To the Editor:
This letter is in response to the letter by Barthell and Handler regarding the existing use of tele-triage in U.S.-based emergency departments. We welcome their expanded review on prior efforts demonstrating the viability of tele-triage as a useful approach in busy emergency departments and fully agree with their arguments in this regard.
We emphasize, however, that our approach is distinct from tele-triage. Electronic personal protective equipment (ePPE)–based medical screening exams can serve as the sole exam during the emergency department encounter, whereas tele-triage is always followed by an in-person exam (unless the patient elopes). This distinction explains our focus on such a low-risk population. We agree with Barthell and Handler that ePPE likely provides benefit beyond this low-risk population. However, existing literature did not support ePPE-only examinations for sicker patients. Future studies may support using ePPE-only exams for sicker patients or for re-evaluations of sicker patients remaining in the emergency department after tele-triage.
Regarding platform choice, we believe that access is critical during the pandemic and, in the spirit of “better is the enemy of good,” that recommending easily adoptable, affordable, and secure platforms has more benefit than risk, especially given the current enforcement environment as discussed in our article. Beyond the pandemic, we suspect that we would converge to their assertion that dedicated telemedicine and tele-triage platforms offer advantages in interface, infrastructure, and security.
As we noted in the article, it is critical that any pathway be implemented in close partnership with local security and legal experts to ensure that systems remain safe to use as the technical and legal environments evolve.
We welcome ongoing discussion and innovation surrounding ePPE and tele-triage.
Sincerely,