Butler Health System has held more than 10,000 telehealth visits in the past two months and is expanding options to patients who might not want to go to a doctor's office due to the coronavirus pandemic.

FasterCare, BHS' urgent care system, will start offering widespread telemedicine visits starting Friday. Staff has been testing the system.

“We've seen several patients very successfully already,” said Dr. Reginald Reginella, medical director for FasterCare and BHS' chief medical information officer.

Most patients who would have been seen at a physical FasterCare site — those with upper respiratory complaints, ear infections, urinary tract infections, sore throats or lacerations — can choose instead to have a virtual visit, although some may still have to come in to a physical office.

“If the patient had normally considered visiting FasterCare, they most likely would be able to be seen by FasterCare telehealth,” Reginella said. “The only exceptions we would have to that would be sprains and strains, because we would really like to do X-rays on those.”

Likewise, patients who should have gone to the emergency department for things like chest pain or stroke symptoms should still call 911 or visit the ER directly, Reginella said.

FasterCare telehealth visits will cost $49 for patients who self-pay, and copays are waived for insured patients during the COVID-19 pandemic.

Remote care

A significant number of urgent care visits may typically require tests, like complaints of upper respiratory symptoms or strep throat.

But these, too, can be done remotely, Reginella said.

“There are criteria that exist that you can apply that are used to diagnose strep likelihood when a strep test is unavailable,” he said.

That's done by “medically proven” algorithms that determine if certain symptoms and their length are consistent with illnesses, Reginella added.

For illnesses that might typically require a chest X-ray, like ruling out pneumonia when a patient has a persistent cough, a nurse practitioner will evaluate and determine if that patient should come in for a radiograph.

“Not everybody that comes in with a cough necessitates getting a chest X-ray, even when you're in person, so that would be evaluated by the nurse practitioner on the telehealth visit,” Reginella said. “If determined necessary, they would recommend that you would come to a FasterCare site to be evaluated via X-ray.”

In fact, telehealth visits are so advanced, they're used for some specialty visits.

“It spans all spectrums of specialities, let alone what we can do at FasterCare,” Reginella said.

Expanded access

Reginella said a large part of BHS' expansion of telemedicine during the pandemic is to ensure patients who may be wary of visiting a doctor during the pandemic still will get medical care.

“In the past, you'd have to go to your PCP's office, the PCP would have the equipment there and they'd dial in a call to a specialist — the cardiologist, for example,” he said. “But with the development of COVID-19, we had to think of ways to get patients communicated, managed and treated by their PCP in their homes … and not have to subject themselves to exposure to COVID-19.”

Across the country — except in COVID-19 hots pots like New York — emergency departments and urgent care centers have seen a 50 percent drop in visits, Reginella said.

“We were worried that people were possibly foregoing their urgent care needs because they were afraid or not knowing what to do, and we were concerned they would be getting sicker than they needed to had they gotten prompt urgent care,” he said.

Not only is BHS offering these services, he said, but it has the ability to continue increasing capacity for telehealth if need be.

Reginella said the health system can add nurse practitioners if the demand is higher than anticipated.

“We don't know yet what our limitations are because we already thought about that, and we can expand more NPs quickly into it,” he said.

In addition to the ability to expand capacity, BHS can help patients who are less technologically savvy access the telemedicine system should they want.

“Once the person calls in, gets all their personal information and their insurance or payment information taken with the call taker, that call taker will help you download an app to either your smartphone or your computer to be able to have the video virtual visit,” Reginella said.

And patients can call the same number before a visit is needed if they have any questions.

“If they have any questions about it, even before the need to go through the process, please give a call to (877-9-URGENT), and the call taker will be happy to discuss in more detail with them,” he said.

Medicine of the future?

The telehealth visits won't replace FasterCare, nor will the buildings close during the COVID-19 pandemic.

“This is not replacing FasterCare sites, this is just an additional means to getting patient access to health care,” Reginella said. “The FasterCare sites are open and have been since the development of cover, and we're committed to keeping them open.”

But the popularity of televisits — and the increasing rate at which they're accepted as a medical tool — will likely persist even after the pandemic is over, Reginella said.

In BHS, more than 10,000 visits have been held virtually since they've been offered in a more widespread fashion about two months ago. UPMC televisits have already surpassed totals from 2019.

“We are here to stay. I think telehealth is here to stay,” Reginella said. “I think this was the metamorphosis or the impetus that really pushed telehealth, telemedicine into the forefront of accepted patient access.”

Patients can access telehealth FasterCare visits between 9 a.m. and 9 p.m., seven days a week, beginning Friday, by calling 877-9-URGENT (877-987-4368).