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Leveraging the power of telehealth to benefit the community

Date: 06/10/2020

The pandemic has changed the way we humans connect. Whether it’s online meetings, virtual classrooms, or video happy hours and book clubs, we are finding ways to interact with each other despite social distancing. At Northern Light Health, we have been using technology like this for a limited few clinical applications and system administration for about a decade. It is particularly useful in states like Maine, where people are spread across vast geography and traveling can be a hardship.
 
Prior to March, Northern Light Health was doing a handful of patient visits using telemedicine. In March the system logged almost 7,500 virtual visits, and in April that number has skyrocketed to 31,000 visits statewide.
 
In the Portland area, Northern Light Home Care & Hospice and Northern Light Mercy Hospital have found a very special way to leverage the power of telehealth. In April, the team there conducted its first telehealth visit in a homeless shelter. The patient was being monitored for COVID-19 exposure, but the nurse noticed he was having trouble walking. “I asked if I could look at his feet and found he had very significant ulcerations and swelling,” remembers Leann Thayer, RN for Home Care & Hospice. “I got the patient registered for services and a primary care doctor saw him via video on my iPhone!” 
 
“It turned out the patient had Foot Immersion Syndrome—commonly called Trench Foot during World War I,” explains George Stockwell, DO, a Mercy primary care physician. “It is a consequence of having constantly wet feet.” The patient had been using boot liners for shoes, which provide no protection in wet weather. The patient was prescribed some medicine, and several days later the patient was doing much better. He has a new pair of donated shoes, clean and dry socks from the shelter, and special access to the laundry facilities there to be sure he can keep his socks—and his feet—clean and dry.
 
There are many barriers in providing care to Maine’s homeless population, of which there are about 200 per night in Portland. Their circumstances change rapidly, they move around a lot, and they don’t have a lot of trust. Providing the service in a place that is familiar to them removes some of those barriers. 
 
“What was keeping me up at night was how we would manage our homeless population, particularly those who have underlying conditions,” says Kristen Dow, the director of Health and Human Services for the City of Portland. “Our shelter staff is not medically trained and not equipped to manage the surveillance of guests who are suspected of COVID-19 exposure.”
 
Home Care & Hospice and Mercy Hospital stepped up in a big way, according to Dow. Nurses are staffing four of the city’s shelters, monitoring guests with suspected exposure, and taking care of other health concerns at the same time. “Our shelter director can’t say enough about these nurses and the way they have interacted with and treated our guests. They seem to know exactly what our guests need and are clearly using some innovative strategies to get the job done,” observes Dow.
 
“As a primary care physician, I’ve been a bit resistant to the idea of telehealth,” says Dr. Stockwell. “But being forced to take advantage of it in this unusual time, we are realizing there’s actually a lot we can do with it. I have found most patients really like it and some patient visits are actually more productive and focused using telehealth. There will always be things that require a face to face assessment, but in the case of this homeless patient, we may have saved him from permanent damage and a need for surgery.”
 
At Northern Light Eastern Maine Medical Center in Bangor, regional medical information officer Michael Ross, MD, is watching what he predicts is a permanent transformation in healthcare delivery.
 
“We are beginning to use it for pre-procedural and follow up visits in cardiology, rheumatology, gastroenterology, neurology, orthopedics, and even some primary care, and I don’t see any reason to go back,” said Dr. Ross. “The technology has been a lifeline and will be a cornerstone going forward as we begin to reopen services across the state, while working to maintain social distancing for the health and safety of vulnerable patients. It’s easy to use and it is secure. For a rural state like Maine, it may be the silver lining in this pandemic. This is a technology whose time has come.”