Rarely, do we get an opportunity to directly observe a distinct event, which materially changes standard approaches to healthcare delivery.
By Michael Nochomovitz, MD and Rahul Sharma, MD, MBA, FACEP
In 2018, we initially published our first article in JAMA introducing the “Medical Virtualist” and the following year, a subsequent piece regarding formalized training and establishment of core competencies in telemedicine. Since that time, there has been significant growth, nationally and globally, in the establishment of new telemedicine and virtual care programs. (1,2)
None of us could have predicted the magnitude of the Coronavirus pandemic nor could we have projected the impact on care delivery. The healthcare industry is massively gearing up for virtual care on an emergency basis as clinically necessary and mandatory, movement restrictions are introduced. We suggest that this unprecedented expansion of virtual care in multiple modalities, will become our new norm.
A 2019 study by FAIR Health covering the period 2014-2019, showed an increase of 1,393% in non-hospital based, “provider to patient” telehealth visits, based on commercial insurance claims. This still accounted for only 0.104% of all medical claims. Despite the perceived value and convenience of virtual health, the majority of physicians, other clinicians and hospitals remained committed to “in person” encounters for cultural and economic reasons. Rural health and other situations short on specialties leveraged telehealth and the need in behavioral health and chronic disease management became apparent. A myriad of direct to consumer virtual health services, not requiring a physician visit, were also developed for oral contraception, erectile dysfunction, HIV prophylaxis and others.
Contrast that norm with the experience in the past week at some of the nation’s leading Integrated Delivery Systems and Physician Organizations.
In the third week of March, the Cleveland Clinic volume of virtual primary care visits increased by more than 26-fold. Advocate Aurora Health completed 11,000 video visits and 2500 e-visits within 12 days. A symptom checker on the website was completed 4000 times in one day! They will also be implementing an interactive mobile enabled symptom tracker for transition management of COVID and PUI’s (Person Under Investigation) discharged from hospitals and Emergency Departments. Advocate will also be leveraging telehealth in partnered SNF’s (Subacute Nursing Facilities) to reduce the need for provider entry into these facilities.
New York Presbyterian with Weill Cornell Medicine & Columbia Doctors, already had a comprehensive telehealth and digital healthcare program across multiple specialties. Since the start of the COVID-19 pandemic, NYP’s telehealth utilization has increased by 45% over the span of 2 weeks. Over the next weeks, it is projected that over 80% of ambulatory visits will be virtual. New York City has become the epicenter of the COVID-19 pandemic and leveraging telemedicine has shifted from being novel to being an absolute necessity.
The Hospital for Special Surgery in New York, has cancelled all elective procedures and limited in person clinical activity to urgent needs. Office visits and post-operative Physical Therapy (PT) have all become “Virtual”.
On a national scale, the closing of hundreds of PT clinics across the country may be transformational and accelerate innovation in that space.
One prototype, PTGenie.com provides remote, interactive PT, guiding patients through exercises remotely measuring and monitoring movement through sensors applied on the skin. Real time feedback is provided to the patient on a tablet.
Intermountain Healthcare based in Salt Lake City, has had experience with Virtual Health for a number of years. Their Nurse Triage Call Center, Health Answers increased its volume from approximately 50 calls a day to 3000 a day in the middle of March secondary to the COVID-19 pandemic. Nurses were redeployed across their system from other non-critical services. A pool of 6-10 nurses has mushroomed to 70 in the call center servicing the entire State of Utah. Connect Care, their Telehealth Video program was focused on meeting the needs of the non-COVID patients in the Intermountain Healthcare physician organization.
PT Genie is a digital health company providing in-clinic and remote physical therapy that keeps patients connected with their providers to drive improved outcomes. A wearable device that keeps patients motivated, measures their progress, and enables providers to monitor outcomes more closely, PT Genie is advancing physical therapy to new levels. Through PT Genie, healthcare providers have a way to measure their patients — as well as their own — success.