Speaker: Use telehealth to redesign health care with the patient in mind
COVID-19 led to increased implementation and use of telehealth; however, with conditions improving, Eric Wallace, MD, asked the question: What about telehealth do we keep and how can we redesign health care with the patient in mind?
“Prior to 2020, health care systems were using telehealth at a rate of nearly 0%,” Wallace, medical director of telehealth at the University of Alabama at Birmingham (UAB), said during a presentation during the virtual Cancer Center Survivorship Research Forum. “Come March 13th of 2020, there was a huge jump in telehealth because of the pandemic.”
Wallace quoted data from UAB that showed an increased use of telehealth visits from 18% to 74% between March and April of 2020. Telehealth visits remained steady, between 32% and 37%, through the summer.
“It had a huge impact not only on patients’ lives but also on our health care system,” he said. “We did more than 280,000 visits in 2020, all telehealth. We were able to bill more than 230,000 of those and, more importantly, we saved approximately 263,000 hours of driving time, which improved our patients’ lives.”
Wallace listed three main highlights he saw from increased telehealth use during 2020. One: The originating site could be the patient’s residence compared with visiting a medical facility in a rural area, which was massively scalable with the number of smartphones in patients’ homes. Two: Audio-only visits were allowed, as CMS had historically required interaction include both audio and video. Three: Coverage for telehealth became nearly universal, which became easier to operationalize.
Going forward, Wallace said that keeping the question of “why continue with telehealth” in the spotlight will keep health care professionals proliferating its use.
“For me it was illness intrusiveness. Every part of the day that a patient puts aside to take care of the illness is part of the illness itself,” Wallace said. “For the dialysis population, my patients were traveling to and from once a month and I thought, ‘Could I do this better for them?’ Not that I was going to improve outcomes, but I was going to make their lives better by reducing the amount of time they spent caring for their disease.”
Finally, he addressed some limitations with telehealth use, especially with synchronous telehealth visits, or visits in which patient and physician are speaking at the same time rather than asynchronous follow-up or remote patient monitoring.
The biggest limitation for synchronous telehealth is disparity, he said. Data from UAB showed that African-Americans were 28% less likely to use video compared with Caucasians, as were patients 60 years and older (42%-49%) vs. younger patients and those with Medicare (37%) or Medicaid (55%) vs. commercially insured patients.
The causes of these disparities included lack of access to infrastructure, internet, videoconferencing devices or technology literacy, any of which could occur in rural or urban settings.
“There are a number of tools at our disposal now, but we need to implement them in a way that we can redesign a health care system that is better, more resilient and one that we’re proud of,” Wallace said. “We must continue to move forward and use technology to improve our patients’ lives, always focused on the patient.”
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Wallace E. Telehealth: Setting it all up. Presented at: Cancer Center Survivorship Research Forum (virtual meeting); April 15-16, 2021.
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