Heart Health Innovation: Telehealth Transforms Cardiac Care During COVID-19
Published: October 30, 2020
During the past 20 years, the heart valve industry has rapidly transformed with new therapies and diagnostic technologies. We have seen innovations like TAVR and sutureless valves go mainstream. We have witnessed the MitraClip restore cardiac function for patients on heart transplant lists.
Then, COVID-19. Fear. Shut-downs. Frustration. Confusion.
As the world stopped to address the pandemic, the patients and caregivers in our community quickly realized that the insidious and progressive nature of heart valve disease would not wait for a COVID-19 vaccine. To help manage valvular disorders, the utility of Telehealth applications skyrocketed to minimize the risk of COVID-19 infections during valvular treatment cycles. Now, many months into the pandemic, Telehealth has become a key innovation for patients, their families and their care providers – doctor, nurses, physician assistants.
To learn about the impact of Telehealth on patient care, I recently met with Dr. Vaughn Starnes, the Surgeon-in-Chief, and Dr. Craig Baker, the Chief of Cardiac Surgery, at Keck School of Medicine at USC in Los Angeles, California. As you may know, Dr. Starnes and Dr. Baker have successfully treated over 100 patients from our community.
Key Learnings About Telehealth for Heart Surgery Patients
Dr. Starnes and Dr. Baker shared a lot of innovative points during this interview. Here are a few highlights I jotted down:
- Drs. Starnes and Baker have dedicated a significant part of their practice and their careers to heart valve therapy given the rising prevalence of heart valve disease within our aging population.
- COVID-19 caused several shifts in the delivery of medicine. USC has implemented several new processes to ensure patient safety during COVID-19. Enhanced safety protocols at USC include social distancing (configuration shifts in clinics), screening protocols (temperature checks, questioning upon hospital entrance), coronavirus testing for all employees, sanitation protocols (sterilization), air filtration system reevaluation, and patient segmentation. At USC, there has yet to be one cardiac surgery patient who has been infected with COVID-19, according to Dr. Baker.
- During the pandemic, Dr. Starnes urges patients with cardiac conditions to monitor and get regular check-ups for their disease. If an intervention is required during COVID-19, Dr. Starnes suggests that patients should not wait to get treatment. If patients delay heart valve therapy, they are at risk for strokes, aortic dissections and heart attacks.
- Telehealth applications have helped Dr. Baker and Dr. Starnes treat patients safely during COVID-19. In addition, Telehealth is providing patients a more convenient way to get high-quality opinions and care without the challenges of long-distance travel, traffic and clinic time.
- COVID-19 challenged the USC team to think of new ways to make the patient experience faster and easier. Dr. Baker also believes that Telehealth is unexpectedly reducing anxiety for cardiac surgery patients as they are connecting with clinicians from the comfort of their own homes with other members of their family present.
- At the peak of COVID-19 infections, Dr. Baker saw between 60%-70% of his patients via Telehealth. More recently, Dr. Baker is seeing about 30%-40% of his patients using Telehealth platforms.
- Dr. Starnes believes that Telehealth is not a compromise during COVID-19. Instead, Dr. Starnes sees Telehealth as a new way for physicians to interact with more patients. However, Dr. Starnes believes there are new considerations that physicians will have to adjust to specific to the social interactions within the patient/doctor relationship that are not available via a screen.
- Telehealth is showing added value beyond the pre-operative work-up leading to a surgical event. Now, Telehealth is providing several opportunities for patients and medical teams after a heart valve procedure. For example, wound healing can be examined in a remote live setting.
- Specific to the future of Telehealth, Dr. Starnes believes the future is very bright. For example, USC has developed an innovative and extensive Telehealth protocol for remote monitoring of potential lung transplant rejection in cardiac patients.
- One potential utility of Telehealth for heart surgery patients is cardiac rehabilitation, according to Dr. Baker. Post-operatively, Telehealth could provide patients a unique remote platform to benefit directly from cardiac rehab classes without on-site attendance.
Many Thanks Dr. Starnes, Dr. Baker & USC!!!
