Telemedicine at IndyCare in Hillsborough

Franklin Roye, president of IndyCare Health, talks with Nisha Kotecha, FNP while she conducts a telemedicine video visit.

 

Imagine waking up early on a Saturday morning, to the sound of your spouse coughing and blowing her nose. The coughing began the day before and was passed off as being “just allergies,” but this morning, a fever has joined the party.

This scenario played out at my house three weeks ago. My wife, a school teacher, was experiencing flu-like symptoms, which — of course — means COVID-19-like symptoms. We immediately checked the hours of the closest urgent cares and headed to one.

Once there, we were given masks and sat in the waiting room for nearly two hours with a handful of other people waiting to be seen, including a small child who was restless and running a fever as his parents tried desperately to keep him from touching anything.

My wife’s flu test came back positive. We left the urgent care and set out for the pharmacy to get her meds, bottles of Gatorade and then go home and hunker down. 

By my casual estimation, we exposed and were exposed to at least 10 other people, most of them in the urgent care waiting room.

Now imagine a similar scenario of waking up with flu-like symptoms, but not having to leave your house to see a doctor, get tested, get your medications, or most important, risk exposure.

This scenario is possible thanks to IndyCare Health in Hillsborough.

“We’ll see the patient on Telemedicine, go through their history and evaluate their symptoms,” said Franklin Roye, president of IndyCare. “If everything is consistent with a possible flu, a flu test will be ordered for the patient. We will deliver the test to their home. We will walk the patient through administering the test. We also have written instructions and we provide a YouTube link to instructions on administering the test. It’s really easy to do. It’s not a difficult test. It works a lot like an at-home pregnancy test in terms of reading the results. The results are given within a few minutes.”

The company was founded in April 2018, and the clinic was opened one year later. Jump forward one more year and Orange County — along with much of the rest of the nation — finds itself in a situation that is seemingly made for the IndyCare model.

“It is,” Roye continued. “One of the things we always thought about and had a vision around with IndyCare and a pharmacy-based clinic is all these independent pharmacies deliver into their patients’ home for the most part. We always had an idea there’s an opportunity to do more with that delivery. Kind of the last mile of care. To be able to complete the care by getting to the patients home. Once you deliver to the patients home, the person doing that delivery is adequately trained, and there’s a lot of different interactions you can have at that juncture. They can bring an iPad with them and get that person on a video call, they can do some assessments at their home. This is really important as our society ages. It becomes really important to keep people in their homes as long as possible. In order to do that medically, sometimes you have to be able to deliver services into that home.”

The onset of the coronavirus pushed IndyCare to make changes in the way it carried out its flu test services. Originally, staff members would got to the patient’s home to conduct the test. But with the lack of personal protective equipment, it became too much of a risk. 

“We just tweaked it a little bit, shot a video showing people how to do the test themselves,” Roye said.

The initial symptom similarities of the flu and COVID-19 has made information gathering between patient and health care worker critically important for keeping hospitals and other health care facilities from being overrun with patients. It’s another advantage of the services offered by IndyCare.

“We’re screening and evaluating people remotely who believe they may have the coronavirus,” Role said. “We do that through text messages and telemed sessions. We want to really funnel down the people who genuinely are potentially needing evaluation for it and who potentially have it. You want to get that number down to the people who really need it, and not everyone who might think they need evaluation. The text messaging runs you through simple ‘yes’ and ‘no’ questions that are based on the guidance of the N.C. Department of Health and Human Services. Do you have a fever? A cough? Respiratory issues? Have you had exposure to someone who tested positive to COVID-19? That helps triage a lot of people. If they have symptoms and have had exposure, then we can direct them to where they need to go to get testing done.

“That’s where the flu test is quite important. About 60 percent of the people we’ve sent flu tests out to have been positive for the flu. There’s still flu around, which makes it more challenging, because if you have flu, symptoms you’re definitely going to think you have COVID-19,” he said.

Roye said IndyCare is seeing a rise in activity, part of which he attributes to the COVID-19 pandemic, and also because people are becoming more aware of the services his company offers.

“It takes a while for the awareness to be generated,” Roye said. “From the patient side, there hasn’t been a lot of use of telemedicine prior to this. We have a real spectrum of patients we see at our practice. I’d say 25 percent of our patients are Medicare-age, 65 and older. That group may not be as willing or able to just get out their smartphone and get on a video call with their provider, so we’re having to talk people through it. Maybe we’ll talk to a son or a daughter or caregiver who’s with them. Just coach them through the process of doing it to get them comfortable with it. We have to really be flexible. A little while back, we had an 88-year-old woman who we believed might have had a urinary tract infection, but she was too sick to come in. So we had her daughter come in to pick up a specimen cup to take it home, get the urine specimen from her mother, and then bring it back so it could be tested here at the clinic and to treat her. Sometimes you have to come up with work-arounds to help people to get the quality of care that they need.”

IndyCare’s partnership with Hillsborough Pharmacy has been critical to its success.

“We’re just fortunate that we have a unique combination of capabilities,” Roye said. “We’re connected to an independent pharmacy, so we have a close collaboration with them. They deliver for free, and they always have delivered. So we worked with them to combine our capabilities. We have the ability to do telemedicine to evaluate and prescribe, and then the pharmacy can get out to the homes and deliver medication, over-the-counter meds and flu tests. When we can combine those two things, it’s a unique offering out of one synergistic operation.”

The advantages IndyCare brings to the community extend beyond concerns about the flu and coronavirus.

“Outside of the respiratory illness patients, it’s also really important to the other people because you may have some who are wary of going to a doctor’s office, or an urgent care because they don’t want to expose themselves,” Roye said. “That’s also risky especially if you have someone with, say, a tick bite. It looks like there may be complications with it, but they don’t want to go somewhere. If you deal with a tick bite right away, you can treat it and prevent complications. But if you wait because you don’t want to be exposed, you’re opening yourself up to significant complications. There’s lots of cases like that — someone with pink eye, or asthma or a range of things that not seeking care because of your concern for COVID-19 exposure can also be dangerous. For those people to be able to get care and to get meds delivered to their home makes a difference. We’re a limited in Hillsborough because our delivery is limited to just the town itself. But that’s why we’ve started to bring on other pharmacies to be able to expand the footprint of where we can do this, because the other pharmacy can offer that last mile of care — the delivery of the meds, the delivery of the flu test to the home. We offer the telemedicine capabilities. Through that, we can offer care to all of Orange County with the collaborations we’ve set up so far.”

More Information:

IndyCare recently secured an order of KN95 masks that we will be making available at Hillsborough Pharmacy and the other independent pharmacies in Orange County we are collaborating with so the they can make them available to their local communities. 

IndyCare has ordered the COVID-19 rapid serology tests. These are different from the molecular tests that you have heard a lot about. Cautioun is advised with regard to expectations with these test and about how the results of the test should be used. However we feel they have a role to play because under the new state guidelines most people even if they are symptomatic will not qualify for molecular testing.