Johns Hopkins Medicine Surpasses 1.5M Telemedicine Visits Since Start of COVID-19 Pandemic
Johns Hopkins Medicine physicians and clinicians have conducted more than 1.5 million telemedicine visits with over 420,000 patients in Maryland, Washington, D.C., Florida and across the country since the start of the COVID-19 pandemic, according to the Johns Hopkins Office of Telemedicine.
“I’ve said before, the adoption of telemedicine use was a dream come true in a nightmare scenario,” says Rebecca Canino, executive director of the Office of Telemedicine. “I’m just so grateful to Johns Hopkins leadership for not only foreseeing the need for this, but investing in it early so that we were ready to support the sudden demand.”
While some medical visits must be in person, approximately 60% of Johns Hopkins physicians and clinicians have used telemedicine at least once since March 2020, according to the Office of Telemedicine.
“It’s really become part of routine outpatient care two and a half years after the start of the pandemic,” says Helen Hughes, M.D., M.P.H., medical director for the Office of Telemedicine. “Now it’s our job to figure out how to make it the best that it can be and make sure that we’re offering the best clinically and technically.”
Some physicians and clinicians have performed a handful of telemedicine visits while others have done thousands. Some had never seen a patient virtually before the pandemic, while others were already practicing remote care. Here are how three have used telemedicine and how it has changed their practices.
Risa Wolf, M.D.
Assistant professor, Division of Pediatric Endocrinology
Medical director, Camp Charm City
Risa Wolf was the first pediatric subspecialty physician at Johns Hopkins Children’s Center to use telemedicine, in early 2018 in Easton, Maryland, as part of a pilot program with the Talbot County Health Department to see Eastern Shore patients for follow-up visits.
Today, she sees a quarter of her patients via telemedicine, including about one-third of her patients who have diabetes. Wolf generally alternates in-person and telemedicine visits for patients with diabetes, who are seen every three months for follow-up care.
“At the start of the pandemic, we transitioned a lot of follow-up care to telemedicine, and diabetes lends well to this because many of our patients with diabetes use technologies such as continuous glucose monitors, insulin pumps and hybrid closed loop systems that upload data to secure platforms that we can view remotely without the patient present,” she says.
During the school year, Wolf schedules early-morning telemedicine appointments before families go to work and school. Parents also appreciate after-school virtual appointments instead of taking children out of school early.
Wolf has developed a system in which patients or their parents report height and weight measurements and physical examination findings as part of a virtual visit, and then she performs a comprehensive exam during an in-person visit. Wolf shares her computer screen with patients during both types of appointments to review clinical data and results.
“Telemedicine can be an effective platform for patient care, and it has a lot of benefits for both patients and physicians, it saves time and money for patients, and it also can allow the physician to be more efficient in transitioning from patient to patient in a clinic setting,” she says.
Denis Antoine II, M.D.
Director, Center for Addiction and Pregnancy, Johns Hopkins Bayview Medical Center
Assistant professor, psychiatry and behavioral sciences
Denis Antoine went from seeing no patients virtually in March 2020 to seeing every patient virtually one month later. That’s because Antoine oversees a clinic in a Baltimore thereapeutic community for people who are homeless.
“There was a high risk of COVID transmission to other clients in the area and also our staff, so we needed to make something that was safe but still keep the high amount of services that we needed,” he says. “Telehealth was the only way we could think of to keep things going.”
Antoine purchased Wi-Fi and equipment for the building, and a streamlined technical workflow was developed so that all patients need to do is click an icon to log in for their appointment.
As a psychiatrist, Antoine’s biggest concern starting telemedicine was whether he could obtain the information he needed from his patients remotely. But many patients have been more open on Zoom, he says, because they feel more at ease speaking from their own environment.
“I can just say, ‘Hey, I’m going to be Bob Ross and I’m going to paint a picture of your life and we’re going to talk about that,’ and that works,” Antoine says. “And for a lot of folks who are coming to my virtual sessions, they have never seen a therapist or psychiatrist before. So, I’m just easing them into the process and making them more comfortable.”
One thing he will apply from his telemedicine visits to in-person visits is to have patients provide more information before their meetings so he is typing less — unlike during in-person visits, patients aren’t distracted by Antoine’s keyboard during virtual appointments.
Antoine and his staff have appreciated the flexibility of telemedicine and will continue to use it, meeting patients in person for more complex cases.
“One day, I was seeing a patient, then I had to go be director of another clinic, so I just swiveled my chair,” he says. “And then, a half-hour later, I was testifying at the state Senate for a bill. You can do a lot without having to drive back and forth to different locations.”
Sherilyn Brinkley, M.S.N.
Nurse practitioner and program manager of clinical services and research, Viral Hepatitis Center
Sherilyn Brinkley started using telemedicine more than four years ago to provide specialized infectious disease services to parts of rural Western Maryland. The program was firmly established by March 2018, with most patients going to a local health department and working with a Johns Hopkins nurse on-site who assisted with the virtual visits.
Brinkley says she was initially concerned her patients would feel like they were getting impersonal and noncomprehensive care, particularly among a population where building trust is crucial.
“What really helped our programs quickly become successful is the fact that we did have that bridge with our practice of having a nurse there, who really smoothed all those pieces out for us,” she says. “Now, so many people are comfortable with the idea of having a video visit.”
The COVID-19 pandemic, however, forced patients to receive care virtually from their homes, where some did not have Wi-Fi or computers and had to use their phones for video or audio calls. Brinkley estimates she now sees 85% of her patients on video and more than half of her patients overall via telemedicine. She helps patients access hepatitis C treatment services or stabilize opioid use, and she treats substance use disorder with buprenorphine-naloxone.
“I’m able to get to people who are not able to get to traditional medical care in their communities,” she says. “The most gratifying part of [using telemedicine] is that we’re helping people that wouldn’t otherwise be able to get this care, and people are exceedingly grateful. That word of mouth is what’s really driven our program over time.”
Brinkley says telemedicine has given her an appreciation of the obstacles some patients need to overcome to get to in-person appointments. Telemedicine will not replace those visits entirely, she adds, but its use will continue to be “absolutely critical” for treating patients.
“It’s not going to go away, and there are many people who greatly benefit from this model of care,” she says.
Looking ahead, Hughes says the Office of Telemedicine hopes to grow its remote patient monitoring capabilities into the ambulatory and complex care space, allowing for more proactive care of patients at home. As digital health care tools are used more routinely, it is more important than ever to ensure equitable access, she says. The office, staffed by a dozen people with a combination of administrative, clinical and IT backgrounds, is working with Johns Hopkins leadership and the Baltimore mayor’s office to help make digital health tools more accessible for everyone.
Telemedicine also will be used to make specialty care more available to patients at Johns Hopkins Medicine hospitals, Hughes says, “to keep patients in the right beds, within their communities and close to their support systems, and to avoid unnecessary transfers.” The idea is to connect patients at any Johns Hopkins hospital to specialized physicians at the East Baltimore campus via video, also known as teleconsultation. A pilot project, for example, is remotely connecting patients at Johns Hopkins Bayview Medical Center’s neonatal intensive care unit with pediatric specialists at The Johns Hopkins Hospital.
“The overall goal is, no matter where you go in the Johns Hopkins Health System, that you get the same high level of access to our specialty and subspecialty care,” says Canino.