telehealth

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Tele-medicine and COVID-19

William Aitken, MD

The coronavirus pandemic has changed the world profoundly over the past few months. Globally, millions of people have contracted COVID-19 and hundreds of thousands have died [1]. Millions more have had their lives up-ended with jobs ending, schools closing, family separations, and varying degrees of quarantine. We face uncertainty daily: Did someone I pass at the grocery store have COVID? How much longer should I stay home? Fortunately, people have been taking precautions to keep themselves and others healthy: washing their hands, covering their mouths, and avoiding unnecessary exposures.

One exposure that I didn’t expect we would be able to avoid here in the US has been visits to the doctor’s office. However, given recent Centers for Medicare & Medicaid Services (CMS) temporary expansions, more people than ever are using tele-health. In March, there was a 50% increase in tele-health visits across the country [2]. This expansion into tele-health has been aided specifically by the recent CMS 1135 waiver that has increased access to and reimbursements for tele-health [3].

That said, I’m left wondering how tele-medicine will affect caring for patients with heart disease and other high-risk groups in the future. Will adherence improve without the hassles of having to drive to the office? Will tele-physical exams be accurate enough to confidently make medication changes? Only time will tell. Certainly something I’ll be looking out for.

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References:

  1. https://coronavirus.jhu.edu/
  2. https://www.cnbc.com/2020/04/03/telehealth-visits-could-top-1-billion-in-2020-amid-the-coronavirus-crisis.html
  3. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
  4. Author: Intel Free Press

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Telemedicine May Play A Role In Rural And Urban Community Engagement

Sherry-Ann Brown, MD, PhD

Telemedicine may be the original term for remote patient care management using telecommunications beyond a phone call, but telehealth is also used. While the two terms are often used interchangeably, one could propose that telehealth could encompass more of a wellness approach that is proactive than the typical reactive nature of medicine. Traditionally, we have focused predominantly on management of disease. Yet, it may be more prudent and cost-effective to focus even more so on health, wellness, and prevention of disease. Nevertheless, for the purpose of this article, the term telemedicine will be used.

Many institutions are now pursuing telemedicine, or are planning to do so in the near future. Of course, several hospitals and medical systems are appropriately concerned about reimbursement. Reimbursement currently associates with more rural communities. However, there is also a role for telemedicine in less rural neighborhoods. If we are to ubiquitously implement telemedicine equitably, we may need to remove those boundaries of rural versus not, in telemedicine allocation decision-making. We need to be great stewards of our healthcare resources, and we need to determine where to best direct our efforts. Rural communities may benefit most from telemedicine, but other communities can as well. Perhaps in the most urban communities, telemedicine might be needed much more than anticipated. It is often in urban communities that we find limited community engagement with nearby health centers. Would the level of community engagement with health care centers in urban communities improve if telemedicine were more available in these areas? Availability and feasibility would depend on the source of provision and financing of the tools needed for telemedicine. These tools would include at a minimum internet access, computers or smart phones, physiology monitoring and diagnostic equipment, and free or costly apps. It should be recognized that telemedicine itself alone cannot effect community engagement. In fact, community engagement itself would be needed for adoption of telemedicine throughout the community. It might seem like a circular argument, because it is.

We often attempt to practice medicine or innovate in silos. Yet, it is when we remove the boundaries between the silos or blur the lines between neighborhoods and cross-pollinate that we can find nonlinear progress. Synergy can be found in the overlap of various kinds of disruptive innovation. Synergy can also be found in the overlap between the perspectives of community dwellers and healthcare professionals and innovators. Healthcare research and practice is now moving towards greater incorporation of the patient voice, choice, desires, values, and goals, not as bystanders, but as drivers. Not only should we take this approach at the level of the individual patient, but at the level of the population or community. Thus, community engagement is needed for adoption of telemedicine, and telemedicine itself perhaps may help to further catalyze community engagement. It therefore appears that telemedicine is not only about providing care for the individual patient in their home, whether due to patient location or mobility or simply patient preference. It would seem that telemedicine is also about providing care for the population and a community and enhancing relationships among community dwellers and their healthcare providers. This would potentially apply to rural, urban, and also global communities and populations.

It may also be more cost-effective to pursue telemedicine for patients in both rural and urban areas locally, regionally, nationally, and globally, before our patients in urban and rural communities become unwell and need to be hospitalized. Overall, medicine is very slowly moving towards prevention. Telemedicine could facilitate disease prevention in urban, rural, and global populations, as well as joint management of the most remote locally hospitalized patients before their inpatient status worsens. This could limit morbidity and mortality and decrease health care costs in the long run.