Virtual Medical Care
Topic Collection
October 29, 2019
Topic Collection: Virtual Medical Care
The recent increase in the use of virtual medical care (also referred to as telemedicine – though care may be provided via telephone, web, or other means) has led many in the emergency medical community to begin implementing call centers and web- or telephone-based triage and treatment systems in anticipation of and during public health emergencies. Additionally, health systems are using virtual platforms to coordinate care and provide remote access to specialty care and assessment (e.g., trauma, stroke, and psychiatric) which can be leveraged during disasters to broaden access to specialty consultation (e.g., for burn injuries or pediatric patients). These resources highlight lessons learned from recent events and strategies for implementing virtual medical care during a disaster.
Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.
Must Reads
This report summarizes the experience of jurisdictions across the country using hotlines and call centers to support the response to the 2009 H1N1 influenza pandemic. Algorithms for antiviral distribution; legal opinions on the use of hotlines; risk communication documents; and standing orders are included in the appendices.
Login to rate, favorite, and comments on the article
The authors explain the development, testing, and implementation of a model to enable community health call centers (e.g., poison control centers, nurse advice lines) to support home-management and shelter-in-place approaches in certain mass casualty or health emergency events. The report includes a matrix with possible call center capabilities aligned with National Planning Scenarios and other guidance that can be tailored by call centers.
Login to rate, favorite, and comments on the article
The authors conducted a literature review covering 2007-2012 to identify mobile health care technology solutions to aid in disaster management. They found five types of applications: disaster scene management; remote monitoring of casualties; medical image transmission (teleradiology); decision support applications; and field hospital information technology (IT) systems, most of which were still under development at the time of their review.
Login to rate, favorite, and comments on the article
This well-organized 22 page issue brief highlights how telehealth is being used in disaster preparedness and response and summarizes the challenges and potential solutions associated with this mechanism of healthcare delivery.
Login to rate, favorite, and comments on the article
This is a summary of a webinar focused on the Nurse Triage Line Project (including lessons learned from H1N1) that included representation from the public health law workgroups of the National Association of County and City Health Officials (NACCHO), the Association of State and Territorial Health Officials (ASTHO), and the Council of State and Territorial Epidemiologists (CSTE). Participants discussed how a coordinated network of telephone triage lines may be useful during a severe pandemic or other public health emergency; legal issues and concerns that may be associated with using such a network; and possible solutions.
Login to rate, favorite, and comments on the article
This workbook guides planners through the process of determining the need for a call center, as well as how to operationalize a call center during public health emergencies.
Login to rate, favorite, and comments on the article
The authors describe the successful use of a telephone nurse triage line (NTL) set up by the Minnesota Department of Health for evaluating individuals with influenza-like illness and tele-prescribing of anti-virals. The NTL diverted callers from acute care visits at low cost and had a high rate of satisfaction among callers.
Login to rate, favorite, and comments on the article
Authors from the University of Texas Medical Branch (UTMB) describe how UTMB was able to get its telemedicine services up and running within a week following Hurricane Ike due in part to the flexibility of its data network and plasticity of its telemedicine program. They offer lessons learned from the UTMB experience for future disasters.
Login to rate, favorite, and comments on the article
Applications for Telemedicine
The authors conducted a literature review covering 2007-2012 to identify mobile health care technology solutions to aid in disaster management. They found five types of applications: disaster scene management; remote monitoring of casualties; medical image transmission (teleradiology); decision support applications; and field hospital information technology (IT) systems, most of which were still under development at the time of their review.
Login to rate, favorite, and comments on the article
The authors describe a mobile application that uses digital images of patients' burns superimposed on a patient-specific 3D model. The application was found to more accurately estimate burn size than burn experts when tested at two separate international burn meetings.
Login to rate, favorite, and comments on the article
The authors tested an in-ambulance telemedicine system and found that pre-hospital diagnoses were in agreement with final diagnoses 90% of the time; pre-notification of the hospital via text message was successful 90% of the time; and transmission of a pre-hospital report was completed 95% of the time. Challenges experienced were related primarily to limited connectivity, but also to hardware, software, or human error.
Login to rate, favorite, and comments on the article
Call Centers and Triage Lines
This report summarizes the experience of jurisdictions across the country using hotlines and call centers to support the response to the 2009 H1N1 influenza pandemic. Algorithms for antiviral distribution; legal opinions on the use of hotlines; risk communication documents; and standing orders are included in the appendices.
Login to rate, favorite, and comments on the article
The authors explain the development, testing, and implementation of a model to enable community health call centers (e.g., poison control centers, nurse advice lines) to support home-management and shelter-in-place approaches in certain mass casualty or health emergency events. The report includes a matrix with possible call center capabilities aligned with National Planning Scenarios and other guidance that can be tailored by call centers.
Login to rate, favorite, and comments on the article
This webpage summarizes examples of the way that hotlines have been used to support disaster preparedness and response.
