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Telehealth Surges During Coronavirus Outbreak

Technology connects doctors to patients and to other physicians. Is this practice here to stay?

Doctor sitting at desk writes notes as she holds up her phone as she video chats with a patient

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En español | Medical practices around the country are closing their offices and opening their laptops to provide health care to millions of Americans who are under guidance to stay home to slow the spread of the new coronavirus. Since the start of the pandemic, telehealth services have soared in the U.S., with some care settings, such as the Cleveland Clinic, reporting that demand for virtual visits is up more than 1,000 percent since the start of the outbreak.

"We have had the most significant increase in demand we've ever seen in our telehealth practice,” says Matthew Faiman, M.D., an internist and medical director of the Cleveland Clinic's virtual-visit platform, Express Care Online, which launched in 2014.

With other virtual care providers reporting jumps in demand during the pandemic, experts predict that telehealth's newfound popularity may be here to stay.

Telehealth is ‘not what it was 30 years ago’

Telehealth — which is simply the use of email, video conferencing, online patient portals and other technologies to aid in the delivery of health care — has been used by medical professionals for decades as a way to connect specialists with rural patients, for example, and as a way for doctors to consult with one another on treatment plans. But newly waived fees and recently relaxed restrictions around its use, including for Medicare beneficiaries — all in response to the coronavirus outbreak — have led to “incredible transformations” in the field, says Karen Rheuban, a cardiologist and director of the University of Virginia (UVA) Center for Telehealth.

"Necessity is the mother of invention — I hate to use clichés,” she says. “We needed ways to get to our patients, all the more so during a public health emergency, and so that's the genesis for that huge scaling of telemedicine nationwide.”

Patients who otherwise would have come into the office for routine care are now visiting with their doctors from home through videoconferencing and remote monitoring. This includes people with COVID-19, the illness caused by the new coronavirus. In the past few weeks, UVA’s telehealth program has monitored around 50 patients in their homes with video-enabled tablets. Nurses check in on the patients with video visits, log their vital signs and make “determinations about the suitability for them staying at home versus coming to the hospital for admission” where they could expose others to the virus, Rheuban says.  

Virtual consultations and mobile telemedicine units, which are equipped with medical instruments and a camera that transmits information to health care providers, make it faster and easier for physicians to relay critical information and provide care to staff and residents daily and on an urgent-need basis, Rheuban explains.

"It's not just what it was, you know, 30 years ago, when [telehealth] was reaching out to rural communities that didn't have access,” the Cleveland Clinic's Faiman says. More patients and providers are realizing its value in emergency situations and in the everyday. Telehealth saves time for both patients and providers, he notes. It also allows people with chronic conditions and their doctors to monitor their health from home. “Patients are asking for it,” and more health care providers are working it into their practices, Faiman says.


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It doesn't have to be complicated

Not everyone is tapping into remote medical care, however. A new poll from the Kaiser Family Foundation (KFF) revealed that while most adults (68 percent) age 65 and older have a computer, smartphone or tablet with internet access at home, very few (11 percent) have used it to talk by video to a doctor or health care provider in the past two weeks. This is about the same percentage as adults ages 30 to 64.

"Of course, these low rates could reflect a lack of need, not lack of interest,” the KFF notes. And the share could “increase somewhat as more patients learn about the option to seek medical care from their providers via telehealth.”

Faiman says that anyone who is hesitant to try telehealth can start with the basics: a phone call.

"Even the old telephone is a tool for us to get information, hear someone's voice, hear their concerns,” he says. Plus, it can serve as a “stepping-stone” for getting patients comfortable with more advanced technologies, so that if a doctor asks to connect in a way that provides more visual cues, “that next hurdle is not so difficult.”

Another benefit of telehealth: Virtual visits eliminate the travel time it takes to get to the doctor's office, not to mention the time wasted in the waiting room, UVA's Rheuban points out. Further, it “empowers patients with remote monitoring to be greater engaged in their care because they are checking their blood pressure, they're checking their blood sugar, their oxygen saturation, and so they are much more aware of their own clinical conditions,” she adds. This type of telehealth requires special at-home devices that take these measurements and transmit them to the doctor.

Not just for patients

The benefits of telehealth aren't limited to patients. Doctors are increasingly using virtual communication with one another to help diagnose and treat clients.

A new study published in the journal Annals of Internal Medicine found that telehealth consultations (e-consults) conducted between primary care physicians and specialists from October 2017 to November 2018 were deemed “appropriate” about 70 percent of the time. What's more, over 80 percent of these consults helped patients avoid in-person visits with specialists.

"This shows that e-consults are effective in allowing frontline providers to get the answers to necessary questions,” says lead author Salman Ahmed, associate physician in the renal division at Brigham and Women's Hospital in Boston. Telehealth use between physicians can also “save patients time that would have otherwise gone into a specialist visit.” Similarly, this preserves a specialist's clinic hours for more “complex or urgent questions,” Ahmed adds.

Then there's the ability of e-consults to “empower primary care providers to provide more complex services to their own patients,” Rheuban says. The input from other physicians can “raise their level of expertise,” she observes.

Data analyzed in the study were collected long before the coronavirus outbreak — “when nobody could have predicted current events,” Ahmed notes. Even then, the findings showed “a tremendous potential for the use of e-consults.” He predicts that going forward, there will be even wider use in the medical community.

Staying power beyond the pandemic

Even when social distancing guidelines are eased and health care facilities return to in-person appointments, the Cleveland Clinic's Faiman believes that the demand for telehealth will remain. “People are so much more aware now of the value proposition of what this can offer,” he says.

Still, Faiman says, it will be important to provide trainings and tools for medical workers so that care remains thoughtful throughout telehealth's growth. “The people are the ones that ultimately deliver the care; technology is just a tool to deliver care for patients,” he adds.

The continuation of relaxed restrictions around telehealth's use will also be critical in allowing doctors to care for more patients through technology. “Hopefully, a lot of the data that are collected in this public health emergency can be used to justify continuation of these services,” Rheuban says.

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