Going to a hospital or clinic can be scary for people who need to see a doctor but are worried about the growing coronavirus pandemic.

Thankfully, many of those seeking care from doctors, nurses and other health care workers at Keck Medicine of USC have another option: a virtual visit from the comfort of their home.

All health care providers with Keck Medicine’s hospitals and clinics throughout Southern California are now credentialed to practice telemedicine. They’ve checked on thousands of patients during the past few weeks using videoconferencing technology, eliminating the risk of spreading COVID-19 to these patients through their practices. At USC Verdugo Hills Hospital, Emergency Department patients presenting symptoms of COVID-19 are being triaged via telemedicine tablets in specialized patient pods.

“What is so heartwarming is when our patients can see their doctor and there is definitely still that connection,” said Laurie Johnson, chief ambulatory officer at Keck Medicine. “That smile and warm touch still comes across, even when it’s a telemedicine visit. Our patients are thrilled, and I see how our doctors are adapting to this, too. Through a stressful and difficult time, we’re seeing that humanity come through.”

It’s all thanks to a massive push by health care providers, information technology specialists and hospital and clinic administrators to expand telemedicine at USC. In only a month, what had been a small pilot project in a handful of locations grew into a full-fledged system that now keeps Keck Medicine patients and health care workers safer.

“All these resources went into overdrive and rapidly rolled out at scale what we previously had been doing at a snail’s pace,” said Dilip Parekh, MD, chief clinical officer for digital health and Keck Medicine’s provider network. “We went from something like 15 visits a week to almost 1,000 visits a week in a matter of a couple of weeks. It’s really a testament to teamwork.”


Telemedicine protects patients and care providers during coronavirus crisis

Like other medical centers nationwide, Keck Medicine must keep its routine patients away from its offices and clinics to curb the spread of COVID-19. But these patients can still talk with their physicians, nurse practitioners and other providers using telemedicine.

Reducing routine in-person visits means that doctors can more safely see patients who would be especially vulnerable to complications from the new coronavirus, including the elderly and those with serious health conditions.

“Our population of patients tends to have more serious chronic conditions than the general population,” said Anjali Mahoney, MD, vice chair for clinical affairs in the Keck School of Medicine of USC’s Department of Family Medicine. “Having them come in for visits can expose them and make them a lot sicker than if we can do a video visit.”

Medical professionals also use telemedicine to screen patients who think they might have the virus. Screening remotely avoids unnecessary contact with other people, including medical staff. That’s critical to the effort to respond to the outbreak, Mahoney said.

“We’re also trying to make sure we preserve and protect our health care workers,” she said. “We know we’re going to experience a surge at some point, and we need those health care workers to be available and not sick themselves.”

Mahoney and family medicine colleagues got their first taste of telemedicine through a pilot project that started last fall. Their experience made the jump to video technology easier. Nonetheless, the shift to telemedicine since the COVID-19 outbreak began has been a tremendous undertaking. Parekh noted that in the past few years, Keck Medicine averaged only 300 to 400 patient visits a year using its telemedicine platform.

“Now we’re seeing about 700 to 1,000 telemedicine clinic visits each week,” he said. “In the last month, we had around 4,000 telehealth clinic visits.”

Of 114 Keck Medicine clinics that are now offering telemedicine services, 80 launched those services this month. Virtual visits account for 86% of patients’ check-ins with their doctors — a stark change from only a month ago, when most patients saw their physicians in person.

“Frankly, one of the most affirmative and proud moments for me was to see how the Keck family all came together in this crisis,” Parekh said. “Yes, we’ve had some problems with the technology, but people worked with it, came together and said, ‘We understand the limitations of this approach, but we want to take care of our patients the best we can under these difficult circumstances.’ The whole spirit of collaboration and working together as a team, driven by our leadership that showed that spirit in daily practice, was a huge factor.”


Keck Medicine doctors find telemedicine to be valuable substitute for in-person visits

Sirisha Mohan, MD, has been conducting virtual visits with her patients in the Department of Family Medicine since October. The clinical assistant professor of family medicine likes seeing patients over a video feed instead of talking by phone.

“At a time when social distancing is going to cause increased rates of anxiety and depression and loneliness, being able to connect with your doctor face to face is reassuring and helpful,” said Mohan, who has helped lead the effort to expand telemedicine in her department. During the COVID-19 emergency, she is grateful to have other options to see her patients safely.

She recently spoke with a respiratory nurse practitioner in Keck Medicine’s chronic lung disease division who had never done virtual visits until recently. She had only checked in with patients over the phone. She told Mohan that a virtual visit allowed her to easily gather much of the information she would normally get during an in-person visit.

“That’s versus just a telephone call, which was giving her maybe 50%,” Mohan said. “We’re really able to move the mark on how well we can assess how somebody is doing.”

Mahoney, her colleague in family medicine, shared similar sentiments. She said health care providers now see five to 10 patients per day through telemedicine rather than in person, and providers and patients are adjusting well.

“One of my providers told me yesterday that she had someone with a sore throat,” Mahoney said. “She saw the back of their mouth better than she’s ever seen in person, because she had them hold their phone camera up to their mouth. It’s pretty amazing how much you can do with this technology.”


Medical professionals encourage people in need of care to try telemedicine

To further reduce risk, many doctor visits can be postponed until a later date to ease the pressure on health care workers, said Johnson, the chief ambulatory officer. Annual physicals and other wellness check-ins are being rescheduled, as are procedures that aren’t considered urgent.

“Let’s push those out until things are more reasonable,” she said. “Patients are more than willing to take that option and stay at home, stay safe and see their doctor over video.”

But health professionals urged people who need medical help to call their physician, especially if they can do that by video.

“Check in with your doctor,” Mohan said. “Make sure you’re getting the care you need. We don’t want other medical problems to become worse or be neglected in light of all this. We have to all stay healthy and do it in a safe way, and telehealth is the way to do it.”

If patients are concerned about using new technology, Johnson suggests they ask for help before their appointments. Support staff members can guide patients as they download the videoconference application and get used to using the platform before they see their doctor.

Providers also are getting up to speed with help from training videos and an information technology team that provides equipment and training sessions.

“It has been an experience that is unprecedented,” Johnson said. “But under these difficult circumstances, the adoption by our patients and physicians has been phenomenal.”

— Eric Lindberg