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      Population-Level Interest and Telehealth Capacity of US Hospitals in Response to COVID-19: Cross-Sectional Analysis of Google Search and National Hospital Survey Data


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          As the novel coronavirus disease (COVID-19) is widely spreading across the United States, there is a concern about the overloading of the nation’s health care capacity. The expansion of telehealth services is expected to deliver timely care for the initial screening of symptomatic patients while minimizing exposure in health care facilities, to protect health care providers and other patients. However, it is currently unknown whether US hospitals have the telehealth capacity to meet the increasing demand and needs of patients during this pandemic.


          We investigated the population-level internet search volume for telehealth (as a proxy of population interest and demand) with the number of new COVID-19 cases and the proportion of hospitals that adopted a telehealth system in all US states.


          We used internet search volume data from Google Trends to measure population-level interest in telehealth and telemedicine between January 21, 2020 (when the first COVID-19 case was reported), and March 18, 2020. Data on COVID-19 cases in the United States were obtained from the Johns Hopkins Coronavirus Resources Center. We also used data from the 2018 American Hospital Association Annual Survey to estimate the proportion of hospitals that adopted telehealth (including telemedicine and electronic visits) and those with the capability of telemedicine intensive care unit (tele-ICU). Pearson correlation was used to examine the relations of population search volume for telehealth and telemedicine (composite score) with the cumulative numbers of COVID-19 cases in the United States during the study period and the proportion of hospitals with telehealth and tele-ICU capabilities.


          We found that US population–level interest in telehealth increased as the number of COVID-19 cases increased, with a strong correlation ( r=0.948, P<.001). We observed a higher population-level interest in telehealth in the Northeast and West census region, whereas the proportion of hospitals that adopted telehealth was higher in the Midwest region. There was no significant association between population interest and the proportion of hospitals that adopted telehealth ( r=0.055, P=.70) nor hospitals having tele-ICU capability ( r=–0.073, P=.61).


          As the number of COVID-19 cases increases, so does the US population’s interest in telehealth. However, the level of population interest did not correlate with the proportion of hospitals providing telehealth services in the United States, suggesting that increased population demand may not be met with the current telehealth capacity. Telecommunication infrastructures in US hospitals may lack the capability to address the ongoing health care needs of patients with other health conditions. More practical investment is needed to deploy the telehealth system rapidly against the impending patient surge.

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          Most cited references6

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              Telemedicine/Virtual ICU: Where Are We and Where Are We Going?

              Intensive care unit telemedicine (tele-ICU) is technology enabled care delivered from off-site locations that was developed to address the increasing complexity of patients and insufficient supply of intensivists. Although tele-ICU deployment is increasing, it continues to cover only a small proportion of ICU patients. This is primarily due to expense, with first-year costs exceeding $50,000 per bed. Meta-analyses of outcomes indicate survival benefits and quality improvements, albeit with significant heterogeneity. Depending on the context, a wide range of estimated incremental cost-effectiveness ratios reflects variable effects on cost and outcomes, such as mortality or length of stay. Tele-ICUs may fit within a hybrid model of care to complement high-intensity ICU staff coverage. However, more research is required to foster consensus and determine best practices. This review summarizes data on tele-ICU structure, operations, outcomes, and costs. Evidence was extracted from meta-analyses, with secondary data from Cleveland Clinic's tele-ICU experience.

                Author and article information

                JMIR Public Health Surveill
                JMIR Public Health Surveill
                JMIR Public Health and Surveillance
                JMIR Publications (Toronto, Canada )
                Apr-Jun 2020
                7 April 2020
                : 6
                : 2
                : e18961
                [1 ] Department of Health Services Research, Management and Policy College of Public Health and Health Professions University of Florida Gainesville, FL United States
                [2 ] Biomedical Sciences Graduate Program College of Medicine The Ohio State University Columbus, OH United States
                [3 ] Center for the Advancement of Team Science, Analysis, and Systems Thinking in Health Services and Implementation Science Research College of Medicine The Ohio State University Columbus, OH United States
                [4 ] Department of Health Care Leadership and Management College of Health Professions Medical University of South Carolina Charleston, SC United States
                [5 ] Department of Community Health and Family Medicine College of Medicine University of Florida Gainesville, FL United States
                Author notes
                Corresponding Author: Young-Rock Hong youngrock.h@ 123456phhp.ufl.edu
                Author information
                ©Young-Rock Hong, John Lawrence, Dunc Williams Jr, Arch Mainous III. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 07.04.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on http://publichealth.jmir.org, as well as this copyright and license information must be included.

                : 29 March 2020
                : 31 March 2020
                : 1 April 2020
                : 1 April 2020
                Original Paper
                Original Paper

                covid-19,telehealth,telemedicine,screening,pandemic,outbreak,infectious disease,public health


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