This week, the US federal government said it would lift restrictions on telemedicine services for seniors under Medicare. The new measures facilitate radical changes in the way medicine is delivered, enabling patients to access hospital-level medical care outside of hospitals—in schools, hotels, and homes.
This is an unprecedented move that should have happened years ago, and would have protected countless high-risk citizens from exposure to Covid-19. But it took a pandemic to spur the change. Now, the way healthcare is delivered will change significantly; and with it, the business of medicine.
We have the opportunity to mitigate the damage ahead by immediately designing new telehealth and telemedicine options. There’s no time to waste.
Coronavirus got its devastating foothold in the US in part because of the dated and inadequate infrastructure of healthcare for older Americans. At the long-term care facility outside Seattle where the first US outbreak began, there was a perfect storm of conditions: elderly people with compromised immune systems or preexisting conditions living in close proximity; a circulating group of workers and visitors in close contact with the residents; and a service model that did not offer on-site medical care for acute conditions. By the time the hazards and shortcomings of the situation became clear, it was too late.
Our healthcare system was designed in an era when patients could only access medical care by physically going to their provider’s place of work. Today, doctors can provide care remotely—in many cases more efficiently and effectively than in a crowded, pathogen-prone hospital. The vast majority of medical issues can be resolved without hospitalization, and many without a physical exam. This new regulation means that medical care can be delivered differently, and far more quickly, to serve more people. By administering care through remote consultation for those less critical patients, we reserve hospital beds for those who truly require them.
As an emergency room doctor, I know first-hand that this kind of radical change is our best option for flattening the curve long-term and ensuring patients get the right care quickly, safely, and in the most human way possible.
A study of Georgia state nursing homes published in The Journal of the American Geriatrics Society found that two-thirds of hospitalizations of nursing home residents could have been avoided. Even without a pandemic, emergency departments regularly run out of beds because they’re filled with populations that have no other recourse: the homeless, the mentally ill, the uninsured, and seniors living in nursing homes that lack medical infrastructure.
To discount the potential of telemedicine and remote monitoring during this pandemic is a mistake that could cost millions of lives. But now that we have the means, we need to make sure we get it right.
Here are some principles for redesigning the system to better serve our most vulnerable:
Care should come to patients—not the other way around
For a lot of patients, a hospital visit poses an inconvenience, if not outright danger. At present, Covid-19 is just one of a number of deadly infection they can acquire. Millions of people currently sheltering in place are leveraging remote digital and social tools in ways they never have before, and realizing just how much can be done without leaving home. This potentially holds true for medicine, too.
In recent years, I have triaged and treated thousands of acutely ill patients via telemedicine—people with strokes, chest pain, and broken bones. Many of the tests required to make safe diagnoses can be done on-site at a nursing home, with results streamed in real time to physicians. X-rays, lab tests, ultrasound, sound transmission of heartbeats and breath sounds, EKGs, vital sign monitoring, and imagery can all be shared remotely. Physical exams can be done visually, with remote guidance from a physician to an on-site nurse, paramedic or a family member.
Technology doesn’t have to diminish the patient experience
A big argument against telemedicine has been that something is lost in the patient-doctor experience without an in-person visit. Yet today’s care is not patient-centered, no matter how a consult occurs. When someone receives a cancer diagnosis, for example, they often have just a few minutes with their doctor, and there’s little time to process. With telemedicine, a doctor can deliver a diagnosis, then schedule a follow-up a few hours later when the patient feels ready to learn more details and ask questions.
The time, flexibility, and compassion enabled by these tools benefits healthy patients for whom doctor visits are inconvenient, and chronically ill patients who may experience panic, disorientation, and trauma during transport to a medical facility. Setting up connected health solutions ahead of when a patient urgently needs them will allow us to treat patients with respect and dignity.
This crisis is an opportunity to reorient healthcare around people
Constraints can be obstacles, but they can also be the guardrails that guide us to radical solutions. Covid-19 is the constraint that is now pushing the whole world to transform. And yet, governments and hospitals persist in reproducing the old system, retrofitting unused buildings for medical purposes.
It’s a necessary response. But had we established our telemedicine infrastructure sooner, new and existing services wouldn’t currently be overwhelmed with unprecedented demand, often to the point of breaking. We wouldn’t need to be turning New York City’s Javitz Center into a temporary hospital. In these crowded spaces, the sick will still infect healthy providers, visitors, vendors, and other patients with milder conditions.
Telemedicine helps eliminate the factors that keep the curve steep, and more effectively facilitate the direct communication between doctors and patients that leads to evaluation, diagnosis, and treatment.
For years, telemedicine has been stymied by the inertia of regulations that do not keep up with the pace of innovation, creating a lumbering system that ignores what’s best for patients.
But Covid-19, for all the damage it has wreaked globally, presents us with an unprecedented opportunity: With major federal restrictions waived, emergency and telemedicine providers should scale up their services, so patients can access those services with fewer barriers or costly copays. If we take action now, it will save the greatest number of lives in the short-term and revolutionize healthcare for this country in the long-term.