October 20, 2021
The COVID-19 pandemic has affected the entire health care system, including patients who need therapeutic apheresis, but it has also provided new opportunities for telehealth practices in apheresis medicine — or telapheresis. The AABB 2021 Annual Meeting session, “Telapheresis (Telemedicine in Apheresis) in the Era of the Sars-Cov-2 Pandemic — Will This Become a New Normal?,” provided an overview of telapheresis, including new and emerging practices models related to therapeutic apheresis.
The first speaker was Walter Linz, MD, MBA, from Mayo Clinic Florida, who went over essential concepts of telemedicine and telapheresis.
Telehealth is a general term for using information and telecommunications technologies for patient care, while telemedicine is a more limited term that refers specifically to the use of telecommunications and information technology (IT) for the purpose of patient/provider medical interaction.
Telapheresis is a new category of telemedicine that was first described in 2020.
Prior to the pandemic, the therapeutic apheresis model involved a team effort, with a skilled apheresis physician and a skilled operator who knows how to operate the apheresis machines. In this traditional model, patients travel to the physician and operator at a tertiary care medical center where apheresis is performed on site.
The traditional model’s advantages are that it’s simple for the provider, there are support structures on site, it supports consistent quality and it provides the opportunity for high throughput. The disadvantages are that it can be inconvenient and potentially costly for the patient, and there is a fixed-cost overhead for the provider.
There is also a mobile apheresis care model, in which the expert operators travel to the patient. In this model, the medical center peels off operators and devices and sends them to another center that’s closer to the patient. The advantages are that it’s more convenient for the patient and there are still support structures in place. The disadvantages are that the model is more complex for expert operators and it complicates communications between the physician and the operator.
The mobile care model also requires tech support, such as encrypted tech for documenting and transferring medical records and logistical support, including equipment that’s either on site or at a central location tethered to a dispatcher.
The post-COVID telapheresis model involves an apheresis center that extends itself to apheresis patients by developing operators in the originating locations — where the patients reside — and supporting the technical and professional requirements via telecommunications.
The pros of this model are that it sends experts into the patient care setting outside of institutions, which expands patient access to apheresis while approximating the quality of a single institution. The cons are that it requires telecommunications infrastructure in addition to training and maintaining the competence of auxiliary operators. Currently, the financial relationship is by contract.
This model requires a great deal of technology. Some of this tech is already in use, including electronic medical records, pagers or phones and patient monitoring devices.
But it also requires additional tech: apheresis devices with a built-in camera and microphone to enable interactions with the operator and patient to review reactions, a link to remote monitoring devices to access the patient’s vital signs and electronic documentation access to upload procedure notes to the electronic medical record.
Use of this model is complicated by state specific medical rules and practices and the need to comply with HIPAA requirements.
Linz concluded that there are situations that are best for each of these models.
The traditional model provides complex care that requires multiple sub-specialty interactions and works well for patients who live near the medical center.
The mobile apheresis model is effective for medical centers that are within driving range of a fixed site that performs apheresis care on an occasional basis; this is a reasonable approach to supplement a small apheresis center with periodic staffing challenges or call issues.
The telapheresis model works well as a support for distant medical centers that require both professional expert oversight and technical guidance and as a supplement to mobile apheresis and classical models. It allows apheresis to take place where it’s more convenient for the patient.
The next speaker, Jan Hofmann, MD, MPH, MSc, from the UCSF School of medicine, introduced the evolving issues related to virtual consultation, privileging, documentation, coding and reimbursement, ethical and medical-legal aspects of telemedicine care.