Due to the novel coronavirus pandemic, approaches to telemedicine and other technologies are flourishing and likely changing healthcare forever.
An old adage states every cloud has a silver lining, which appears to be true when it comes to the coronavirus pandemic. COVID-19 has triggered a near revolutionary approach to healthcare delivery. The global health crisis has spurred on new technology and accelerated the acceptance, by both physicians and patients, of existing technology, including virtual doctor visits and apps for monitoring health and symptoms.
Obviously, positive developments growing out of the pandemic don’t discount or lessen the fact COVID-19 quickly became a devastating health crisis, taking countless lives and causing serious and often disheartening economic and personal consequences. As the coronavirus virus spread, it revealed existing problems in the U.S. healthcare system, too.
For example, when cases spiked early on, a lack of preparation for a pandemic was evident in many areas, with hospitals scrambling for enough ventilators and adequate protective personal equipment (PPE) for staff. The COVID-19 outbreak also highlighted difficulties arising when data about patients and supplies couldn’t be shared quickly — either due to privacy concerns or problems with technology interoperability.
The crisis, however, created a positive climate for rapid change in these areas. According to a report from Morgan Stanley Research, the urgent need to trace and treat the novel coronavirus has illuminated the benefits of streamlined healthcare regulations and promoted innovation in telemedicine, digital health technologies, and the development of better ways to share medical data safely, while protecting privacy.
The coronavirus pandemic has also resulted in unprecedented cooperation between local, state, and national governments. For example, in response to the crisis, Congress lifted restrictions on reimbursement from Medicare for telehealth. The Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) quickly responded with new regulatory flexibility, including accelerating the approval process for tests to diagnose COVID-19. What’s more, the FDA released guidance in support of virtual clinical trials, a move expected to open the door for novel, alternative ways to conduct research.
Here are some more highlights of how coronavirus is changing healthcare — developments that will likely influence the practice of medicine and patient care long after COVID-19 is no longer a medical crisis.
Telemedicine is here to stay
Telemedicine was already a relatively small but growing area of healthcare before the coronavirus pandemic. But now its use and related modalities have exploded.
The numbers reflecting this surge are staggering. Consider Philadelphia’s Jefferson Health hospital network. Before COVID-19, doctors were conducting dozens of virtual out-patient visits a week. After the coronavirus outbreak in the U.S., they began scheduling 500 to 600 telemedicine appointments a day, according to a report by the American Association of Medical Colleges (AAMC).
Doctor appointments via video visits are gaining acceptance with the public and large companies, too. In fact, a survey from Willis Towers Watson found almost 90 percent of employers polled are now promoting the use of telemedicine, including virtual healthcare visits. And the number of telehealth doctor and nurse visits could surpass one billion by the end of 2020, with 900 million related to the pandemic, according to a Forrester Research report.
Telemedicine is playing a key role in the diagnosing of people with the novel coronavirus and getting them quickly to appropriate medical care. The use of telemedicine at LCMC Health in New Orleans, a city with the second highest number of COVID-19 patients per capita in the U.S. at the time this article was published, is a case in point, and the protocols used there could well transfer over to other potential emergency situations going forward.
Scott Mackey, DO, is associate chief medical information officer for LCMC. Due to exposure to the coronavirus, Mackey himself was quarantined but still able to evaluate patients, thanks to LCMC Health’s rapidly evolving telemedicine program.
“We have a COVID hotline, which patients can call to get screened by a nurse. If they screen positive, then we step up the telehealth visit, and they’re connected with one of our emergency department physicians,” Mackey explained in an interview for the AAMC website.
About 10 percent of those screened via virtual visits have symptoms suggesting they need to go to the emergency department at University Medical Center New Orleans, where they are immediately isolated in one of six video-equipped rooms. A nurse wearing full PPE enters the room to take vital signs and draw blood for testing, and an emergency physician evaluates the suspected COVID-19 patient virtually, deciding whether he or she needs to be admitted to the hospital, tested for COVID-19, or discharged and told to self-quarantine. The only glitch in this telemedicine approach so far, according to Mackey, is the hospital needs more laptops and iPads to expand the program.