On behalf of our patient community, I would like to thank Dr. Starnes and Dr. Baker for helping our community learn how Telehealth is helping heart valve patients at USC. I would also like to thank the entire USC team for the incredible care they have provided to the patients from our community!
- Are COVID Vaccines Safe After Heart Valve Surgery?
- Surgeon Q&A: Mitral Valve Surgery with Dr. Vaughn Starnes
- Physicians Unite for Telehealth Reform During COVID-19
- COVID-19 & Heart Valve Disease: 20 Facts to Know
Keep on tickin!
P.S. For the hearing impaired members of our community, I have provided a written transcript this video below.
Adam Pick: Hi, everybody. It’s Adam with HeartValveSurgery.com. Today, we have a very interesting surgeon question and answer session with not one leading surgeon but two. Today, we’re going to be talking about innovations in cardiac surgery, specifically the use of telehealth during COVID-19. I’d like to bring into the call Dr. Craig Baker. Dr. Baker, are you there?
Dr. Craig Baker: I am, Adam. It’s great to be here. Thank you.
Adam Pick: Dr. Baker, you have performed successful surgery on many patients in our community, including Ken Hall, Robert Adler, and Elaine Pratt. Question for you. Can you quickly share with the people what it is you do at USC?
Dr. Craig Baker: I am the Division Chief of the Division of Cardiac Surgery at the University of Southern California.
Adam Pick: Dr. Baker, I understand that valve therapy is a very big part of your practice. Can you talk a little bit about that?
Dr. Craig Baker: Yeah, no, certainly it is. Valve disease is becoming more prevalent, especially as people are aging. It’s become a dominant thing that I, as well as many of my partners, do. There’s as I think a lot of people know, four valves in the heart. We frequently get presented with people that have one-valve disease, two-valve disease, sometimes even three or four-valve disease. Operations can be very complex. They can involve replacing valves, repairing valves, or saving valves in different capacities.
Adam Pick: Now, let’s maybe talk about what’s been happening at USC with regards to COVID. Obviously, some very big change is happening in the way that healthcare is delivered to patients. Can you maybe share with all the great patients out there what’s been some – one or two of the biggest shifts in your practice since COVID began?
Dr. Craig Baker: One thing we learned, especially in heart surgery, is your health doesn’t stop and diseases don’t stop. At least in our field, emergencies and urgent cases present. Most of what we do, at least here at the University of Southern California, is not elective. We don’t have the luxury of stopping patient care. I think the biggest change was really asking ourselves how do we deliver the same quality patient care as timely as we have in the past in this COVID era knowing how concerned patients are about coming into hospitals. It really was all about making sure we had – always had safe protocols; I guess I’d call them enhanced safety protocols to make sure patients could come and feel safe coming to the hospital knowing that there may be patients that had COVID around this area around this hospital in the past.
Adam Pick: Dr. Baker, could you maybe share for the patients out there, put into context for them the new processes, or new protocols, or new precautions that you USC has implemented to ensure their safety?
Dr. Craig Baker: Sure, well, obviously, we had to look at all of our processes. Like most places, we had to figure out how to run our clinics with social distancing. That meant changing the configuration of all our personnel, of our waiting rooms, of how many people we could see in a day, maybe spacing out our clinics. Nobody gets into this hospital, physician, caregiver, nurse practitioner, physician assistant, or patient, without really adequate screening protocols. That means questions and temperature checks at every point just to be able to enter the facility because we wanted other patients to feel comfortable that everybody they may be around has been through a screening process.
A number of us had to have multiple COVID tests to just ensure as we continue to deliver healthcare that those are negative. USC instituted an institution-wide COVID testing for all employees so we could all show up to work knowing that we were safe. I think the sanitization protocols of our rooms changed a lot. We have really rigorous ability to sterilize patient rooms after patients are in. We’ve worked really hard with our clinic managers to make sure that gets done.
