Coronavirus pandemic makes virtual house calls in vogue. Here's how they work

telehealth 1.jpg — Heidi Olson-Fitzgerald, a Sanford Health physician's assistant, meets virtually with Ella Streff, a 12-year-old Harwood, N.D., patient, to check on her allergies and asthma. Virtual visits have exploded in popularity as routine clinic visits have been suspended or sharply curtailed during the coronavirus pandemic. Special to The Forum by Sanford Health

April 17, 2020 at 6:00 AM

FARGO — Ella Streff’s asthma was flaring, making her cough, interfering with her sleep and prompting her to use a rescue inhaler more often than usual.

So the 12-year-old Harwood girl’s primary care provider adjusted her medication and scheduled her for a follow-up examination in four to six weeks to see how she was managing.

Ordinarily, that would have meant coming into the clinic in Fargo for a face-to-face visit with Heidi Olson-Fitzgerald, her physician’s assistant.

But the coronavirus pandemic derailed that plan, as health providers have largely canceled routine clinic visits to prevent the spread of the infectious respiratory disease the virus causes, COVID-19.

Unfortunately, the arrival of spring would mean Ella’s seasonal allergies would return, exacerbating her asthma.

So Ella did what countless other patients are doing in these times of stay-at-home advisories: she met with her provider via video conference, which her mother arranged on her smartphone.

“It went really well,” said Randi Streff, Ella’s mother. “The two of them talked like they normally would.”

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Patients have embraced video visits in a big way at both Sanford Health and Essentia Health.
Before the coronavirus pandemic hit, as recently as early March, Sanford was averaging 100 weekly video visits throughout its network. That number has exploded to 10,000 weekly visits, said Jennifer Morrison, a Sanford senior executive.

“It’s continuing to go up, so I see that number getting higher,” she said.

At Essentia, the numbers are even higher, with almost 3,000 virtual visits daily and, at any given moment, more than 100 visits happening simultaneously.

In fact, the response has been so strong that Essentia has conducted more than 34,000 virtual visits, catapulting a trend the health system already had been encouraging.

“We had been working toward this goal prior to the COVID-19 pandemic,” said Dr. Richard Vetter, Essentia’s chief medical officer in Fargo. “The pandemic certainly accelerated our plans and moved the launch date forward.”

The virtual visits include physical, occupational and language therapy, and the results have been encouraging, according to Essentia.

Bruce Neuhalsen of Moorhead, who suffered a stroke at age 47 that left him unable to walk, sit up or balance, said the video visits are less stressful for him than entering the clinic, where his blood pressure is elevated, a response called “white coat syndrome.”

“The virtual visit where I’m at home and not entering the clinic leaves me more relaxed and offers a more conducive therapy experience,” he said. “I’m free with my thoughts and conversation.”

Randi Streff also appreciates the convenience of allowing her daughter to visit the clinic virtually, without having to leave home, which saved time traveling and having to sit in a waiting room.

Her children already were at home instead of attending school as a precaution. “It’s best to keep them safe,” she said. “So I was happy to do it by video. I think for this kind of thing it definitely is easier. It seems a lot simpler to do it online.”

Streffs’ experience appears common. Olson-Fitzgerald, Ella’s physician assistant, said her patients have quickly adapted to virtual visits.

“Now it’s gotten to be our way of daily care of patients,” she said. “They liked coming in and seeing their primary care provider. This virtual visit has been able to maintain that.”

Virtual visits have a few advantages, she said. It allows an appraisal of home safety status for elderly patients, for example, and has allowed her to meet patients’ family members, including children who are future patients.

“It was an opportunity to see them in their home environment,” Olson-Fitzgerald said. In another example, during a virtual visit she was shown how a family had arranged their home for a child with attention deficit hyperactivity disorder, with areas set aside for homework, artwork and play.

Virtual visits work for many routine visits, but are not suitable when laboratory or other testing is needed, or when physical examinations are needed, she said.

“As an organization, we’re trying to do whatever we can remotely,” Olson-Fitzgerald said. Also, she and others predict, now that patients are becoming familiar with virtual visits, they likely will become normal.

A few patients preferred to handle their visits by phone or alternatives including Apple FaceTime or Google Duo, Olson-Fitzgerald said.

“When we come out of this we’re going to see much more virtual care and probably a decline in face-to-face visits,” she said.

How to prepare for a virtual clinic visit

Be sure to download the appropriate app for your health provider, such as Essentia MyHealth or My Sanford Chart, which have built-in virtual visit capability.
Make sure your Wi-Fi connection is working. Check the batteries of your device.
Write down a list of questions you have for your provider.
Have a list of your current medications, or have them handy.

1/2: A tablet split screen displays Heidi Olson-Fitzgerald, a physician's assistant at Sanford Health, top, conducting a virtual clinic visit with Ella Streff, bottom, whose visit was a checkup to see how medication alterations were working to control her asthma. Special to The Forum by Sanford Health

2/2: Heidi Olson-Fitzgerald, a physician's assistant at Sanford Health, believes that virtual clinic visits, which have largely replaced conventional clinic visits during the coronavirus pandemic, will continue to be widely used after the public health threat subsides. Special to The Forum by Sanford Health