Oncology Practices Shift to Telemedicine to Combat COVID-19

While many oncology practices, including those in the community setting, face unprecedented obstacles in light of the coronavirus disease 2019 (COVID-19) pandemic, the Community Oncology Alliance (COA) set to providing their members with more educational materials and expert insights on how telemedicine is combatting some of the issues by adhering to social distancing and minimizing office visits.¹

COA conducted a webinar on the impact of COVID-19 on oncology practices and introduced several experts across the nation to share how their institutions have adjusted during this time to accommodate patients. A number of actions have already been taken by COA, includingtheir recent open-letter to the President of the United Statesaddressing the concerns of “prior authorization” requirements for cancer treatment.

COVID-19 Task Force Initiated

The Northwest Medical Specialties in Washington State consists of 5 locations surrounding the Tacoma, Washington, area and was among the first to initiate a task force to combat the COVID-19 pandemic. During the COA webinar, Sibel Blau, MD, a medical oncology provider at Northwest Medical Specialties, discussed the policies mandated at her institution as the pandemic progressed.

“We put together a Viral Illness Task Force (VITF) 1 weekend after the government’s [initial] response that most people are healthy, and you should not worry about going out,” said Blau. “If you do your daily business, you will be fine as it will only affect the older patients or patients with medical problems. My partners and I sat down to talk about taking this more seriously now than later.”

Blau and colleagues looked at several guidelines, policies, and procedures to determine an appropriate VITF at Northwest Medical Supplies. An online document was utilized so that all staff could access the most up-to-date version of the policies and guidelines, as well as to keep open lines of communications on these procedures.

As early precautions, the VITF ordered that all patients wear masks when facing staff but was later updated to include mandatory use of gowns for all patients and goggles and gloves for those in isolation. All staff were tested and told to stay home if they were symptomatic until test results were found negative. Non-patient-facing staff were required to work remotely. All staff were required to sign off that they had reviewed educational materials on COVID-19 as well.

Over the course of the ongoing global crisis, the VITF has continuously updated policies and procedures to ensure the safety of all faculty, patients, andvisitors.

Telemedicine Evolves in Clinical Settings Across the Nation

While the VITF is essential in securing the health and safety of providers and patients who have to come into the clinic, patients who can avoid going into the clinic but still need to see physicians have the telemedicine option.At Northwest Medical Specialties, like many other practices in the nation, all possible patient visits are done virtually to avoid an excess of patients in the clinic.

The use of telemedicine has been a topic of conversation in the medical care space for some time. The Cancer & Hematology Centers of Western Michigan was close to implementing telemedicine in early 2019 with a local provider, but they did not move forward with this initiative at the time. However, the COVID-19 pandemic has led to the implementation of telemedicine in many practices.²

As of March 18, 2020, the Cancer & Hematology Centers of Western Michigan made a selection of a HIPPA-compliant telemedicine platform for them to use based on what would be simple for the patient as well as the physician, according to Dennis Zoet, director of Business Development, Cancer & Hematology Centers of Western Michigan, who joined the COA webinar with Jennifer Ewing, RN, MSN, NP-C, AOCNP, an advanced practice nurse at Michiana Hematology-Oncology, to discuss the implementation of telemedicine at their institutions.

The team at Cancer & Hematology Centers initially planned to have 8 providers set up for telemedicine, but after a week of using the platform, there are now at least 32 providers, and medical assistants are being trained to use telemedicine as well.

Schedulers call patients to determine if they can reschedule an appointment and confirm the patient’s readiness for a virtual video visit with a physician. However, physicians pointed out that initial visits should not be scheduled in 15-minute intervals as these visits appear to take more time as patients familiarize themselves with the telemedicine process.

After learning this lesson the hard way, Zoet said schedulers are now setting up appointments with breaks between 2 appointments at a time so that physicians can regroup or have spare time should an appointment run later. Zoet suspects this routine will not be as necessary as both the providers and patients grow more comfortable with the telemedicine process.

Virtual visits are conducted at 1 of the 5 clinic locations to control the environment around the call, such as to avoid the sounds of dogs or children in the background. Zoet says patients do not need to see dogs or children, etc, in the background of their visits, so it is important to control the environment. Physicians also need multiple screens and nearby support staff available for any potential problems. For these reasons, it is important to have separate spaces or offices for the physicians to work out of, as well as to help in social distancing from other staff members.

Scripts have also been given out to physicians, which include instructions such as reminding the patient they are still working in the clinic and have access to their same materials and that they are working in a closed-door office so that their virtual visit may remain private. Additionally, physicians are advised to share with the patient that they are working on 2 screens so that they can see the patient at all times on 1 side and their medical records on the other side.

Physicians are also encouraged to remind patients that telemedicine is new to their practice, just as it is new to the patient. Most physicians will be doing virtual visits with patients, but some will not and will be in the frontline working directly with patients in the clinic physically.

Telemedicine, of course, has led to some typical technological challenges, such as patients not having video capabilities or not understanding the new technology. Ewing notes that many neighbors and friends of patients have been of great assistance in overcoming these challenges.

One thing that Zoet is working toward in his institution is a virtual visit checklist that can be sent out to the patient in advance. This advises them on ways to prepare for the visit, such as checking audio and wi-fi, as well as having devices charged to avoid having to find a charger mid-call or the device turning off.

At Ewing’s institution, they are finding it more challenging to keep space between staff and to give them enough rooms for private visits, so older physicians or those at greater risk of contracting COVID-19 are being told to work from home but to still ensure a capable work environment without the dog and children in the background out of respect for the patients.

“For the most part, we have had a pretty good experience,” Ewing said. “I have really been impressed with the response of our providers. They understand what is happening and have been supportive and helpful in starting this technology.”

Overall, the use of telemedicine has been able to cut down the number of patients coming into the clinic while still providing oncology patients the ability to see their physicians. Both patients and providers have been supportive in this new space and understanding of the fact that this is new for all.

Zoet also noted that social media has been an important tool in providing information to the public, letting them know telemedicine is available at their institution, as well as sharing timely COVID-19 updates. Ewing and her team have implemented strategic social media plans to help spread awareness of policies and the role of telemedicine at her institution.

Telemedicine is new to almost all practices at this time, but it is providing an important tool to decrease the impact of COVID-19 on patients and providers in the clinic. This is an evolving space that is expected to help practices even more in the future, so at this time, the use of telemedicine is providing physicians and staff the ability to explore how this works as it moves toward more long-term use in the medical space.

“Telemedicine can really help our practice over the next few years to come, not just during COVID-19. I think this is here to stay, but we do need support,” Zoet concluded.

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References:

1. Community Oncology Alliance. March 26, 2020. The Impact of COVID-19 on Oncology Practices and How They Are Adjusting [Webinar].
2. Ewing J, Zoet D. Virtual (video) Visits [Webinar]. March 26, 2020. https://communityoncology.org/pdfs/Telehealth.pdf.