By Jeanie Davis
The COVID-19 pandemic pushed healthcare systems to quickly adopt digital technology to keep providers, patients, and family interactions safe. Cellphones and tablets were literal life-savers, supporting videoconference meetings to avoid one-on-one interactions.
At the outset, telemedicine was in the spotlight as the Centers for Medicare & Medicaid Services relaxed regulations that had limited application of teleservices throughout the country. Many hospitals quickly engaged telemedicine services to connect providers with patients and families.
Now, with the initial surge a few months past, healthcare analysts are assessing the lessons learned.
“The crisis showed us what’s possible,” says Dan Clarin, CFA, senior vice president at Kaufman Hall Consulting, who has counseled hospitals on digital planning. “The telemedicine industry has been in some ways held back by reimbursement considerations and regulatory red tape. The CMS response to COVID removed a lot of that. What we’re seeing now is an exponential increase in use of telehealth.”
The technology “is so widely available we can use it in any setting, not just acute care or a physician’s office,” says Hussein Michael Tahan, PhD, RN, FAAN, a case management expert and corporate vice president of nursing professional development and workforce planning at MedStar Health in Columbia, MD.
“Telehealth provides personnel resources in a crisis, including consults from specialty providers — especially palliative care or infectious disease,” explains Tahan. “With a virtual consult, we are able to provide a high level of care, yet the provider didn’t need to be present on site. This is specialist care provided in a timely manner, very efficiently.”
Rural Hospitals Benefit
These readily available specialists often are not on site at rural and suburban hospitals, Tahan explains. “Telehealth technology can bring the service to them remotely, which expedites patient care planning and prevents unnecessary transfers to a tertiary hospital. It can expedite transfer when indicated so the patient receives a higher level of care in a more timely manner — which would contribute to improved outcomes.”
Clarin agrees: “It can be very difficult to recruit physicians to a rural environment, whether primary care or specialists. Virtual hospitalists are relatively new, whereas the telespecialist is a model that’s been prevalent for a longer time, whether supplementing ICU [intensive care unit] coverage or providing patient consultations on an as-needed basis.”
Also, small hospitals are burdened with the cost of locum tenens (temporary doctors) to cover vacations. Telemedicine provides a more cost-effective way to manage coverage — another attractive feature in recruiting efforts.
Telerounding is when team members can remotely discuss patient care and/or discharge planning. Some clinicians may find it easier, even more effective, participating remotely, says Tahan.
“During the COVID crisis, telerounding minimized use of PPE [personal protective equipment] and the number of people needing to visit patients in their rooms,” Tahan explains. “It showed team members don’t need to be in the patient care area to be effective. With audio or an audio/visual bidirectional telehealth system, they can access the patient’s electronic medical record and discuss the plan of care, with the patient present or without the patient, and gather the healthcare team only as necessary.”
During the crisis, use of telehealth technology has reduced risk to patients discharged to home care as the patient could be monitored remotely, Tahan says. On the first day after discharge, the clinician can visit the patient virtually, perform any necessary assessments, speak with the patient and family, and initiate interventions to enhance the patient’s engagement in his or her own health and well-being.
“Video technology, even a simple cellphone or tablet, can be used pre-discharge to assess the patient’s home for any risks, like furniture setup that may increase risk for falls,” he adds. “Video can be used to scan medications the patient has at home, instead of asking and waiting for the family to bring them into the hospital for medication reconciliation purposes. Such requests may not be feasible during a pandemic.”
Home monitoring apps and digital tools can be helpful in monitoring a patient’s status remotely, Tahan adds. However, it is critical the patient can use them correctly. “It’s important to do a remote assessment of whether the patient can perform a blood glucose reading or blood pressure check effectively.”
Some available tools work via automated sensors that can run in the background as a form of remote monitoring. These do not require direct patient intervention. The tools communicate key information about the patient to the providers, he adds. With such opportunities of ongoing remote monitoring, timely and necessary interventions can be proactively initiated.
Follow Up with At-Risk Patients
Tahan prefers the term “telehealth” or “tele-case management” over “telemedicine” because the technology can be applied beyond medical care to address social determinants of health and other social/human services that are conducive to healthcare outcomes.
“Finances often are an issue for some patients. They cannot afford copays for medications, so they may ration them instead,” he explains. “Or they can’t afford — or don’t have access to — food appropriate for their required special diet based on their chronic health conditions, like diabetes or end-stage renal failure. They may not have transportation to a doctor’s office, or their family member may not be able to take a day off from work to accompany them to the clinic. Telehealth can be helpful in maintaining follow-up care of these patients to prevent their condition from deteriorating, resulting in an otherwise avoidable trip to the emergency department or a readmission to acute care hospital.”
Financial Benefits to Hospitals
Hospitals can realize significant cost savings from telemedicine, adds Clarin. “There’s definitely the opportunity to get a more efficient care model here, but there haven’t been a lot of hospitals that have optimized that.”
In the past, telehealth was an appendage to the current system, Clarin says. “It was not integrated in such a way that the benefits were fully realized, so there’s work ahead for us. Now that we’ve seen significant adoption of different telehealth adaptations, hospitals will be more open to redesigning their overall care delivery to take it into consideration.”
Now that hospitals have seen significant adoption of different telehealth adaptations, they will be more open to redesigning their overall care delivery systems and take such tools into consideration, Tahan adds.
Telehealth digital technology also can help healthcare leaders set up contingency plans for future disaster planning, says Tahan. “We had never before considered increasing the number of critical care beds to the extent we needed to during the pandemic, for a crisis like this. Now we know we must have a number of contingencies in our disaster plans for expanding such beds to 200%, 300%, or even 400%.”
Additionally, the plans must include a deliberate focus on the use of digital technology that can assist with telehealth services, such as specialty consults for all patients to expedite care progression, and yet still control the need for special supplies like PPE.
Tahan believes the pandemic experience has changed professional case management practice. “It will never be the same. It must always be updated to include impactful care delivery strategies and interventions for all people.”
Innovative care sites such as “virtual clinics” have contributed to timely access to health and human services despite the COVID-19 pandemic, Tahan explains. “In essence, a natural experiment has occurred that shows virtual care delivery is as important as the services provided in traditional care settings such as primary care clinics. In fact, virtual care delivery may result in patients’ enhanced adherence to care regimens and engagement in their own health and well-being.”
The pandemic “has forced nonconventional collaborations,” Tahan says. For example, acute care settings are providing training, education, and personnel to long-term care providers. This facilitates “healthcare services in place,” rather than transferring skilled nursing facility residents to the acute care setting when such may not be preferred during a crisis like COVID-19.
Ultimately, “these person-centered care approaches have served to advance case management very well,” Tahan says. “The future is bright for all involved — patients, providers, payers, patient advocates, leaders, and all other stakeholders.”