Lessons Learned from Ebola Help UVA's Telehealth Center Take on COVID-19

The University of Virginia Health System is applying lessons learned during the Ebola crisis to advocate for telehealth expansion during the ongoing Coronavirus pandemic and beyond.

Telemedicine technology used during the 2014-16 outbreak, which killed more than 11,000 Africans and one person in the US, helped the health system contain the deadly outbreak, reduce instances of patient-to-provider transmission and reduce the use of personal protective equipment (PPE), according to a paper published in the Annals of the American Thoracic Society.

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That, in turn, has helped UVA’s Karen S. Rheuban Center for Telehealth improve access and care management during the COVID-19 crisis.

“One of the few bright spots of the COVID-19 crisis is that it’s shown us how remarkably powerful and versatile telemedicine can be during outbreaks of novel contagious diseases,” UVA Health epidemiologist Costi Sifri, MD, said in a press release. “Its importance in helping us care for patients in their home while sheltering-in-place is clear. What we show here is that telemedicine solutions can also be used within the walls of hospitals, emergency rooms and clinics to help provide enhanced, more efficient and safer patient care for those potentially infected with high-risk pathogens.”

During the Ebola crisis, the UVA Health team created the UVAHS Isolation Communication Management System (iSOCOMS), a real-time video-enabled telemedicine platform, to help healthcare workers treat infected patients in isolation. The platform was used at the University of Virginia Medical Center, which was designated an Ebola Treatment Center in 2014, and used to treat three patients.

According to the report, the telemedicine platform offered seven potential benefits:

1. It could be used to facilitate communication between care providers in isolation, such as a biocontainment room or sealed ICU unit, and those on the outside, including nurses, specialists and the patient’s family.
2. It could be used to facilitate communication between the patient in isolation and those outside the room, including care providers and family.
3. It could be used for remote monitoring of patients and staff, either in the room or elsewhere.
4. Because it’s mobile, it could be used to help transfer patients from one place to another, such as from the home to the hospital or between care facilities.
5. It could be used to help providers who hadn’t completed training in infectious disease care (including PPE training) to participate in consults.
6. It could be used to provide patient access to family, counselors, chaplains and other remote services.
7. It could aid in training students to become infectious diseases care providers.

Conversely, the telemedicine platform comes with some adverse outcomes or problems, including the potential for the technology to expose patient health information to outside sources. It could also cause care providers to become overconfident in treating infectious patients, to the point that they’d expose themselves or others to the virus. In addition, the equipment is expensive, and no studies were undertaken to measure patient acceptance or provider confidence in the technology.

Balancing the two, the researchers reported that a telehealth platform has the potential to do more good than harm in treating patients with viruses like Ebola or COVID-19.

“The opportunities of incorporation of telemedicine to care for patients with highly virulent contagious diseases to enhance HCP safety, patient safety, the patient experience, and medical education are significant and could be considered during the care of other patients with Ebola virus and highly contagious and virulent infectious diseases,” they concluded.

UVA Health has been using the connected health platform since the Ebola crisis in its Special Pathogens Unit and a biocontainment room in the Emergency Department, as well as in rooms in the health system’s newly-built South Tower.

“The digital transformation of healthcare has unquestionably been propelled by the COVID-19 pandemic,” Karen S. Rheuban, MD, a founder and medical director of UVA’s telehealth program and former president of the American Telemedicine Association, pointed out in the press release. “The use of iSOCOMs and a broad range of telehealth solutions has positively impacted patient access and reduced exposure for our patients and providers alike.”