Then when it gets down to the procedural things, getting surgery, we looked at our air filter systems, how much the air is recirculated, what rooms could be used for patients that may have had COVID, and what would be used for elective. We don’t do any – we don’t have any COVID patients in our elective cardiac surgery rooms. That keeps them safe while we’ve had other rooms designed with enhanced HEPA filtration systems and things like that. If we do have someone in an emergency, we can take care of them as well. Fortunately, I can’t think of one patient that had cardiac surgery that got exposed and converted in any capacity. I think we’ve done a nice job with that.
Adam Pick: Great to hear all the things that you’re doing at USC to make your patients safe, Dr. Baker. Now, we want to bring in Dr. Vaughn Starnes. Dr. Starnes, are you there?
Dr. Vaughn Starnes: I am here, Adam. Nice to see you.
Adam Pick: Great having you with us. So everybody knows, Dr. Starnes is the Surgeon and Chief at Keck Medicine of USC. Dr. Starnes, question for you is should patients wait until they feel safe from COVID to come in and see their doctors and get treatment?
Dr. Vaughn Starnes: I think safety is a relative term, Adam. I would just urge patients that have a history of hypertension, diabetes, maybe have had a past issue of TI or a stroke, heart disease, all those things need to be continually monitored. I would not delay care. I would continue to see my physicians and get input into my care over those issues.
Adam Pick: Dr. Starnes, if patients were to wait too long to come into the hospital, what type of risks or health emergencies might they face?
Dr. Vaughn Starnes: Our biggest concern, particularly in the cardiovascular space, Adam, is strokes, maybe devastating complications of high blood pressure like aortic dissections, and even cardiac myocardial infarctions, or heart attacks. All of those can be devastating complications of delayed care.
Adam Pick: Dr. Baker, can you help the patients watching this video understand how telemedicine helps you treat patients safely?
Dr. Craig Baker: That’s a great question, Adam. It’s interesting because, in the pre-COVID era, we talked a little bit about telehealth. I couldn’t help but think I get a lot of patients for example from Bakersfield or the Inland Empire. They spend two hours on the road coming to see me and then the clinic time. It’s a whole day experience.
We always thought in the back of our minds, there’s got to be a better way for patients to get opinions and get high-quality care without putting them through that whole day. By the time you have your clinic visit, come back for labs, get scheduled for surgery, you can spend a few days just getting to your operation. As difficult as COVID’s been, it’s really challenged us to put some of these ideas at the forefront. As you said, I think telehealth and telemedicine is one of the things that really took off because of this.
Adam Pick: I’ve got to ask you, given all those efficiencies, Dr. Baker, and the ability for patients to talk with leading clinicians like yourself and Dr. Starnes, do you think this does anything for the anxiety level of patients given that they’re getting to meet you and be with you in a way that wasn’t previously possible?
Dr. Craig Baker: Yeah, well, it’s funny; we always talked about whitecoat hypertension. People come to your office. There’s a tremendous of anxiety, of nervousness. I certainly think people being able to get a consult in the comforts of their own home, or not having to take a full day off work, or be able to be home on their computers while they’re waiting for the interview to start takes a huge amount of anxiety away from patients. They often now can involve other people in their families at that interview that may not have all been able to coordinate a day off to come to the physician’s office.
Adam Pick: Anytime you put a new process into place, there is often friction. What I’m really curious to know though is you’ve been doing this now for a while, several months. I’m curious, what percent of your meetings with patients are done by telemedicine?
Dr. Craig Baker: I think when COVID was at its heightened period and we were really trying to have almost no contact in the clinics, I think that number got as high as 60 or 70%. I think it’s probably back down to about 30 to 40% now. Certainly, there’s patients that are close by, that know how safe our hospital has been, that know how much we’ve put the effort in. They want to come in; they want to meet face to face. I think on some level, the seriousness of what we do in open-heart surgery and stopping people’s heart, at some point, I think that personal interaction is important.
Adam Pick: Let’s go back to Dr. Starnes. Dr. Starnes, quick question for you. With telemedicine coming online in a big way due to COVID, do you feel like this is a compromise that we’re working around now during COVID?