Login to rate, favorite, and comments on the article
The authors describe a pilot program in which dental school faculty members received training in outbreak investigation and telephone triage to assist the New York City Department of Health and Mental Hygiene in preparing to respond to pandemic influenza. They propose the use of dental professionals and/or other "nontraditional healthcare personnel" in support of call centers and telephone triage lines.
Login to rate, favorite, and comments on the article
The authors describe the Centers for Disease Control and Prevention's Nurse Triage Line Project and its goals of using a coordinated network of nurse triage telephone lines during a pandemic to assess the health status of callers, help callers determine the most appropriate site for care, disseminate information, provide clinical advice, and provide access to antiviral medications to those who need it.
Login to rate, favorite, and comments on the article
This is a summary of a webinar focused on the Nurse Triage Line Project (including lessons learned from H1N1) that included representation from the public health law workgroups of the National Association of County and City Health Officials (NACCHO), the Association of State and Territorial Health Officials (ASTHO), and the Council of State and Territorial Epidemiologists (CSTE). Participants discussed how a coordinated network of telephone triage lines may be useful during a severe pandemic or other public health emergency; legal issues and concerns that may be associated with using such a network; and possible solutions.
Login to rate, favorite, and comments on the article
This presentation discusses how Nurse Triage Lines (NTLs) may be used during disasters and includes an assessment of laws and regulations that impact the ability to set up NTLs in each state. Minnesota's experience during H1N1, and the CDC's Nurse Triage Line Project, are also discussed.
Login to rate, favorite, and comments on the article
This workbook guides planners through the process of determining the need for a call center, as well as how to operationalize a call center during public health emergencies.
Login to rate, favorite, and comments on the article
The Minnesota Department of Health developed several tools to support healthcare providers during the 2009 H1N1 influenza pandemic, including MN FluLine, a nurse triage line, that reached many rural and uninsured residents, and, according to the authors, may have prevented up to 11,000 in-person health-care encounters.
Login to rate, favorite, and comments on the article
The authors describe the successful use of a telephone nurse triage line (NTL) set up by the Minnesota Department of Health for evaluating individuals with influenza-like illness and tele-prescribing of anti-virals. The NTL diverted callers from acute care visits at low cost and had a high rate of satisfaction among callers.
Login to rate, favorite, and comments on the article
The University of New Mexico School of Medicine.
(2016).
Project ECHO.
The Extension for Community Health Outcomes (known as Project ECHO) was created to help healthcare providers in rural and underserved areas with information they need to treat conditions such as Hepatitis C, chronic pain, and behavioral health disorders. In the event of a disaster, one or more of ECHO's "hubs" could assist with virtual healthcare education and consultation / provider collaboration.
Login to rate, favorite, and comments on the article
The author proposes bringing together the expertise of emergency response organizations, public health agencies, and poison control centers to institute call centers and/or triage lines to disseminate information to the public during emergencies, and answer questions and concerns to keep concerned individuals from flooding local emergency rooms. Real-world examples of successful collaborations from Canada, Great Britain, and the U.S. are included.
Login to rate, favorite, and comments on the article
Event-Specific Lessons Learned
This well-organized 22 page issue brief highlights how telehealth is being used in disaster preparedness and response and summarizes the challenges and potential solutions associated with this mechanism of healthcare delivery.
Login to rate, favorite, and comments on the article
The authors, whose work focuses on telemedicine to meet post-disaster mental health needs, conducted semi structured interviews with both regional key informants and national organizations with Gulf Coast recovery interests and determined seven factors for telehealth success: funding, regulatory, workflow, attitudes, personnel, technology, and evaluation. Included in this resource is also a discussion of prior research conducted on the use of telemental health services.
Login to rate, favorite, and comments on the article
This is a summary of a webinar focused on the Nurse Triage Line Project (including lessons learned from H1N1) that included representation from the public health law workgroups of the National Association of County and City Health Officials (NACCHO), the Association of State and Territorial Health Officials (ASTHO), and the Council of State and Territorial Epidemiologists (CSTE). Participants discussed how a coordinated network of telephone triage lines may be useful during a severe pandemic or other public health emergency; legal issues and concerns that may be associated with using such a network; and possible solutions.
Login to rate, favorite, and comments on the article
This presentation discusses how Nurse Triage Lines (NTLs) may be used during disasters and includes an assessment of laws and regulations that impact the ability to set up NTLs in each state. Minnesota's experience during H1N1, and the CDC's Nurse Triage Line Project, are also discussed.
Login to rate, favorite, and comments on the article
In 2018, Hurricane Florence forced thousands to evacuate their homes in Wake County, NC. Six shelters were set up and a local telemedicine firm staffed them. Of the 95 patients seen over a 10 day period, nine were sent to the emergency room for further evaluation. Eighty percent reported that they would have gone to the emergency room had they not been cared for by a telemedicine provider.
Login to rate, favorite, and comments on the article
The authors describe the successful use of a telemedicine videoconferencing system to treat patients following a 2013 nightclub fire in Brazil.
