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TELEMEDICINE

Telemedicine in COPD and

Other Vulnerable Patients

By John J. Seidenfeld, MD, MSHA, FACP & Alexandra G. Bailey

Consideration of best practices for the vulnerable patient, or single consultation. Even in emergency departments which have a
those at greatest risk of death and disability, is imperative. COPD high burden of behavioral health patients, staff can work directly
patients are a cohort vulnerable to infections, pollutants, and other with a telehealth behavioral provider, for example, to determine the
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toxic inhalants such as streptococcus pneumoniae, ozone and toxic best course of action and enable staff to treat other critical patients .
gases, and pollens, respectively. Another daunting task the health care system faces is monitoring
Previous evidence has pointed out that these patients receive a adherence to treatment and treatment success. Telemedicine and
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high degree of low value services without improvement . These pa- the incorporation of biomedical devices that fit into our hands or
tients value and prioritize convenient, high quality, and inexpensive lay on our wrists allow for a more quantitative assessment in deter-
aspects of medical care. Telemedicine may be used for many appli- mining the success of a treatment plan. From rings that monitor
cations from health care provider (HCP) to HCP consultation, HCP your oxygen saturation, displaying data on your phone, to watches
to patient visit, patient management and monitoring of disease, re- that can detect if you have an irregular heartbeat, patients may play
source sharing, and communication for alerts, advice, and education. an active part in their treatment and providers gain tools for man-
Since the widespread use of the “smart” phone in 2010, this mode agement and treatment.
of eHealth has been explored and discussed with journals solely de- Like the current healthcare system, an efficient telemedicine sys-
voted to it. While some may have been skeptical of telemedicine in tem is complex and will not be built overnight. In a time of crisis,
the past, it has allowed practitioners to continue to treat their pa- we make do with what we have. However, if we hope to incorporate
tients in these demanding times . the use of telemedicine after this pandemic, we must conquer a few
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Consider problems with the waiting room before 2020: confined barriers. These include CPT coding broad acceptance, inter-oper-
space and air rebreathing, other vulnerable patients and their care- ability of eHealth record systems, licensing acceptance nationwide
givers, no screening prior to entry of health care personnel or pa- and HIPAA compliance. Other concerns or fears are the threat of
tients and family members, rare PPE use and a high likelihood of “Bot” replacement of health care workers, the lack of “hands on”
contagion spread. Conversely, telemedicine promises greater con- perception of impersonal care, “best” site of care decisions for
venience and reduced exposures for all vulnerable patients, includ- providers and patients, and inertia of “overcoming the way it has
ing those with COPD, improved access for close and distant always been done”.
patients, enhanced immunization education and prompts, environ- In addition, some vulnerable patients and communities that could
mental hazard warnings, and fewer ED visits. Improved screening, most benefit from telemedicine lack the infrastructure capable to
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diagnosis, triage, and prioritization may be done with algorithms support telehealth . Governmental action is necessary to provide
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and mid-level provider interactions . these communities, that often have the greatest health disparities,
Telemedicine, both in the time of this COVID-19 pandemic and with adequate infrastructure. At the very least, we could provide re-
what was once considered “normal” life, provides many benefits gions most affected by COVID-19 with low cost or free broadband
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for the entire healthcare system . Organized medicine has long internet access which might accompany rural electrification.
fought to provide adequate medical care to rural America, supplying Technology itself is a substantial hurdle for telemedicine. Older
incentives to young doctors to work there even if only for a few individuals should be directed toward telemedicine, especially during
years. Urban America, as well, poses a challenge. The same areas pandemics or epidemics, and helped to understand the technology.
that have become known as “food deserts”, are also known to be In this case, technological literacy may be a matter of life and death;
short on medical staff and supplies. Telemedicine brings exceptional so improving access to technological education or creating an intu-
care to these underserved areas. Telehealth opens the doors for spe- itive user interface is imperative to the use of telemedicine for older
cialists to treat patients without requiring a trek cross country for a populations.

12 San Antonio Medicine • November 2020