Telemedicine – the use of remote monitoring, video conferencing and other technologies to provide health care services and consultation to patients and their caregivers – has grown exponentially in recent years. In addition to offering invaluable assistance to sick individuals who have few or no appropriate health care providers nearby, it enables multidisciplinary care for complex medical issues.
Dr. David McSwain, the chief medical information officer for the Medical University of South Carolina, is an authority on this significant new health care technology.
“We have seen a huge expansion that’s driving a real transformation in the way we care for patients and the way that our patients expect to receive care,” Dr. McSwain commented.
Some of this growth is clearly due to the limitations placed on patients and providers by the COVID-19 pandemic and the undiminished need for health care. Dr. McSwain, however, said that for many practitioners, whether in practice for themselves or as a part of a medical group, increased reliance on telemedicine is not just a response to the coronavirus.
“This technology is being used to keep patients connected to their doctors, to keep patients’ families and loved ones involved in their care, to keep health care providers connected to one another and to keep the care team connected to the community,” he said.
That’s the philosophy that informed MUSC as it built its external and internal systems for telemedicine. The medical university also put in place education and training programs for all personnel who might be utilizing them.
“The technology can only get you so far,” McSwain noted. “You have to have the people and processes in place around it to have it all fit into the way we provide care.”
The doctor observed, “Sooner or later, everyone is going to have to integrate telemedicine into their practice,” adding that “providers who have previously had no experience in either providing or setting up telehealth services are now getting a huge amount of very valuable experience.”
Dr. McSwain said that while telemedicine – particularly among solo practitioners – “was focused primarily on the management of minor conditions” the promise for telehealth in the future will be “the use of this technology to provide services to patients with chronic illnesses and complex medical conditions who are a high cost to the system, reducing excessive ER visits, hospitalizations and face-to-face doctor visits for patients who require a lot of care across multiple specialties.”
In the past, he noted, “Telehealth was a niche service in many ways. Now that so many medical professionals in every specialty across the state and across the nation are using telehealth services and are familiar with the way this technology can improve the care of their patients, a lot of barriers to creating a truly coordinated approach to telehealth care have fallen by the wayside.”
As one example, Dr. McSwain cited a child with chronic lung disease who is on a home ventilator.
“They are some of the most medically complicated patients and among the most challenging patients that we have. They have a high rate of complications and unexpected death. They are extremely difficult to care for in their homes, and they require considerable coordinated care across multiple specialties and disciplines. But that population, in my view, may represent one of the most promising applications for telehealth when you combine its multiple capabilities, including home monitoring via wearable devices, patient monitoring through electronic health record integration and video visitation capabilities.
“Across the highest complexity patient populations,” he added, “we have the ability to maintain contact with them in their homes, to extend specialty services to them alongside coordinated services to improve their compliance with care and remotely evaluate them.”
While the numbers for telehealth consultations continue to soar, especially as many individuals fear face-to-face consultations in the time of the coronavirus – and numerous doctors have adopted remote-visits-only policies – the question often arises, “My insurance will pay for an office visit. But what about a telehealth visit?”
According to Dr. McSwain, ”In response to the pandemic, insurance companies have dramatically opened up their payments for telehealth services. That’s expected to continue at least through this emergency period. The question now is whether expanded payment for telehealth services continues beyond this emergency. We have to take this opportunity while so many practitioners are using telehealth to collect the data to show the real value of what we are doing. Beyond what we are doing for our patients, we will need strong data to prove to those insurance companies that telehealth improves patient care and brings real value to the health care system.”
The doctor observed that if there is any silver lining to the pandemic cloud it is that “we have taken a huge leap forward in getting closer to realizing telehealth’s potential.”
Yet another tool in telemedicine’s bag for treating recovering coronavirus patients is physical therapy. Traditionally a hands-on aspect of health care, PT has adapted its practices. Patients who have been sickened or even hospitalized by the coronavirus, in particular those with comorbidities, “need to get back to normal,” according to Jessica Heath-Byerly, CORA PT’s director of clinical education.
“They often need some rehab for their pulmonary function, as well as a regimen to improve their strength and endurance,” she said. “We also see people who have been following isolation and haven’t been able to exercise as they usually would and are deconditioned. We can work with that also.”
And, at CORA PT, they can frequently accomplish those goals remotely via telemedicine.
With some 200 physical therapy clinics, including numerous South Carolina facilities serving communities such as Greenville, Spartanburg, Greenwood and Mount Pleasant, CORA PT has wide-ranging experience in virtual healing.
Whether for coronavirus recovery or more traditional referrals such as for orthopedic injuries and post-surgical recovery, including pelvic disfunctions, CORA PT offers telemedical solutions virtually.
“First we observe the patient,” Heath-Byerly said. “One large part of telehealth is the ability to educate them. We are able to teach them how to get a better night’s sleep and manage their pain. We also set them up with a home exercise program and watch them virtually to correct them as required.”
Most patients are “very pleased” with their telemedicine results, the clinician observed, and virtual healing is particularly important to high-risk patients and those who are simply reluctant to make office visits while COVID-19 persists. There also are patients whose condition requires at least some hands-on physical therapy. For these patients, CORA PT has established a hybrid program of treatment. Patients come to the office for one or two visits, then continue their regimen at home under the clinician’s watchful virtual “eye.”
“I believe that with the arrival of coronavirus, there was a rush to telehealth,” Heath-Bylerly concluded. “I think that telehealth is already bringing many benefits to patients and that telemedicine and telehealth will be around for long after the coronavirus pandemic has passed.”
By Bill Farley