Digital Health: Telehealth and the Need for Access During a Crisis

Rachel Marcheskie, Princeton University

Compassion During Covid-19

Dr. Glenn Wakam, a critical care physician in Detroit, recently published a perspective article in the New England Journal of Medicine detailing just one of the many unbearably upsetting situations his patients and their families are suffering: 

“It’s 11 p.m., and I’m worried that my patient won’t survive until morning…I call the patient’s wife to inform her about her husband’s trajectory. The conversation makes her feel overwhelmed and helpless. She asks to come into the hospital to be with her husband, or at least see him through the door to his room. Unfortunately, I am told by the unit charge nurse that hospital policy permits no visitors for patients who have tested positive or are under investigation for Covid-19,” (Wakam et al., 2020).

These types of widespread policies are an unfortunate, but necessary, measure in an attempt to curb the spread of Covid-19 in the United States. The intense distress from patients and family members that follows exemplifies the need for communication despite isolation. For many, more than simple communication, but the need for an emotional connection with people they trust. 

This global pandemic has been associated with increased rates of depression, distress, anxiety, and suicides. Uncertainty, economic issues, fear, and isolation have cost some of those most vulnerable their lives. In order to combat this, experts suggest striving to decrease loneliness and maintain virtual relationships, among other things (Sher, 2020).

In-person vs. Virtual Healthcare

For many, the traditional in-person care has been the only option for quality healthcare. With the advent of new technology comes many new opportunities. When comparing in-person healthcare to virtual healthcare, the positives are obvious and plentiful: physicians are able to perform physical tests, act quickly in emergency situations, more easily emotionally comfort patients, swiftly assess the situation with more of the variables known, have set work boundaries, and have a lower chance of misdiagnosis. Additionally, the current system is not biased against vulnerable populations, in particular those who are especially old or young, who have less technical knowledge or access. Furthermore, there is less likely to be an overuse of unnecessary visits. An overhaul of the entire medical system in a transition to telehealth would require the hiring of new technical staff and aids and new insurance models to cover the financial aspect. For educational purposes, interactive teaching is more burdensome online than in person. Finally, a closed door consultation is bound to be more confidential from uninvited participants, both from online hackers and members of the household.(Wijesooriya et al., 2020) However, virtual healthcare has many benefits that in-person health care cannot compete with, especially during a pandemic. In addition, with specific training, virtual healthcare can compete with the levels of empathy physicians are able to provide their patients.

Long before our current global crisis, healthcare in the United States was already a looming problem: extraordinarily expensive, intervention focused, and geographically restrictive. However, virtual options seem to be the economical light at the end of costly and constraining tunnel. 

●      Efficient: reduce costs from less travelling by patients, more streamlined services with a higher usage of primary care physicians and lower usage of ERs, less overhead, ensures there is space for patients who crucially need to be seen in person, more flexibility in time spaces for physicians to hold appointments

●      Proactive: patients are able to reach out to their doctors 24/7, patients can access a physician sooner and receive a diagnosis before their condition worsens/can no longer be treated, can lead to more preventative healthcare measures and help patient outcomes

●      Access: provide healthcare to those who are geographically distant from medical centers, gives medical professionals remote opportunities to equalize their education or work when it is most convenient for them, easier to collaborate with specialists from different locations, more individuals can access online medical conferences for educational purposes

Telehealth during Covid-19

Telemedicine has many Covid-19 specific practical uses. The technology allows medical professionals to keep their distance from potentially infected patients and allows vulnerable patients to keep their distance from medical institutions when physical care is not needed. This helps keep physicians serving those who need in person care, while minimizing their amount of exposure. This ensures the healthcare system is able to operate at the same capacity as before, while avoiding new infections (Wijesooriya et al., 2020). In addition, intake forms can be used to create a comprehensive travel and exposure history (Hollander & Carr, 2020). Spatially, waiting rooms would have fewer people, which would lead to a lower chance of spreading Covid-19. However, in many suburban areas, patients are instructed to wait in their cars until their physician is ready to see them.  

In regards to healthcare, telemedicine has picked up at an exponential rate since the beginning of the pandemic. President Trump issued a statement mid-March which authorized Medicare patients to use telehealth for no additional fees (Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Briefing, 2020). This authorization gives more opportunities to access telehealth to a more vulnerable population. 

The effects of this authorization were soon felt in the telemedicine realm, as both technological infrastructure and online physicians were quickly overwhelmed by the number of patients using their systems (Brodwin & Ross, 2020). Extra saturation of patients can lead to worse care by physicians simply because they may have to rush. Due to the already impersonal impression of video calling or traditional phone calling, overworked physicians may not be able to connect with their patients on the personal level which is necessary for high quality care. Combining these two factors, fewer compassionate encounters are likely to happen. 

Education in Telehealth Realm

Training for telehealth etiquette and technology is currently woefully inadequate. There are only a few organized initiatives at universities which offer instruction and guidance regarding telehealth programs (Papanagnou et al., 2015). Project ECHO is a relatively widespread telehealth program that attempts to fill the unmet need of training and educating rural physicians (Rocha et al., 2019). Unfortunately, due to Covid-19, the medical community may be diving head first into a new, experimental world in which there may not be enough evidence to substantiate claims of quality medical care. 

