Before the pandemic, seeing a doctor meant being limited to health-care providers in a drivable distance, trudging to the office, and sitting for up to an hour in a germy waiting room—even after you were told to arrive 15 minutes early. But the widespread acceptance of telehealth—the use of telecommunication technologies and electronic information to deliver care—has changed everything.
With telehealth, you receive care from home, appointments are usually on time, and you can see a provider from anywhere in the country if you live in a state that has waived in-state doctor requirements. (At press time, only Florida has allowed its waiver to expire.) That’s because the federal government responded to the overwhelming need for care and a shortage of health-care providers in any given place by easing restrictions on telehealth and providing more money for the visits.
From acute to chronic care
In the simplest form of the technology, you can use a phone or computer to have a doctor’s visit using a platform such as Zoom or Skype. These programs are easy to use, and most doctors’ offices will walk you through getting set up. You and the doctor can see each other during the visit.
A growing number of health-care providers are going a step further and using technology to better monitor chronic health conditions to keep you well and out of the hospital. At home, you can use tools such as wireless blood pressure cuffs, pulse oximeters, and scales, a glucometer, and wearables such as Fitbits or Apple Watches to gather data and upload it into software and services that run on the Internet (the Cloud). Your doctor’s office can then monitor that data manually or with the use of artificial intelligence. When a nurse navigator (a nurse who serves as a liaison between you and your doctor) sees a trend that could suggest worsening symptoms, he or she can intervene before those symptoms become a full-blown problem.
Consider a patient with congestive heart failure (CHF). When CHF worsens, patients may have a sudden weight gain in a short time and have shortness of breath that leads to walking less due to increased retention of fluid. If a wireless scale detects a 5-pound weight gain in a few days, a pulse oximeter shows low oxygen levels, and a Fitbit shows that a person’s steps have dropped dramatically, a nurse navigator can set up a telehealth appointment for the patient with the doctor to address those concerns before they worsen.
“I would strongly encourage you to manage any chronic disease using these tools,” Dr. Wilcox stresses. “They will increase your quality of life and allow you to avoid nasty germy hospitals and doctor’s offices. It should decrease the amount of time you spend going to doctor’s appointments and should cost you only minutes a day of your time.”
Hospital at Home
Telehealth isn’t limited to routine doctor visits: It’s affecting hospitalization too. Hospital-at-home can make any room in your house into a hospital room complete with oxygen tanks, medical supplies, and almost anything else you may need. Many of these programs are linked to a 24/7 monitoring system to monitor your vital signs and other pertinent health-care data in real time. Your health-care team can go over your data and communicate with you remotely, and send a nurse when you need one. Plus, you’ll have a button you can press at any time for emergency help.
For people with lower-level health issues, this is the perfect combination of technology and clinical care in which patients can derive the benefit of staying at home while their chronic care is being managed or they are recovering from an illness. Patients sleep better in a quiet home, fall less often, are more mobile, and can eat whatever they want. And studies are showing that patients recover just as well at home as in the hospital.
Dr. Wilcox predicts that, “in the future hospitals will consist only of emergency departments, intensive care units, step-down beds which is where a patient is cared for before they become a low-acuity (less sick) patient, and home care.”
The technology that doctors are using is streamlined and quick to learn and use—even for people who don’t consider themselves to be tech-savvy. But access isn’t equally available to everyone. People in rural areas may not have the broadband internet access that is necessary for video. A telephone call may be adequate in some cases, but not all. As such, in October 2020, the Federal Communications Commission introduced a $20 billion fund to improve broadband access in rural America. The Coronavirus Aid, Relief, and Economic Security (CARES) Act of March 2020 included another $200 million to help provide devices to patients who don’t have phones or computers to access telehealth.
A New Model of Care
Telehealth will play a key role in the transformation from fee-for-service health care (where doctors are paid according to how many tests and procedures they perform) to value-based care (where doctors earn more by keeping patients healthy and out of the hospital). Value-based care is provided by groups of health-care providers called accountable care organizations (ACO). In the model, a health-care team is paid a set amount of money for each person they treat—no matter what care that person needs.
If the group spends less than they’ve been given for a patient, they get to keep the difference. The best way for these groups to save money on a patient’s care is to keep them healthy and out of the hospital. Technology makes it easier for patients and providers alike to stay in touch and on top of chronic health conditions, reducing the likelihood of hospitalization.