Coronavirus Pushes Telemedicine to New Levels
By Kristen Uppercue
The coronavirus pandemic brought with it heightened attention to many of the disparities facing rural West Virginians, including the burden of traveling long distances to receive health care. It also brought new habits, such as social distancing and quarantining, to limit the virus’s spread—increasing overall acceptance and the level of importance placed on bringing telehealth services to the Mountain State.
“The concern over COVID-19 and social distancing pushed the need for physician and patient encounters to be managed over telemedicine whenever possible,” says Matthew Upton, M.D., chief medical officer at Thomas Health. “In the past, physicians and patients were both reluctant to break the traditional model of doctor/patient visits, but with COVID-19, that changed quickly.”
Understanding Telemedicine
Telehealth refers to health services provided using telecommunications technology, such as by phone or video. Telemedicine, a subset of telehealth, refers to the clinical services provided through this technology.
In West Virginia University (WVU) Health System’s facilities, the largest percentage of telehealth occurs over video visits. Similar to the process of using FaceTime or Zoom, the patient will be on one end of the conversation with a physician on the other through an encrypted, HIPAA-secure service, according to Shannon McCallister, assistant vice president for population health and telemedicine for WVU Health System.
WVU Health System also provides telemedicine care through an ambulatory setting. Through this care model, patients can travel to one of WVU’s regional centers in the state rather than traveling to Morgantown to see a specific doctor or specialist. There, an advanced practitioner will facilitate the physical exam needed by using a telemedicine cart made up of specific devices like stethoscopes and magnifying glasses that feature microphones and cameras so the physician on the other end of the call can also see the results of the exam. Through this process, the physician can examine and assess the patient virtually just as they would if the patient had traveled to their facility.
Many of the other health systems in the state have also focused on using video visits, which allow physicians to complete limited physical exams as well as follow-ups and allow ancillary staff like social workers, care managers and pharmacists to monitor a patient at home, significantly decreasing the number of times a patient would need to travel across the state for these services.
“The ability to harness and leverage these capabilities can move the needle with our state’s population,” says Mark Gilliam, chief administrative officer at Mon Medical Center and chief information officer for Mon Health.
Jaschar Shakuri-Rad, D.O., urologist and director of robotic surgery at Mon Health, believes these services will stick around even after the pandemic comes to an end.
“Telemedicine is nothing new; it has been around for quite some time. However, with the pandemic, the government allowed us to utilize it more broadly and really show what it’s capable of,” says Shakuri-Rad. “Using telemedicine over the past several months, we have learned we can really assist patients and provide better, more convenient and safer care in some instances.”
There is also still a common misconception that a patient cannot receive the same quality of care from a telemedicine visit as an in-person visit. However, Tiffany Auvil, LPN, clinical nurse manager and telemedicine coordinator for Davis Health System, says quality care can still be achieved through telehealth as long as the patient and physician have access to the necessary equipment.
“The most common misconception is that you don’t get the same treatment as you would face to face, but with proper cameras and microphones, a solid assessment can still be completed,” she says. “With other technology, such as home blood pressure and pulse ox tests, information can even be viewed and analyzed by providers prior to the appointment with the patient.”
Charleston Area Medical Center (CAMC) has provided telemedicine services for the last few years and launched a 24/7 Care program to offer patients round-the-clock medical care by phone or computer. A survey analysis of CAMC’s telehealth services found that more than 95% of telemedicine users said their visits were about the same or more useful than a face-to-face encounter with their provider. Additionally, close to 70% of those users said they would recommend 24/7 Care to a friend. Other health systems throughout the state also report positive feedback from patients able to access telehealth services.
“It’s not just during the pandemic when this telehealth is useful but also other circumstances, such as when there’s a snowstorm outside,” says Shakuri-Rad. “We can change an office appointment to telehealth so the patient doesn’t put themselves at risk by driving in bad weather, or there may be transportation issues for patients who are reliant on the bus system or family members to bring them into the office. By simply being able to connect to them through these technologies, we can really streamline and make it easier, more convenient and safer for patients.”
Addressing the Benefits and Challenges
Telemedicine offers the benefit of keeping patients from gathering in waiting rooms and physicians’ offices, which can limit the spread of COVID-19 and keep patients from coming in contact with the virus. While this reason alone might have sparked the statewide attention on telehealth, the biggest advantages of the service is that patients can access this care directly from home—a critical aspect for those who live in rural areas and were previously traveling hours to access health care or weren’t receiving care at all due to this burden.