Lessons learned: How the coronavirus epidemic expanded healthcare options
The coronavirus pandemic brought to light the need for an important option for more routine care to be delivered with virtual office visits. Virtual visits make sense when circumstances make it safer or simply easier and faster to have a remote doctor or nurse practitioner visit.
What’s more, the success and acceptance of telemedicine during the COVID-19 crisis has demonstrated how virtual office visits can be far more convenient (reducing travel time, parking fees, and wait time in an office) and allow doctors and nurses to see, virtually, far more patients.
For example, Capital Digestive Care, a large gastroenterology practice in the Mid-Atlantic, quickly increased their telehealth practice within a few months of the coronavirus cases appearing in the U.S. Soon the medical group’s almost 70 physicians, nurses, and physician assistants had conducted more than 10,000 virtual visits with patients, according to a report on the Helio clinical information website.
Of course, gastrointestinal doctors can’t perform colonoscopies, endoscopies and other procedures remotely. David L. Jager, MD, a Capital Digestive Care physician who led the practice in implementing telemedicine, however, noted follow-up visits with patients when a hands-on physical exam is less important (for gastroesophageal reflux disease, for instance) are especially easy and convenient to conduct.
What’s more, telehealth visits can help doctors prioritize which patients need to be seen most quickly for elective endoscopies and other procedures, based on guidelines recently developed by the American Gastroenterological Association and the Digestive Health Physicians Association, which reflect concerns for patient safety raised by the coronavirus pandemic.
Social distancing, telecommuting, and quarantines due to the coronavirus epidemic sparked greater interest than ever in video chats with friends, support groups, and virtual business meetings using Zoom, Skype, Facetime, and other modalities for video conferencing. That’s made the idea and practice of virtual visits and meetings more comfortable for patients and doctors.
The coronavirus epidemic has also led to a growth in services from companies that provide virtual help to doctors using video communication. Remote assistants, sometimes called virtual scribes, observe doctor-patient interactions via video and record and document virtual or in-person office visits fo electronic health records (EHR), digital versions of real-time patient chart information that is made instantly and securely available to authorized users.
This allows doctors to spend more time focusing directly on patients during office visits and saves hours of additional time writing up detailed information about patients for CMS and insurance companies.
To facilitate the move toward more reliance on virtual office visits and related virtual assistance, medical groups are increasingly putting special telemedicine platforms in place for their practice to help organize and document patient log-its and visits.
While it may seem unusual to millions of us who are constantly online or tied to our smartphones, not all patients have a computer, tablet, or smartphone for virtual office appointments. So, finding out if a person can participate in a telehealth visit has changed the appointment process in many doctor offices and medical centers that now rely heavily on virtual doctor appointments due to the coronavirus, according to Davin Lundquist, MD.
Lundquist, a family medicine specialist in Camillo, California, is also chief medical officer of Augmedix, a company providing remote EHR assistants and medical documentation to healthcare practices. He explained how the move toward more virtual healthcare has changed his own practice.
When patients are told their appointment will be a telehealth visit, they are informed they can opt-out if they don’t have video capabilities or access to a computer or smartphone. When a virtual appointment is scheduled, a medical assistant calls patients to ask basic health questions and do a technology screening to confirm the patient has downloaded required software and has a camera in working order.
Patients then receive a unique meeting ID, allowing them to enter a virtual waiting room on the day of their appointment while their doctor checks the patient’s EHR. Then, with a click, the virtual office visit begins.
It doesn’t always go smoothly, however, Lundquist noted. There can be technical glitches with internet connections, and some patients are concerned about privacy during a telemedicine session: they may not want partners or roommates to hear or see the office visit, for example.
What’s more some people, especially seniors, may not be comfortable with computer and smartphone technology and have difficulty with virtual visits. “In those cases, we try to have them recruit a son or daughter who can help. And once my patient figures it out, they sometimes go on to video chat with their families. What a beautiful side effect,” Lundquist reported.
