The Transition to Telehealth

Emily will be working on developing a Telehealth system at a medical student-run free health clinic in Fremont, NC in order to continue to provide care to patients in the setting the COVID-19 pandemic.

A doctor coming out of a computer and examining a sick boyThe Fremont People’s Free Community Health Clinic is a student-run free clinic located in rural Fremont, NC. The clinic itself is run out of a trailer parked on a plot of grass, and it has two patient rooms, a workroom, and a waiting area. It is maintained by a board of community members. Prior to the novel coronavirus, each month, a small group of first-year medical students, third-year medical students, and one supervising physician traveled to the clinic 1.5 hours away from Durham to provide basic medical care including chronic disease management, annual physicals, prescriptions for medication refills, and basic lab tests.

Although many of the services we provide appear simple at first glance (we cannot perform life-saving surgeries or conduct imaging), this clinic serves a critical role in the Fremont community. In the town of 1,200 people, there is only one other clinic, and it is not free. Finding transportation to see doctors in neighboring towns is an enormous obstacle for most of our patients. Thus, for many, Fremont clinic is the only feasible option for receiving healthcare. Our liaisons and coordinators in Fremont relayed to us that patients were asking when the clinic would reopen so they can refill their medications, as many suffer from several chronic health conditions and feel their health deteriorating. As a medical student, I felt an incredible urge to figure out a plan so that we could get back to caring for our patients.

Initially, we worked with the DukeMed administration and the Duke Infectious Disease department to come up with a COVID-safe “outdoor clinic,” that involved a tent with some tables and chairs. This would allow us to keep most of our functions intact – we could have only clinic personnel run into the trailer to run critical lab tests, we could take walk-up appointments, and we could give flu shots. When we presented this plan to the board members of the community clinic, they told us that this would not be a feasible plan for the patients in Fremont – many would not be able to stand outside for a period of time while they waited for their appointment, and, with winter fast approaching, many thought the cold weather would turn people away. Thus, in order to be able to provide care in the setting of COVID, we have decided to shift gears from trying to find an in-person option and dedicate the winter and spring terms to creating a telehealth option for providing care.

Our project is to create a virtual, telehealth clinic in Fremont, NC in place of a clinic that was previously run entirely in person. We will run two Saturday mornings a month (8 AM-5 PM), with appointments scheduled for an hour-long period. If patients have a computer and Wifi at home, they will simply join a zoom appointment from home. If they do not have a computer or Wi-Fi at home, they will come to the clinic at the time of their appointment to log onto a computer and join the zoom call for their visit.

Some of the logistics we need to figure out are: what platform can we use to conduct Telehealth appointments to make sure that we are compliant with HIPPA?  How can we document our appointment notes so that we are compliant with HIPPA? As most of our patients were previously walk-in, how are we going to coordinate scheduling for appointments?

I think one of the things that I hope to learn through this process is how to listen and understand to community needs. One of our biggest oversights when we first set out to open up the clinic after COVID was that we had failed to ask about what the community needed, and we had created this whole detailed plan with Duke administration without realizing that it would not be a good option for the community we were trying to provide for. It was only after this failure that we stopped to ask what might work for them, and that is how we stumbled upon the Telehealth option. We will need to keep these conversations open as we navigate the waters of creating a virtual clinic for the first time.