“Telehealth takes the time and distance out of health care, creating access to populations that have historically struggled to access needed health care. Telemedicine allows this population to have another entry point into health care,” says Rebecca Harless, associate administrator of the ambulatory division at CAMC.
Despite the many benefits telehealth offers West Virginians, there are also systemic barriers to accessing the services, the most significant of those being the state’s lack of broadband and cellular access in certain rural areas, which has also been experienced across other industries in the state such as education.
“The technology is there, but the broadband connection is essentially the limiting factor, and as we continue to expand these services in rural West Virginia and other places, I think it’s going to become less intimidating for both physicians and patients,” says Shakuri-Rad. “Other than that, I think it’s a great tool—another tool in our toolbox that we can use.”
West Virginians who aren’t tech savvy will also have to learn how to use their mobile devices prior to engaging in the telehealth services. Additionally, some families will have to bear the cost of obtaining these mobile devices, as well as at-home testing kits if not covered by an insurance provider.
Tackling Payment Parity
Prior to the pandemic, most insurances were not fully covering telehealth services because they weren’t considered equal to a face-to-face visit. Medicare would not pay for in-home virtual services or clinic-to-clinic telemedicine at all if the patient was not considered to be outside a health care shortage area. However, with the challenges brought on by the pandemic, insurance companies made adjustments in 2020 to reimburse telehealth services the same as in-person visits, making telemedicine more affordable, but the future of this reimbursement is unknown and will likely be part of a larger conversation on health care access in upcoming legislative and congressional sessions.
“There wasn’t a widespread acceptance of telemedicine before, especially in West Virginia because our broadband hasn’t always been the greatest, but the pandemic has made us all think about things a little bit differently and forced us to try it,” says McCallister. “I have called COVID-19 an unfortunate opportunity for telemedicine.”
Looking to the Future
Other than continuing reimbursement for telehealth services and resolving the state’s broadband challenges, David Campbell, executive director for health care innovation at Cabell Huntington Hospital, says educating the public on how to use these services effectively needs to continue and that telehealth training should be included in health care providers’ education
programs.
He also believes providers need to make the services easily accessible and convenient for patients, and artificial barriers and restrictions should be removed from regulations and statutes governing telehealth.
Mountain Health Network unveiled its Mountain teleHEALTH mobile app in 2020, available through the Apple Store and Google Play.
“The greatest benefit is you don’t have to leave home to get the care you need,” says Campbell. “Mountain teleHEALTH is a faster, easier way to see a doctor from your home, vacation spot or business trip.”
Experts across the state agree that providing access to broadband in rural areas is the state’s number one hurdle to jump before telehealth services expand.
“It’s tough being a mountainous and a rural state,” says McCallister. “The amount of money it takes just to get to one household when we’re talking about fiber optics is a large sum and a large amount of infrastructure, but I think it has to be the number one focus. Chipping away as quickly as we can at those pieces of infrastructure is going to be the most impactful because the technology is there. We just need to make sure every person in West Virginia has equal access to it.”
Looking forward, the state’s health systems have major plans to expand upon the telehealth services they’re currently providing. CAMC is working on increasing its telemedicine offerings for cardiology visits as well as developing hubs in Southern West Virginia connecting rural patients to a CAMC specialist without having to travel to Charleston.
“Overall, I think the future of how patients interact with medical providers will become a blend of in-person and telehealth, sometimes even in the same encounter,” says Harless. “We are learning how to use this technology as a tool, which if we apply correctly, will be able to solve a lot of issues that have hindered health care for years. I believe telehealth will play a part in how we address the physician shortages that are predicted to become greater over the next 20 years.”
Davis Health System recently implemented its Care-A-Van feature, which is a mobile unit that can travel for checkups and administer vaccinations, amongst other services.
While prior to the pandemic Thomas Health was not using telehealth to provide care, the system is currently working with WVU Medicine’s neurology department to provide telestroke services in its emergency department. By using an iPad on wheels, a neurologist in Morgantown will be able to help a physician in an emergency department evaluate a patient who may be having an acute stroke and decide if patients are candidates for clot-busting medications, according to Upton. Thomas Health is also looking to expand telehealth services with partners to supplement other areas of care in its facilities.
“Telehealth is here to stay. The services it will provide will only expand with time and better connectivity,” says Upton. “COVID-19 has pushed health care into a new model of care. Gone are just the traditional office appointments and labs every few months. What is coming will be a more interactive relationship between patients and their health care team using telemedicine as a bridge between multiple parties to interact and share visits and data electronically to improve patient-centric care. Using technology and clinical staff as an extension of the physician will allow for improved care and better outcomes.”
