TRENTON, N.J. – Addressing emergency health care needs virtually during telehealth visits has become increasingly necessary during the Covid-19 pandemic, says Assemblywoman Holly Schepisi. The lawmaker introduced a bill this week that acknowledges this new trend in health care delivery by revising the standards and protocols for activating emergency care plans during virtual sessions.
“Telehealth and telemedicine technologies have become crucial to meeting the needs of patients during the public health crisis,” said Schepisi (R-Bergen). “People have not only put off in-person annual screenings and visits with primary care physicians and specialists, but they have also avoided emergency rooms and instead sought medical care from their home. We must recognize that doctors will inevitably encounter more emergency situations as more patients choose to seek all types of medical care through telehealth.”
A survey from DrFirst found that 44 percent of Americans used telehealth services during the pandemic and 60 percent of patients rescheduled or postponed a doctor’s appointment. Forty-four percent of Medicare primary care visits were done via telehealth in April last year, compared with less than one percent in February before the COVID-19 public health emergency. The Centers for Disease Control and Prevention found a 154 percent increase in telehealth visits during the last week of March 2020, compared with the same period in 2019.
“When my patient has an emergency in the hospital or my office, I take responsibility to handoff or transition care appropriately by coordinating the emergency,” says Dr. Jon Ditkoff, an ophthalmologist in Bloomfield. “We should have the same standard of care for telehealth.”
Under current law, health care providers engaging in telemedicine or telehealth are to make appropriate referrals for emergency care. Schepisi’s bill (A5451) would require providers to determine the patient’s need for emergency services and then make an effort to directly activate and coordinate for emergency medical care in the patient’s area. Doctors would need to give the patient’s name, location, and contact information to emergency care providers.
“Our telehealth platforms already incorporate 911 activation software which satisfies the best practice referenced in the bill Assemblywoman Schepisi is sponsoring,” said Bergen New Bridge Medical Center President and CEO, Deb Visconi. “We are proud to be leading the way in maximizing technology to further patient safety and care and pleased to see this bill introduced supporting 911 tracing and activating platforms similar to what we’ve already adopted.”
The Joint Commission stated in their Sentinel Event Alert 58 that hand-off communication should standardize critical content to be communicated by the sender during a hand-off in both verbal and written form. One study published in the New England Journal of Medicine found that when similar standards for handoff of patient care was implemented, medical error decreased by 23 percent and preventable adverse events decreased by 30 percent.
“While the convenience of receiving and delivering care from practically anywhere is very attractive to patients and doctors, there are logistical challenges that need to be addressed,” said Schepisi.
The bill asks doctors to develop standards and protocols for both verbal and written handoff to ensure the same standard of care is upheld for telehealth.
“When COVID hit, our telehealth visits increased, and so did the rare emergency cases,” says Dr. Alexander Chiu, President at Air Visits telehealth practice and board-certified emergency doctor. “During an emergency is not the time to ‘figure it out.’ We’ve created our emergency plan to include corner case scenarios, and it’s great that Schepisi’s bill asks doctors to create a similar comprehensive plan.”
Schepisi’s bill also requires providers to report suicide attempts during telehealth visits to the Department of Health and document emergencies.
“The coronavirus has not only taken a toll on people’s physical health, but greatly increased the need for mental health care. Residents are grappling with increased anxiety and depression, suicidal thoughts and abusing substances to cope,” said Schepisi. “In order to save lives, we need to make sure that people can receive immediate medical intervention, even when they are not in a medical setting.”
The CDC found that 40 percent of adults reported experiencing mental health and substance abuse issues during the pandemic. More than 10 percent of respondents reported having seriously considered suicide in a 30-day period.
“Patients who are suicidal or have a drug overdose may not be able to call our 911 public safety answering point,” says Little Falls Township Police Chief Steve Post. “Receiving the patient’s address digitally and verbally from a doctor is at times the only way we know where to send first responders. The doctor may also have medical and situational information and needs critical to the case. I’m happy to see a bill promoting the cooperation between our emergency services and telehealth doctors.”
Sen. Michael Testa (R-Cape May) sponsors the companion bill in the Senate.