Dr. Vaughn Starnes: Telemedicine is going to be a new way of physicians interacting with their patients, probably even more so than we were in in-person interviews. We obviously have to get used to is the social interaction if you would that we would have in a physician’s office. We see each other on a screen, but sometimes we don’t get all the physical cues that we could get if we were together.
The quality of healthcare won’t change. It might be even increased. I don’t think it’s a compromise; it’s just another way we’re going to be delivering healthcare. I think we can deliver healthcare to more people by telemedicine.
Adam Pick: Dr. Baker, there’s been so many great stated benefits of telehealth that you and your team are harnessing to deliver care to your patients. I’ve got to ask you, I’m curious, has there been anything unexpected that you have seen happen as a result of this movement to telehealth?
Dr. Craig Baker: Yeah, it’s interesting, Adam. We obviously put all of our thought and processes into the preoperative environment. How can we see patients about their problems, safely console them and talk about a surgical plan, and then get to their surgery? We didn’t really think through in the beginning what the potential benefits may be after somebody leaves the hospital and is recovering from their surgery. I think this has been another tremendous advantage.
Obviously, despite our best efforts to educate, to go over medications, to go over incisions and wound healing, things come up. Patients have questions and concerns and ailments. In the past, they may have been called and had to come down for another clinic visit or we tell them to go to an emergency room because these are really hard things to visualize over a phone. Now, our office, myself, my allied health professionals can connect in a video live environment, actually get a feel for is the patient looking distressed? Are they diaphoretic? They can show us their wounds. We can decide, is it red? Is it just a tape reaction or cellulitis? It’s really made the ability to even take care of people after surgery better, which is not something I had really anticipated.
Adam Pick: With all the great innovation that’s happening right now with telehealth, Dr. Starnes, I’m curious to know, what do you see as the future of telehealth?
Dr. Vaughn Starnes: Telehealth is going to have an amazing future. For example, our lung transplant program has got a pilot program going on today, where after a person gets a lung transplant, they can be followed by telemedicine at home. By looking at a PFT remotely, that is pulmonary functional test, they can actually have the potential to pick up early rejection. Even with a complicated patient like a lung transplant patient, you can communicate about their medicines, reassure them that they’re not having a lung rejection process. If they do pick up signals that they need to come in, we can relay that to them and do it in a planned fashion such that we don’t have critical emergencies happening all the time. This is a remarkable addition to what we do with healthcare medicine.
Adam Pick: Dr. Baker, do you see any upcoming opportunities in which telehealth might be used in another way to help patients?
Dr. Craig Baker: Yeah, we were just recently talking about cardiac rehab. I think, as you know, we have the great intermediary step for people not ready to go home. They’re actually discharged at USC where we have an excellent rehab unit. They’re actually discharged from the hospital. They go down to a different floor where they’re readmitted to a rehab service. That’s great, but there are a lot of patients that want to go home and come in for outpatient rehab. I think one of the things we’ve been talking about is there a possibility to add telehealth to rehab?
It’s ironic; my son, like many people’s children, are in virtual school. My son is now having virtual PE where he has an instructor. His basketball and football coach are going through drills and exercises. Never would have thought about this before, but you could see now how physical therapy postoperatively could have a telehealth program where patients would log in with instructors and go through the right exercises.
Adam Pick: It’s in these really challenging times that innovations occur and appear for us in ways that we just never expected. It really great to hear almost about a new layer of virtualization of medicine and how you and your team are so aggressively, Dr. Baker, going after this. On behalf of all the patients out there, I really want to thank you and I want to thank Dr. Starnes and the entire team there at USC for all the great work that you’re doing to help patients during this very difficult and trying time. Thank you so much.
Dr. Craig Baker: Thank you, Adam, very much. Thank you for what you’ve done for patients. I can’t tell you how many patients come in and see me after reading about heart surgery on your various platforms. I think it’s been a terrific asset for patients, so congratulations.
Adam Pick: Thank you so much, Dr. Baker. As we always say here, keep on ticking.