The St Paul Pioneer Press recently posted an interesting article on the future of telehealth. It’s a fun look at the practical and a look at the difference between online and in person service and expectations…
In a sterile hospital environment with little more than a magazine to keep them company, most patients are fairly forgiving, and can chalk up a 20- or even 30-minute delay to the demands of the profession.
But online? If virtual care is scheduled for 3:30 p.m., it had darn well better start at 3:30 p.m.
“That took me by surprise,” said Ingham, vice president of Health Information for Allina Health. “We’ve struggled a bit to deal with that. … They could literally be on their couch waiting, and they still get kind of perturbed if you’re running more than a couple minutes late.”
While waits were verboten, suddenly interpreters were easy (easier)…
Since the outset of the pandemic, linguistic interpreters — who once might have taken hours to be tracked down when needed — are entering clinical settings via video screen in a fraction of the time. Family members of immigrants are suddenly able to assist nurses and physicians bridge cultural and language barriers through three-way calling. Doctors are beaming into the living areas of their patients like an old-fashioned home visit or consulting with medical teams to provide in-patient care from across the state.
The COVID19 has been the impetus, but telehealth will outlast the pandemic…
The M Health Fairview system logged some 3,500 virtual care visits last January. That was before the pandemic. By April, with hospitals and clinics scrambling to find safe alternatives to in-person care, that number had grown to 120,000 virtual visits.
For M Health Fairview, which has completed more than 1 million virtual care encounters since March, telehealth in some months has accounted for 80 percent of outpatient service.
Health systems say it’s unlikely they’ll put the genie back into the bottle, even though there’s plenty of room for improvement.
Here are some of the advances and hurdles that will lead us forward….
- In October, Minnesota-based 3M introduced the new Littmann CORE Digital Stethoscope — a device that makes it possible to listen to a patient’s heart sounds from anywhere, wirelessly, by recording or livestreaming data to a remote provider.
- Hospitals and community health centers have rolled out team-based meetings by iPad and remote monitoring equipment that allows them to check on patients with chronic diseases such as diabetes and hypertension, to examine their blood levels and to adjust medication from afar.
Nicholson said that’s an especially important innovation given that dexamethasone — a core treatment for COVID-19 — can raise blood sugar levels precipitously, and there’s not enough endocrinologists available to send to every hospital.
- There are still plenty of hurdles to come. Using everyday communications technology like FaceTime, Skype and Zoom for patient visits requires a state and federal regulatory framework that allows Medicare reimbursement and other licensing, approvals that had to get rushed into place on a temporary basis in the early days of the pandemic.
Those rules are still evolving, and in some cases being rolled back. Allina’s Ingham noted that many states require medical practitioners to be licensed in-state. Rules around in-state licensing that were relaxed for virtual care in the early days of the pandemic have since been widely reinstated.
- “Historically, no one really wanted to pay for virtual visits,” Ingham said. “They would reimburse much much less, if they would reimburse at all. … We can’t work for free.”
Given the experience of the pandemic, the federal Centers for Medicare and Medicaid Services appear willing to continue to reimburse providers for virtual care, but it’s unclear the degree to which the private market will do the same once the COVID crisis has passed.
- Online care also requires that all parties have access to broadband internet, which can be challenging for rural and low-income residents.