Christina Fournier, MD, Co-Director of the Emory Amyotrophic Lateral Sclerosis (ALS) Center and Georgia Clinical & Translational Science Alliance (Georgia CTSA) Master in Science in Clinical Research (MSCR) graduate, worked to create a highly innovative telemedicine system for Emory ALS Center patients in partnership with Dr. Jonathan Glass and the Emory ALS Center team. These patients can now receive their care from home and avoid going to the clinic, thereby reducing their risk of exposure to COVID-19. This new telemedicine system is especially unique since it simulates the Emory ALS Center which is a multi-specialty clinic where the patient sees a range of providers during a single visit for their complex medical needs.
"Our patients have this relentless disease where they go from being healthy and active, to over the course of two to three years, losing their ability to walk, use their hands, speak, swallow, or even breathe. We have modest treatments but not a cure. The most important thing we do with our care is optimizing their ability to function, stay at home and have a good quality of life despite having ALS," says Fournier. "The way our physical clinic works is instead of the patient having to go to separate appointments to see a neurologist, physical therapist, social worker, etc., the patient comes into our clinic and sees all clinicians in one place. Our team members also interact with each other and plan care as a team. This is the gold standard for ALS care. Studies show that patients who receive multidisciplinary care have better outcomes."
"When COVID-19 hit, this was a specific challenge for our clinic because it's a practice that relies normally on significant physical interaction with our team and the patient. We had to determine how we could still deliver multidisciplinary care. Our patient population is especially vulnerable to infection. They have impaired breathing, many are older, and they may have additional pre-existing conditions. A lot can change for an ALS patient in one month, two months, and three months, so we had to figure out a way to continue to provide this multidisciplinary care remotely so the patient is not put at risk and still receives the care they need."
By using an inventive approach, the team developed a telemedicine system to virtually simulate this multidisciplinary experience. Rather than having to make several different calls or separate video visits, the patient joins a single video call where each of their clinicians comes into the virtual room in succession. Behind the scenes, there is a virtual command center that keeps the flow going and moving quickly. The command center team monitors the patient rooms and directs the providers where to go virtually, so the patient experience is seamless. Patients can see multiple providers during their visit, and providers can see multiple patients over the course of a day.
The team spent over a week planning and practicing this new telemedicine system. Last Friday, 14 patients were seen at the new virtual ALS clinic by up to 9 providers based on a patient's needs (neurology, physical therapy, occupational therapy, speech pathology, social worker, nurse, etc.) and aided by clinical research coordinators, an IT expert, and an administrative support person.
"Our telemedicine system is working well thanks to an impressive team effort. The patients seemed to enjoy the virtual clinic while they received the care they needed. Initially, we were concerned about how much of the patient experience would be lost by not having the physical contact, but we are pleased by how much we are able to accomplish through their telemedicine visit,” says Fournier. "There are some clinical advantages by being able to see the patient in their home environment where we can identify things we might not have known. For example, I had a patient who reported tripping frequently. On their telemedicine visit, I noticed they were wearing flipflops, and I identified that could be a cause. While this virtual clinic won't entirely replace in-person care for ALS patients, we definitely see a role for telemedicine moving forward."
"Some of our patients travel up to three hours away to visit our physical clinic. They have breathing equipment and wheelchairs, so it's a big challenge. Being able to offer a virtual option moving forward will be a huge enhancement to our care for patients. We had been exploring this for a while, but the COVID-19 situation forced us to operationalize it overnight. Now that our virtual clinic is in place and operating successfully, we can utilize this telemedicine system moving forward, at least as an option for some patients or an enhancement in between in-person visits as a hybrid model in the future."
Fournier adds, "This vulnerable patient population needs care. Even during an unprecedented pandemic, the care can't stop. The fact that we found a way to provide multidisciplinary care without face-to-face visits and are meeting our patients' needs through telemedicine is very gratifying."
As a Georgia CTSA MSCR graduate, Fournier remarks, "Having my MSCR degree has been extremely valuable. ALS is unique in that the clinic and the research aspects are very intertwined. Our research population is our clinic population. The research training I received connects with the clinical care. It was our research team members that operationalized the clinic. My experience in the MSCR program not only helped me build our ALS research program, but it also ties into the day-to-day care I provide to our ALS patients."
The Emory Master of Science in Clinical Research (MSCR) degree program, in the Laney Graduate School at Emory University, provides innovative didactic and mentored research training to those interested in pursuing a career in clinical and/or translational research. The MSCR degree is designed for predoctoral, postdoctoral trainees, and junior faculty from Emory, Morehouse School of Medicine, Georgia Tech and UGA.
The Georgia CTSA is a statewide partnership between Emory, MSM, Georgia Tech, and UGA and is one of over 60 in a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences (NCATS) and the National Institutes of Health's Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators. For more information, visit GeorgiaCTSA.org.