The Doctor Will Zoom You in Now
Telemedicine is the new house call
To call Lois Geisler reluctant to partake in her first virtual doctor’s visit would be an understatement. The 72-year-old Floridian flatly refused to consider telemedicine, also known as telehealth.
“I’ve never thought about doing a visit like this,” she says. “I’ve always gone into the doctor’s office.”
But after the COVID-19 pandemic shuttered doctors’ offices for everything except emergencies, an online visit with a rheumatologist changed her mind. With no driving, parking, or time spent in waiting rooms, she accomplished in 20 minutes what usually takes her two hours.
“Unless you need to be examined, it’s easier to do than traipsing to the office,” she says.
Geisler is part of the sea of patients whom the pandemic has sent to the virtual world. Industry watchers are calling this the “tipping point” for a trend that was already gaining traction.
In a 2019 J.D. Power survey, healthcare providers said no more than 11% of their patients had been on a virtual visit. At the time, they expected to see those numbers rise to 15% to 25% in 2020.
While getting a complete picture of the uptick is difficult, the experience of several health systems that have shifted consultations online blows those old adoption estimates out of the water. At the US epicenter of the pandemic in New York City, NYU Langone went from performing no telehealth visits to 5,500 a day over the course of two weeks. Similarly, Tampa’s Moffitt Cancer Center realized a 5,000% increase in telehealth visits in the wake of COVID-19.
“I don’t think anyone was ready for this kind of scaling,” says Dr. Joseph Kvedar, president-elect of the American Telemedicine Association. “The beautiful thing is that, overwhelmingly, it’s gone well.”
Remote healthcare’s moment
Like Geisler, many of those who complete their first consultation out of necessity during lockdown are realizing now how convenient it is. While Kvedar doesn’t expect to maintain today’s inflated patient usage numbers — many of the telemedicine visits happening are stopgaps for in-office consultations, elective procedures, and diagnostic tests — he says it could turn out to be a defining moment.
As healthcare providers learn just how much they can do with a teleconferencing app and a camera, diagnosing and prescribing medication for relatively minor issues like sinus pain and headaches, urinary tract infections, rashes, and eye infections is a natural fit. So is the talk therapy at the heart of many mental health treatments. And providers can also help patients manage their stable chronic conditions from afar.
Along with these benefits, doctors say telemedicine could become far more common because of a convergence of three things: mature core and supporting technologies, the benefits of social distancing, and pandemic-inspired regulatory changes.
First, technology developments over the years — from broadband penetration to at-home blood pressure cuffs and telehealth platforms—have improved connectivity, diagnostic power, and remote monitoring. Video chatting is now as common as phone calls and texting. And patients no longer need high-end desktops or laptops to take advantage of telehealth. They can connect with their doctors with nothing more than the smartphones in their pockets and a good cellular connection.
When a virtual visit with a patient takes place, the doctor can go over the results of at-home diagnostics coming from such devices as an electrocardiogram unit, blood glucose monitor, or Wi-Fi–enabled thermometers and blood pressure monitors.
From the provider’s side, new technology like HP’s EliteOne 800 G5 Healthcare Edition All-in-One PC is being purpose-built for ease of use in telehealth consultations, streamlining the experience for physicians by integrating live patient-video-feeds with patients’ vital signs and electronic medical records.
Then there’s the exploding demand from patients who need healthcare but also need to stay home to avoid coronavirus exposure, especially the elderly and those with compromised immune systems. HP remote care enabling technologies can further extend access to care by helping doctors monitor and connect to patients at home. The software can digitally send patients’ vital data directly to providers from a purpose-built monitoring device intended for remote care management.
Finally, public health officials have taken a new look at regulations — at least temporarily ending the pre-pandemic requirement that providers be licensed in the same state as the patient resides and increasing reimbursements to providers for seeing a patient remotely.
“If we can keep showing benefits and value, then we’ll see a continuation of this uptake trend after COVID-19,” says Frances Ayalasomayajula, worldwide head of population health at HP. “Ease of use and high-quality digital interactions are paramount. Together with ecosystem partners, HP is enabling better telehealth experiences for both providers and patients.”
Reimagining what’s possible from a distance
Dr. Mark Victor, CEO of Cardiology Consultants of Philadelphia, says the group’s 96 cardiologists working at 35 centers throughout the region performed no virtual visits before closing for everything but emergencies on March 13. The following Monday, Cardiology Consultants reopened virtually and its doctors started performing up to 4,000 telemedicine checks a week.
Virtual triaging of established patients over the ensuing months revealed to Victor that only about 20% needed to have an in-person follow-up. These were people experiencing shortness of breath, chest pain, or lower-extremity swelling that suggested something serious going on. His doctors could manage the vast majority of patients remotely by talking to them, ordering lab work, and adjusting medications. And so far, patients have been happy with the experience.
“We’ve heard from our patients that they’d like to have follow-up visits with telehealth,” Victor says. “A cohort of these patients will opt for this service, and we’ll continue it even after COVID-19 ends.”
Ayalasomayajula says that while telemedicine won’t ever replace the need for in-person visits, it will increasingly help doctors deliver a range of care to patients, from virtual triage all the way through disease management.
“Your computer is becoming your wellness check as part of a true continuum of care,” she says.
Can telehealth bridge the access gap?
To realize the technology’s full potential, HP’s Ayalasomayajula says the healthcare system must address unequal access to technology and connectivity due to age, socioeconomic factors, or geography.
“We need to figure out how to do this for anyone who would benefit,” she says. “This isn’t just about responding to COVID-19 lockdowns. Digital health can help us address the many healthcare challenges that are staring us in the face — if we get it right.”
One way to broaden access, says Raja Bhadury, worldwide head of enterprise healthcare at HP, is for tech companies to keep innovating to drive down costs of computers, webcams, and broadband. Cheaper tech, patient and doctor education on how to use it, and programs like language translation will help alleviate longstanding access gaps.
“Look at the number of psychiatrists we have in some rural areas — it’s abysmal,” Bhadury says, pointing to the fact that 90% of psychiatrists and psychologists work in metropolitan areas. Thousands more would be needed to address rural shortages. “Telemedicine can provide access to so many more people,” he says.
Another way to get more patients access is to get more doctors to adopt telehealth as a normal part of their healthcare offerings. The pandemic caused federal regulators in charge of setting Medicare and Medicaid reimbursement rates to increase payments to doctors for providing telehealth, creating incentives that make virtual care an option for many more older Americans.
Geisler, the Florida retiree, says she scheduled appointments for online visits with two specialists after that first online rheumatology visit.
“COVID-19 definitely brought virtual visits to the front of my mind,” she says. “Why go in if I don’t have to?”