The only solution to this quickly developing issue is more adept training courses for telehealth in medical schools. One of the many important teachings of the courses would involve an intense focus on teaching compassionate care within telehealth. 

To show compassion during an in person consultation is relatively natural, as compared to compassion through video calls. Within telehealth, however, physicians must be trained how to properly (Rutledge et al., 2017):

●      position themselves within their camera view to avoid distractions for the patient

●      construct a professional meeting that helps the patient instill trust in the physician 

●      maintain eye contact not with the patient’s eyes, but with the camera 

●      empathize using words, as opposed to touch

●      dramatize their body language   

Access and Empathy

An important consideration to keep in mind while advocating for the advancement of telehealth technology is the need for widespread technological access. This measure ensures the widening medical gap for vulnerable populations begins to close. The limiting factor for implementing this new technology in more settings are the populations which have it and are able to use it. The rollout of new systems should include multiple languages, simple login procedures, and an aide to assist patients with their appointments or medical information (Horn, 2020). Unquestionably, these steps must accompany the utmost security protection for patient data.

Once a proper system is set up which mediates the potential disparity for medical access between certain populations, the most important factor in telehealth is the quality of care. It is important to emphasize that medicine is going to a more technologically driven realm and the need for a strong core of medical professionals who are as competent at giving care online as virtually. This, of course, depends on the virtual or disembodied instruments which they are able to take advantage of, as well as their education of telehealth practices. 

The emphasis of the vital significance of telehealth education may be deemed as more important due to the fact that we are living through a pandemic, where telehealth is an essential service for many people. However, even after restrictions lighten up and physicians feel comfortable seeing patients in their offices once again, there will always be individuals who deem telehealth to be a better fit for their health needs. As long as there are still people using telehealth for their medical services, then telehealth must be at the same quality as in person care. 

For some physicians, however, telehealth has brought a new, closer perspective to their patient’s lives. Medical professionals who are able to slow down with their patients over video calls and meet their spouses, grandchildren, and pets have a newfound appreciation for this long distant technology. These doctors have found ways to provide compassionate, personal care in disembodied settings (Saksena, 2020). In a more personal setting, patients could be incentivized to disclose more intimate conditions. There is always a need for an emotional connection, regardless of the physical space separating physician and patient. These types of interactions give hope that, with proper training and equitable roll outs of technology, quality virtual healthcare is more than a possibility: it’s the future.

References

Brodwin, E., & Ross, C. (2020, March 17). Patients overwhelm telehealth services amid coronavirus pandemic. STAT. https://www.statnews.com/2020/03/17/telehealth-services-overwhelmed-amid-coronavirus-pandemic/

Hollander, J. E., & Carr, B. G. (2020). Virtually Perfect? Telemedicine for Covid-19. New England Journal of Medicine, 382(18), 1679–1681. https://doi.org/10.1056/NEJMp2003539

Horn, D. (2020, July 9). Perspective | Telemedicine is booming during the pandemic. But it’s leaving people behind. Washington Post. https://www.washingtonpost.com/outlook/2020/07/09/telemedicine-is-booming-during-pandemic-its-leaving-people-behind/

Papanagnou, D., Sicks, S., & Hollander, J. E. (2015). Training the Next Generation of Care Providers:Focus on Telehealth. Healthcare Transformation, 1(1), 52–63. https://doi.org/10.1089/heat.2015.29001-psh

Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Briefing. (2020, March 17). The White House. https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-4/

Rocha, L., Powers, M., & Siegfried, A. (2019, May 21). Telehealth Models for Promoting Workforce Education and Training—RHIhub Toolkit. https://www.ruralhealthinfo.org/toolkits/telehealth/2/workforce-development/education-training

Rutledge, C. M., Kott, K., Schweickert, P. A., Poston, R., Fowler, C., & Haney, T. S. (2017). Telehealth and eHealth in nurse practitioner training: Current perspectives. Advances in Medical Education and Practice, 8, 399–409. https://doi.org/10.2147/AMEP.S116071

Saksena, R. (2020, April 19). Doctors discover silver linings in telehealth during Covid-19 crisis. STAT. https://www.statnews.com/2020/04/19/telehealth-silver-lining-discovered-covid-19-crisis/

Sher, L. (2020). The impact of the COVID-19 pandemic on suicide rates. QJM: An International Journal of Medicine. https://doi.org/10.1093/qjmed/hcaa202

Wakam, G. K., Montgomery, J. R., Biesterveld, B. E., & Brown, C. S. (2020). Not Dying Alone—Modern Compassionate Care in the Covid-19 Pandemic. New England Journal of Medicine, 382(24), e88. https://doi.org/10.1056/NEJMp2007781

Wijesooriya, N. R., Mishra, V., Brand, P. L. P., & Rubin, B. K. (2020). COVID-19 and telehealth, education, and research adaptations. Paediatric Respiratory Reviews. https://doi.org/10.1016/j.prrv.2020.06.009