridge for individuals who needed closer monitoring upon leaving the hospital.

“We give them a kit that contains a scale, blood pressure cuff, tablet, pulse oximetry machine, thermometer and blood glucose machine so that we can monitor them closely and track their health,” she said. “Especially now, with people staying home to remain safe, we’re able to help them feel connected to their health care teams in ways that simply wouldn’t be possible otherwise.”

Many patients are new to the video visit system, so Neeb and her team provide them with this extra level of care by tracking things like their vital signs and weight, which help inform their primary care providers and other relevant specialists.

Virtual care offerings currently in use at Michigan Medicine include:

• E-visits, where a patient fills out a questionnaire and receives a written treatment plan
• E-consults, where a primary care provider and another provider, typically a specialist, consult regarding a specific patient/condition
• Tele-specialty consults, conducted between Michigan Medicine providers and affiliates/partners to coordinate patient care
• Video visits, involving two-way audiovisual communication between a patient and a Michigan Medicine provider
  

  Pat Pooley of Ann Arbor, MI, is a Michigan Medicine patient who has taken advantage of virtual care. Image credit: Eric Bronson, Michigan Photography

The COVID-spurred move to telemedicine also provides an unexpected boost to ongoing research by Ellimoottil and his team to study the impact of telehealth on health outcomes, cost and quality of care.

“Not only is this pandemic period uncovering new knowledge gaps, it’s giving us the ability to assess the existing knowledge gaps in a more robust way,” Ellimoottil said.
Meanwhile, virtual care is offering patients peace of mind during a very challenging time.

“Sometimes when you’re not feeling well and you’re concerned about something, you would like to know what the doctor or the nurse has to say about your situation,” said Pat Pooley, who is a Michigan Medicine patient. “And with my virtual visits, I feel free to talk to someone if I have questions. I’m very impressed by how easy the setup is, it’s a great advance in client care and I feel very well cared for.”

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