The COVID-19 pandemic is changing the way many of us visit our doctors.
Instead of in-person visits, patients are increasingly seeing their physicians via a computer or smartphone, avoiding a crowded office full of sick people. They even get to skip the dreaded weigh-in check.
Welcome to the age of telehealth, where patients and providers can communicate in real time across town or even across the state.
The technology has been available for years, but has been slow to catch on mainly because of a reluctance by insurance companies to reimburse physicians for the video visit, as well as privacy concerns.
But the pandemic has forced people to adapt, as governments ask residents to stay home as much as possible and avoid any chance of exposure to the deadly virus.
“One of the things we realized very quickly was that patients were fearful to come into the clinic and intermingle with sick patients,” Cathy Dreher, practice manager at the Iola office of the Community Health Center of Southeast Kansas, said. “We saw a dramatic drop in visits for chronic health conditions and well visits.”
Chronic health conditions are issues that need to be monitored on a regular basis, including diabetes, heart disease, high blood pressure or cholesterol, arthritis, cancer, anxiety or depression.
Some medication refills require physicians to check a patient’s vital signs. Many of those visits, it turns out, can be accomplished with telemedicine services.
Erin Splechter, a nurse practitioner and clinical informatic specialist, recently helped set up telehealth at Allen County Regional Hospitals’s health clinics in Iola, Humboldt and Moran. She studied telehealth in college, but didn’t expect to see it adopted so quickly.
“COVID-19 has pushed forward the ability of our providers to offer it at rural health clinics,” she said. “In a rural health setting, we still drive a fair distance to see a doctor. Telemedicine is a definite perk. You can do it in the comfort of your own home.”
Every health clinic is different, though.
CHC/SEK calls its telemedicine services “alternative visits.” Such visits could include something as simple as a phone call, Facetime calls, Google Hangouts, or downloading an app and logging into the clinic’s “Patient Portal” for a meeting. Staff work with patients to determine which service works best and walk them through the steps.
At its various offices across 12 communities, CHC/SEK has seen an 86% increase in alternative visits. Dreher did not have figures for the Iola clinic alone.
“You’d be surprised how many of our patients are eager to use this,” Dreher said. “Our providers are really excited, too. CHC was concerned that our patients would not get the care they need, and then we would have another crisis when this is over. Now our providers can make sure patients have the medications they need and they can see them face-to-face.”
CHC only allows existing patients to use telemedicine services.
ACRH’s rural health clinics are taking new patients via telehealth. The clinics are able to take advantage of resources through Hospital Corporation of America, one of the nation’s largest health systems that manages ACRH.
Clinic staff send patients an email, which they use to log into the doxy.me service. They’ll go into a virtual “waiting room,” where a staff member will review medications before connecting them with a physician.
“We can see them for anything you would normally see the doctor for that is basic health care or chronic conditions,” Splechter said.
TELEHEALTH itself isn’t new. The idea of using technology to connect doctors and patients began with the earliest days of the telephone in 1876. In the 1960s, NASA began using a type of telehealth monitoring for astronauts in space.
Electronic medical records have been used for decades, allowing healthcare providers to quickly transmit records and images across great distances for review by specialists.
Telehealth refers to the overall use of remote services, including administrative and educational meetings as well as clinical visits. Telemedicine typically is used to describe remote clinical visits.
Still, challenges remain.
Security is a top concern, and the need to protect sensitive medical information is a primary reason why states and providers have been slow to approve wider use of telehealth services.
Also, not everyone has access to a computer or reliable internet service. Some patients and providers simply aren’t comfortable with the technology and prefer one-on-one interaction. If you haven’t established a personal relationship with a doctor, how do you trust him or her?
And not all illnesses and conditions lend themselves to video calls. It could be difficult to assess vital signs. Some rashes, for example, don’t show up well on screen.
Another hindrance has been in determining who pays for the service. “Telehealth” is a fairly broad term, so coverage can vary depending on the types of services, such as for behavioral health services and management of a chronic disease, compared to more complex medical needs like monitoring remote patients who have congestive heart failure.
The rules may vary for private insurance companies, and states determine their own policies for paying for telehealth for those with Medicaid and Medicare.
In response to the COVID-19 crisis, many rules have been relaxed.
“Once Medicare does it, the private insurances follow,” Splechter said. “Most major insurances are now covering telehealth visits.”
Splechter and Dreher see this time as a learning experience.
“I think this will evolve. We’ll see more opportunities in how to use telehealth,” Splechter said. “It’s going to depend on what the insurance companies want to cover.”
“This is a new normal,” she said. “We’ve seen lots of changes in the last month in healthcare in general. I don’t think we’ll necessarily go back to the way it was. Who knows what the future holds?”