Login to rate, favorite, and comments on the article
The authors describe the successful use of a telephone nurse triage line (NTL) set up by the Minnesota Department of Health for evaluating individuals with influenza-like illness and tele-prescribing of anti-virals. The NTL diverted callers from acute care visits at low cost and had a high rate of satisfaction among callers.
Login to rate, favorite, and comments on the article
Authors from the University of Texas Medical Branch (UTMB) describe how UTMB was able to get its telemedicine services up and running within a week following Hurricane Ike due in part to the flexibility of its data network and plasticity of its telemedicine program. They offer lessons learned from the UTMB experience for future disasters.
Login to rate, favorite, and comments on the article
The author proposes bringing together the expertise of emergency response organizations, public health agencies, and poison control centers to institute call centers and/or triage lines to disseminate information to the public during emergencies, and answer questions and concerns to keep concerned individuals from flooding local emergency rooms. Real-world examples of successful collaborations from Canada, Great Britain, and the U.S. are included.
Login to rate, favorite, and comments on the article
Using experience from the 2010 Haiti earthquake, the authors discuss the need to ensure that networks are properly constructed and wireless connectivity is robust to optimize health care delivery, medical documentation, logistics, response coordination, communication, and telemedicine during disasters.
Login to rate, favorite, and comments on the article
General Information
Participants in a conference breakout session were asked to respond to a series of questions about current and future use of telemedicine for public health disasters.
Login to rate, favorite, and comments on the article
The authors discuss the use of telemedicine to bring the specialized expertise of burn centers to more patients. They also describe its challenges, including technical difficulties, legal uncertainties, limited financial support, reimbursement issues, and the need for more evidence of its value and efficiency.
Login to rate, favorite, and comments on the article
The authors describe the Virtual Naval Hospital, a digital library set up in 1997 to "make the Internet a useful medical reference tool for naval primary care providers at the point of care, by helping them take better care of patients, and, as a health promotion tool for sailors and marines, to help personnel live healthier lives."
Login to rate, favorite, and comments on the article
This vendor's guide provides overviews of 19 categories under telemedicine (e.g., pros and cons, telemedicine and clinical guidelines, telemedicine and Medicaid, and HIPAA and telemedicine).
Login to rate, favorite, and comments on the article
Latifi, R.
(2010).
Telemedicine for Trauma, Emergencies, and Disaster Management.
(Book available for purchase.)
This book discusses the use of telemedicine in the management of trauma, disaster, and emergency situations. Critical discussions on the practicality, logistics, and safety of telemedicine from recognized experts in the field are included.
Login to rate, favorite, and comments on the article
The authors conducted a literature review covering 1980-2013 to identify when telemedicine or telepresence was reported for disaster management, both in real life and in mock and simulation situations. They concluded that it is critical to establish telemedicine infrastructure and protocols in areas prone to disasters prior to an event occurring to avoid having to establish a telemedicine program in a chaotic environment.
Login to rate, favorite, and comments on the article
The authors discuss how telehealth provides surge capacity by providing medical and public health expertise at a distance, limiting safety and logistical concerns. They note several applications for telehealth in disaster response, and propose ways to expand its use more broadly in future.
Login to rate, favorite, and comments on the article
This paper describes the use of telemedicine in the pre-hospital setting for disaster response. The authors discuss telemedicine disaster applications and technology, as well as implementation barriers and legal and ethical issues.
Login to rate, favorite, and comments on the article
This report to Congress discusses telehealth and its potential uses during public health emergencies and disaster medical responses. Payment and reimbursement considerations, as well as pertinent legal issues, are included.
Login to rate, favorite, and comments on the article
The authors developed and measured a model application in order to quantitatively analyze the potential health benefits of telemedicine in disaster response. They found that the model can support disaster response activities and enhance surge capacity; enhance the speed and effectiveness of medical response; and improve resource and operations planning, as well as internal and external situational awareness.
Login to rate, favorite, and comments on the article
Plans, Tools, and Templates
This report summarizes the experience of jurisdictions across the country using hotlines and call centers to support the response to the 2009 H1N1 influenza pandemic. Algorithms for antiviral distribution; legal opinions on the use of hotlines; risk communication documents; and standing orders are included in the appendices.
Login to rate, favorite, and comments on the article
The authors explain the development, testing, and implementation of a model to enable community health call centers (e.g., poison control centers, nurse advice lines) to support home-management and shelter-in-place approaches in certain mass casualty or health emergency events. The report includes a matrix with possible call center capabilities aligned with National Planning Scenarios and other guidance that can be tailored by call centers.
Login to rate, favorite, and comments on the article
This workbook guides planners through the process of determining the need for a call center, as well as how to operationalize a call center during public health emergencies.
Login to rate, favorite, and comments on the article
Agencies and Organizations
Login to rate, favorite, and comments on the article
Login to rate, favorite, and comments on the article
Login to rate, favorite, and comments on the article
U.S. Department of Health and Human Services, Health Resources and Services Administration.
Telehealth Programs.
Login to rate, favorite, and comments on the article
Login to rate, favorite, and comments on the article
Login to rate, favorite, and comments on the article