It may or may not be obvious, given that we’re emerging from a worldwide pandemic, that the country is facing a shortage of infectious diseases (ID) clinicians. To try to expand services to areas without easy access to these experts, ID experts at the University of Pittsburgh in 2019 launched a telehealth-based infectious diseases consultation service, which they discussed during a May 2023 webinar hosted by Becker’s Healthcare.
Other hospitals and companies are offering Tele-ID — a term for telehealth-based infectious diseases services — through companies like Eagle Telemedicine to diagnose and manage patients with conditions such as COVID-19, staph or strep infections, tick-borne diseases, flu, sepsis, RSV and more. It’s an interesting trend for journalists to follow and one of several telehealth models I have learned about for specialty areas of focus such as physical medicine and rehabilitation.
The University of Pittsburgh’s model, called Infectious Disease Connect (ID Connect), contracts with other centers to provide infectious diseases services in three types of visits, according to ID Connect President and CEO Rima Abdel-Massih, M.D. These types are:
- Live audio/video visits, in which infectious diseases experts review patients’ electronic medical records, take a full medical history and provide a comprehensive exam along with an on-site presenter/health care worker attending to the patient. All information is documented in patient charts. This can be used for an initial or follow-up visit.
- An asynchronous visit or e-consult, in which infectious diseases experts conduct a chart review and make recommendations noted in patient charts but do not interact live with the patient. This also can be used for an initial or follow-up visit.
- Telephone physician-to-physician consults, which usually are reserved for rapid or simple questions.
Telehealth versus in-person visits
The team has conducted several studies to evaluate the service’s performance, Abdel-Massih said, including one comparing tele-ID at three of its own hospitals early in the pandemic (March-May 2020) to in-person infectious diseases consults provided between March-November 2019. Patients were evaluated by the same general and transplant infectious diseases experts. Excluding COVID patients, tele-ID services had comparable outcomes to in-person services and even achieved a lower 30-day hospital readmission rate and shorter intensive care lengths of stay. Results were presented in an abstract at the IDWeek meeting in 2021.
Karen Bash, M.D., chief medical officer for WakeMed North Hospital in Raleigh, N.C., said during the Becker’s Healthcare webinar that her hospital already had been using telehealth services for access to experts in behavioral health, endocrinology, neurology, pain management, palliative care and stroke when they decided to add a tele-ID service.
Infectious diseases experts from her health system’s main hospital weren’t available at her location, which meant patients often had to be transported to the main hospital campus just for infectious diseases consultations. It was dissatisfying for patients as well as clinicians and nursing staff and resulted in inefficient care and delayed evaluations. Plus, it tied up the mobile transport teams.
Now, a dedicated telepresenter at the hospital schedules all tele-ID consultations in the mornings, and a telemedicine template built into the electronic record ensures the billing department has all the necessary information to submit claims. A certified nursing assistant is able to help during the online physical exams for tasks like wound assessment and interpreting heart or lung sounds.
Resources like this are important in an era with a growing demand for infectious diseases experts, said John Mellors, M.D., chief of infectious diseases at the University of Pittsburgh, during the webinar. There is an aging population and more immunosuppressive therapies, a growing threat of antimicrobial-resistant organisms, a continued risk of virus outbreaks and drug-resistant pathogens, and expanding regulatory mandates for more judicious use of antimicrobial drugs and better infection control and prevention.
However, Mellors said, 80% of U.S. counties — comprising more than 200 million citizens — are without access to an infectious diseases physician, referencing a 2020 study published in the Annals of Internal Medicine.
The problem is multifactorial, Mellors said, resulting from an aging, largely male infectious diseases workforce; fewer people going into the infectious diseases field; few jobs in desired locations; inadequate salary relative to other specialties; a potentially undesirable mix of clinical activities; and a high workload and risk of burnout. Some 44% of infectious diseases fellowship training programs and 57% of pediatric infectious diseases fellowship training programs had spots unfilled this year, he said, citing 2023 statistics from the National Resident Matching Program.
“Will the U.S. have enough [infectious diseases] physicians moving forward?” Mellors asked. “The answer is no. … There is a troubling future for access to [infectious diseases] care.”
Reporters could pursue a number of story angles in stories on specialty uses of telemedicine, looking at areas such as cost savings, outcomes, access to care, providers’ and patients’ experience with the services, and staffing — i.e., is it easier to recruit experts for telehealth-based services than in-person ones? This issue also hints at some story angles for infectious diseases, including what any innovators in the field are doing to attract and retain new professionals.
Experts for infectious diseases telehealth stories
- John Mellors, M.D., chief of the infectious diseases division and distinguished professor of medicine at the University of Pittsburgh: firstname.lastname@example.org
- Rima Abdel-Massih, M.D., president and CEO of Infectious Disease Connect, and associate professor of medicine at the University of Pittsburgh: email@example.com
- Karen Bash, M.D., chief medical officer, WakeMed North, Raleigh, N.C.: 919-350-8000 (main hospital switchboard)
- American Telemedicine Association – Gina Cella, PR representative: firstname.lastname@example.org or 781-799-3137