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Porter expands telehealth services to ensure safety of patient and health care providers

DR. NATASHA WITHERS, shown in her office with some equipment used in telehealth, is the medical director for primary care at Porter Medical Center.

We expect these telehealth programs to continue long after pandemic restrictions have ended.”
— Dr. John R. Brumsted, head of UVM Health Network

MIDDLEBURY — Porter Medical Center has a client base of 16,000 adult and pediatric patients in Addison County.
That’s a lot of potential patient visits during any given year.
But what’s an ailing person to do when he or she has been ordered to self-isolate during a pandemic?
The answer: Telehealth visits, through which patients receive remote, “virtual” checkups — through a phone and/or computer monitor — with their physician. Though not as ideal as an in-person visit, telehealth appointments are allowing physicians to diagnose patients from afar and either link them with medications and directions for healing, or tell them to get to the hospital or doctor’s office pronto for a more in-depth assessment.
It was just a few years ago that telehealth was being piloted in Addison County. It’s now being fast-tracked and expanded, to great effect, in the COVID-19 era.
“It’s exciting to see that it’s catching on and patients are really benefiting during this pandemic,” Dr. Natasha Withers, medical director for primary care at Porter Medical Center, said during a recent telephone conference with the Independent. She and Porter Medical Center Regional Physician Leader Dr. Carrie Wulfman provided a tutorial on how telehealth is being used — not only in this county, but also throughout the state. Porter and other affiliates of the University of Vermont Medical Center are all offering the service.
“We’ve seen a big increase in video visits daily,” Dr. John R. Brumsted, president and CEO of the UVM Health Network, said through a written statement. “Last week, we reached more than 4,000 meetings — a number that includes patient visits as well as internal staff meetings. We’ve worked quickly to equip all clinical practices with devices, education and technical support. We’re also supporting patients who make Zoom appointments by offering technical assistance prior to their visit, and we have addressed concerns regarding Zoom’s security and privacy… We expect these telehealth programs to continue long after pandemic restrictions have ended.”
Here’s how it works.
Porter staff works with the patient to schedule an appointment. The patient must sign an “Informed Consent” form prior to the telehealth visit, indicating he or she understands and agrees to the benefits and risks of a telehealth videoconference.
The patient might get a call form a Porter official the day before the appointment to make sure the appropriate technology is set up at both ends.
Patients should ideally prepare for the videoconference by having weight and height measurements ready, as well as pulse and blood pressure readings. The patient should also be ready to describe any illness symptoms and prepare questions for the attending physician.
“I’ve been quite impressed with my patients,” Withers said. “They are very prepared when I sign on. They often have their blood pressure, their weight, their pulse — they know all the things I want them to have, and they have all of those things teed up for me ahead of time.”
Health care providers have complete access to the patient’s electronic medical record, and can electronically order prescriptions and write medical orders based on the person’s need.
A patient visit is private and confidential, and the technology — the Zoom platform — includes privacy safeguards and security of patient health information. State law doesn’t allow any recording to be made of a telemedicine session, nor are patients allowed to record it from their end.
“UVM has taken a close look at the safety of Zoom and we are confident this is the best platform to use,” Withers said. “We’ve added a new level of security by adding a password, in an effort to eliminate any hacking into the system. All of our patients have both an individualized  meeting ID, and a password.”
Patients can have a caretaker and/or family members with them during the telehealth visit. All Vermont health insurance plans and public health care assistance programs (like Medicaid) are required by law to pay for many types of live, telemedicine services.

