If the COVID-19 pandemic has taught us anything, it's that the vast majority of the population can be served, for health and safety reasons, virtually and online.
NAMD is now in the planning stages of creating a "free clinic" to transition into a "virtual hospital" in the next few years. After this pandemic has cleared, hopefully soon, we'll begin work on the new "virtual hospital".
It's purpose is to serve the general population through catastrophes such as the COVID-19 Pandemic. It will be a volunteer academic hospital for doctors and will operate as a "free clinic" to serve the general population.
We've been approached by humanitarian groups and other non-profits that want to assist us, and see the need as urgent. We're presently working with start-ups that have new touchless technology that can be useful. We look forward to it's completion and your involvement.
- Provide telehealth services to patients
- Diagnose patients
- Determine whether patients should receive lab tests
- Determine the level of treatment and care they should receive
- Monitor patient vital signs using electronic technology
- Know how to interact electronically with other healthcare professionals when troubleshooting
- Give patients advice on healthcare matters and when they should seek medical care
- Process insurance claims
- Triage online patients
- Operate a call center
Medicine has always been a physically demanding job, but with virtual care, this may help ease the physical demands. It is anticipated that virtual nursing will help reduce physician turnover and increase compensation.
Today the potential of virtual hospitals is endless. The availability of high definition video and two way communication allows the system to be used in the following situations:
- Monitor patients at home
- Monitor infants in hospital and at home
- Manage emergency units
- Observe post-operative patients at any location. This is of growing importance as many patients are now discharged home the same day after surgery. The virtual hospital can now monitor the patients in their home
- Monitor elderly in nursing homes for falls
- Monitor the safety of patients in mental healthcare institutions
- Monitor critically ill patients in rural areas who are not able to visit tertiary care centers
- Follow patients with chronic disorders
- Virtual hospitals allow for an extra pair of eyes with vast monitoring capabilities. Physician's can assess a patient’s home condition without even going to the residence. The system allows for better connectivity with patients with hopefully long term benefits.
- The virtual hospital has removed many physical barriers. The system is of the greatest benefit to patients living in parts where access to healthcare is not available. By using currently available technology and expertise of better-trained healthcare workers, virtual hospitals offer improved healthcare across geographical boundaries.
- A virtual hospital helps connect patients in secluded areas of the nation where there are no healthcare specialists. In addition, a large number of patients today have limited mobility and others may not have sufficient funds to make the long journey to tertiary care centers. Thus, virtual hospitals may turn out to be a cost-effective option for these populations
- For patients with chronic disorders like diabetes, COPD, cancer, congestive heart failure, arthritis, or coronary artery disease, it can be a real struggle to physically come to the hospital to be seen by a clinician. Now virtual hospitals can make a difference. Because of the possibility of remote monitoring, patients with chronic disorders can minimize the number of real-time visits and instead have their checkup done by a virtual team. This reduces time, costs, and the aggravation of travel. The savings can be real for patients who do not have to make long journeys.
- A virtual hospital means patients do not have to sit for hours in the waiting room to be seen by a physician there are no delays seeing a specialist because the virtual team already has specialists on board. There is no need to continuously rebook or cancel appointments for whatever reason.
- Finally and very important, virtual healthcare helps decrease the spread of infections that are so common in real-life hospitals. Not only does it eliminate the spread of injection from the patient to the physician but also to other patients.
For the most part, Telemedicine is not routine practice and only a few select institutions and healthcare providers have been granted permission to conduct healthcare in this manner. To date telemedicine has been approved by a few states and allows clinicians to attend to the medical needs of patients living in rural areas. For the most part, almost every state has laws that discourage the practice of Telehealth and the same applies to Virtual Healthcare delivery.
The Health Resources and Services Administration (HRSA) of the Dept of Health and Human Services defines telehealth as the use of electronic information and telecommunication technologies to support and promote long-distance healthcare, patient and professional health-related education, and public health administration. Technologies include the internet, video conferencing, webinars, live streaming, use of the landline, and wireless communications. In addition, both Medicare and Medicaid also have certain restrictions on the types of technologies that can be used as part of telehealth. The use of telehealth services is rigidly controlled and enforced by the Office of Civil Rights. And the penalties for those who disregard HIPAA are severe.
However, with the recent COVID 19 pandemic, the rules of telehealth have been relaxed and the covered healthcare providers will not be subject to penalties for violations of HIPAA as long as the rules are obeyed in good faith. Healthcare providers and healthcare institutions have the onus of ensuring adequate security and safety of all medical information during telehealth delivery-there is no exception to this rule; it is mandatory. Further, before undertaking delivery of telehealth, all healthcare workers who partake in this activity must be fully aware of HIPAA rules and be up to date with the latest information on the topic.
At present, telehealth is permitted because of the COVID-19 crisis but when this Notification of Enforcement Discretion will expire is not known. The Office of Civil Rights will issue a notice to the public when it is no longer exercising its enforcement discretion based on the latest facts regarding COVID 19.
In the meantime, physicians are expected to conduct telehealth in private settings like a clinic or an office with a patient who is at home or in another clinic. It is absolutely forbidden to receive or transmit telehealth services in a public or semipublic setting unless there are exigent circumstances. If telehealth cannot be provided in a private setting, the provider should implement reasonable HIPAA safeguards to limit disclosure of protected health information (PHI).
Some examples of what OCR may consider a bad faith provision of telehealth services that is not covered by this Notice include: Conduct or furtherance of a criminal act, such as fraud, identity theft, and intentional invasion of privacy; Further uses or disclosures of patient data transmitted during a telehealth communication that are prohibited by the HIPAA Privacy Rule (e.g., sale of the data, or use of the data for marketing without authorization); Violations of state licensing laws or professional ethical standards that result in disciplinary actions related to the treatment offered or provided via telehealth (i.e., based on documented findings of a health care licensing or professional ethics board); or Use of public-facing remote communication products, such as TikTok, Facebook Live, Twitch, or a public chat room, which OCR has identified in the Notification as unacceptable forms of remote communication for telehealth because they are designed to be open to the public or allow wide or indiscriminate access to the communication.
All physicians should be familiar with their own platforms and not use other platforms for telehealth.
As long as the telehealth communication is done in good faith during the COVID outbreak and even if there is a disclosure of PHI to a third party, OCR will not impose a penalty for HIPAA violation but the agency will consider all facts and circumstances before making a decision. The provider needs to discuss with the patient the limitations of electronic technology and the potential for disclosure despite adequate safeguards. The patient must agree to this before telehealth services can take place.
Before undertaking telehealth or the practice of virtual medicine, it is important to speak to the Administrative Dept as to how to conduct Telehealth. Penalties for violating HIPAA are expensive and can ruin a healthcare institution’s and the physician's reputation.
In the USA, many hospitals are now adopting virtual hospital technology as this has become a necessity since the COVID pandemic. Patients, in fact, also prefer this type of medicine. But at the same time, there is a demand for more computer-savvy physicians- making a diagnosis virtually is not always easy. Plus, physicians need to know the limits of virtual care. But for many physicians who are computer literate, this may be a great specialty as it is less physically demanding and satisfying but on the other hand, requires broader medical and computing knowledge.