Help for mental health, addiction and recovery during the pandemic
When it comes to mental health, including addiction, there’s good news and bad news. The bad news includes reports of anxiety and depression spiking due to worries over the coronavirus, job losses, and feelings of isolation during quarantine.
What’s more, the pandemic has increased some non-healthy and addictive behaviors, according to the Blue Cross Blue Shield Association's COVID-19 National Pulse Survey. Since the emergence of COVID-19 in the U.S., alcohol consumption has increased 23 percent, smoking is up almost 20 percent, vaping has increased by 15 percent, and non-medical drug has risen by 13 percent.
The good news is more insurance companies have increased coverage of telehealth mental health visits, due to the coronavirus crisis, allowing therapists to counsel patients remotely. Emory psychologist Nadine Kaslow, PhD, for example, notes that while she was on self-quarantine she was still able to work with patients virtually.
For people struggling with addiction problems or needing help with their recovery, in-person Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and other support group meetings were put on hold due to the pandemic. But technology has come through to offer alternative help, particularly as AA and NA members quickly adapted to technologies like Zoom to maintain the importance of attending meetings.
The Substance Abuse and Mental Health Services Administration (SAMHSA), an federal agency that leads public health efforts to reduce the impact of substance abuse and mental illness in U.S. communities, notes while social distancing and self-quarantining have been necessary to limit and control the spread of the disease, “continued social connectedness to maintain recovery is critically important. Virtual resources can and should be used during this time.”
To that end, SAMHSA provides an online, comprehensive list of addiction, recovery and mental health online support and virtual meetings accessible via Skype or Zoom. Most district areas of AA and NA also provided a list of meetings via such technologies.
Bottom line: Where do we go from here, tracking the coronavirus symptoms and spread?
Scientists and doctors still have much to learn about COVID-19. After all, it is a new infectious agent and the full impact of the virus, the variety of symptoms, and how the disease spreads aren’t fully known. Gathering more data about individuals and populations of people is important to help understand the virus, including how and where it is spreading, and to find ways to mitigate COVD-19 infections.
Using apps to track health and even diagnose symptoms isn’t new, of course. There are apps for helping with fitness and weight loss goals and charting blood pressure, blood sugar, and other health parameters. Smartwatches can even take on-the-go ECGs, record the information about heart rhythms, and transmit the data immediately to a doctor.
Now, several tech giants are working to help not only the public document COVID-19 symptoms and other health information with special coronavirus apps but also public health agencies track coronavirus symptoms and the progression of the epidemic.
Apple launched its coronavirus screening app and website, developed in partnership with the Centers for Disease Control and Prevention (CDC), in March of 2020 to provide information on how to prevent COVID-19 (including handwashing, wearing masks, and sanitation methods). The app includes screening tools to help users decide, based on what is now known about the coronavirus, if they need to seek testing or contact their doctor.
To help coronavirus research, Apple updated its COVID-19 app and website with new features that allow users to anonymously share personal information, including any existing health conditions, symptoms, exposure risk, age, and state where they reside. This personal data, which is not linked to any other information that can identify users, is being collected to help CDC research and potentially improve the current protocol for screening.
In addition, the CDC and other public health agencies will use this app-gathered information to study potential risk factors for the novel coronavirus, and to track symptoms and progression of the pandemic. It’s an approach that holds promise for additional future research, enabling public health scientists to identify clusters of other diseases.
What’s more, Apple, and Google collaborated on the COVID-19 Exposure Notification API. This public version of a contact-tracing software tool is designed to notify people when they have been possibly exposed to others who have confirmed cases of COVID-19 — yet it preserves individuals’ privacy by using new, high-tech methods to assure all identifying information, including location, is anonymous.
Apple and Google are not creating the apps but have provided a beta version of the software tool to public health agencies who can now use it to develop and issue their own apps.
June 22, 2020
Janet O’Dell, RN