VALUABLE INSIGHTS
Wulfman said telehealth visits can give physicians insights they wouldn’t glean from a conventional face-to-face appointment.
“I did a video visit today and there were three generations of the family in the room, and they all peeked their heads onto the camera and wanted to say, ‘Hello,’” she observed. “It was interesting to see the how the family dynamics were working in this isolation time. You can see whether they’re getting along, and they sometimes show us their pets. There’s a lot we can tell based on observation and home environment, too.”
True, physicians can’t lay instruments upon a patient from afar. But that’s not an impediment to an effective checkup, officials noted.
“There’s a lot you can tell by just looking at the patients,” Withers said. “If we’re talking about respiratory, we can’t at this point lay a stethoscope on virtually, but what we can do is look at how the person is breathing — see their chest rise. That’s really important with the pediatric population, especially when trying to determine if they need to come in for an office visit. The video visit is really helpful for us to take a look at the patient, see how difficult it is for them to breath, and then make a determination based on that.”
Technology will soon get better for Porter physicians and their charges. The hospital has ordered what Withers called “peripherals” — equipment that’s attached to a computer and can also be inserted into the patient’s ears and throat.
“An (Ear, Nose and Throat) physician can be at home and look at (the ear and throat diagnostics) and have a consult that way,” Withers said. “So there is some creativity here.”
Wulfman noted she and her colleagues are using telehealth proactively. Officials are constantly surveying the hospital’s list of most chronically ill patients in order to check up on them regularly through video visits.
“We can reach out to these patients and see how they’re doing, then also hopefully use our telehealth modalities so they can actually have a visit in a safe manner,” she said. “We are seeing acute people who we really think need to be seen, and that list is scrutinized by our providers on a day-to-day basis.”
And patients may soon get quicker “on-demand” telehealth appointments, according to Wulfman. There will be a trial through Porter’s ExpressCare clinic. Ailments appropriate for on-demand visits will include such things as severe headache, urinary tract infection, dog bite, rashes, mental health complaints and back strain.
Patients will be able to say, “I want to be seen now.” They get into a queue, and someone at ExpressCare will go pull them out of the queue when their number is called.
“All of a sudden, the video will pop up with a provider, and the patient will be able to have an on-demand visit that way,” Wulfman said.

KEEPING A SOCIAL DISTANCE
In other related COVID-19 developments, Porter Medical Center has:
• Firmly established an incident command system for COVID-19. Porter leaders meet regularly at 8:30 a.m. and in 3:30 p.m., sharing all relevant information so each person knows what’s going on in the different areas of the organization. This ensures no overlap in assignments or mission.”
• Opened an Acute Respiratory Clinic (ARC), stationed at the Porter Primary Care parking lot off Exchange Street in Middlebury.
“The idea was to route patients with respiratory illnesses patients to a single location for treatment, rather than having them spread throughout multiple PMC offices and where they could present a greater the risk of infecting other people,” Wulfman explained.
The ARC has been operating for almost three weeks, and has been accommodating around 20 patients daily, she said.
“It’s a very safe environment,” she stressed, noting some seriously ill patients have been delaying hospital visits because they afraid they might be at risk of getting COVID-19 in the hospital setting. Wulfman and Withers stressed the ARC and all of the PMC campus is regularly sanitized and kept safe for visitors and staff.
Patients requiring treatment at the new ARC must first call their primary care office to get an appointment. Once that’s done, the patient drives to the ARC — which is in a tent in the parking lot to allay fears for those who don’t wish to go into an office — and wait in their car until it’s their turn. At that point, specially designated health care providers in protective attire go out to meet and examine the patient. Services might include a COVID-19 screening, Wulfman noted.
“It’s one of our biggest accomplishments, in my mind, and one of the reasons we’ve been keeping people safe,” she said.
“Some patients are really sick, and they have delayed being seen because they are fearful. But they’ve seen patients there with suspected cardiac conditions, respiratory conditions like asthma and COPD… and they have been delaying a visit. I think it’s important to emphasize we have this (ARC) site and it is safe and people should not delay being seen.”
• Has routed all of its outpatient X-ray services to a single location: The orthopedic office at 1436 Exchange St., Middlebury. Usually, such X-rays are offered at four different locations. The idea is to reduce chances of mingling X-ray patients with respiratory patients, officials said.
• Re-directed outpatient cardiology visits from Porter’s primary practice site within the hospital to its Brandon Primary Care practice, which has historically had a satellite cardiology site for patients who live in Brandon. All patients with respiratory symptoms are met at the entrance.
John Flowers is at johnf@addisonindependent.com.

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