A Hybrid Approach to Telemedicine Could Change Healthcare as We Know It
After COVID-19 forced doctors’ offices to close to all but emergencies this spring, many patients and specialists found themselves meeting in a new kind of clinic—a virtual one.
“We’ve seen an explosion in telehealth,” says Patrick Barth, MD, a pediatric otolaryngologist and medical director for telehealth specialty care at Nemours Children’s Health System. “I went from knocking on people’s doors trying to convince them to do telehealth to a 2,000% increase in specialty virtual visits from February to April.”
Telehealth can’t and won’t entirely replace ambulatory care. Many in-person appointments have since resumed with additional safety measures. But the sudden, mass adoption of telehealth over the past few months helped popularize its many benefits with both patients and providers. “COVID has put telemedicine on the map,” says Alfred Atanda, Jr., MD, an orthopedic surgeon at Nemours. “This is the new normal.”
Making Diagnoses Via Telehealth
Online care is naturally suited for a number of common scenarios, such as discussing test results, but doctors have also found new ways to use it for certain diagnoses. Dr. Barth, for example, often sees suspected cases of stridor or tonsillitis via telemedicine now as patients can easily provide detailed photos or videos. “Phones these days have such high-quality images you can learn a lot,” he says.
“For diagnosis, telehealth is our preferred method of assessment, as we can observe a child’s social and communication functioning best without masks and the need for social distancing, as would be required in the clinic,” Dr. Dewey says. “We have the added benefit of observing the child in a familiar environment, with preferred toys, and interacting with familiar caregivers and siblings.”
“We can see ‘in real-time’ behaviors that are concerning for parents,” she adds. “We can watch what happens during a meal, when a demand is placed, what happens when a favorite toy is removed, etc. in real-time, and also watch the parents’ response. This often gives us valuable data to help parents adapt their techniques to work best for their child.”
Combining Telehealth With In-Person Attention
Paired with traditional appointments, telehealth can also benefit providers and patients in innovative ways. At Nemours, provider-assisted telehealth allows families to visit a nearby primary care office and virtually connect with a specialist who may work hours away. Not only do these assisted appointments help circumvent technological issues (like slow Wi-Fi at home), but they also enable families to have a nurse or medical assistant in the room with them. This professional can work with the specialist to conduct a more detailed exam.
For example, many of Dr. Barth’s pediatric ENT patients need to get tubes in their ears checked on a regular basis. “For our families within the Lancaster area or southern Delaware area, they would have to drive quite a distance for those very short visits,” Dr. Barth says. “This way they can just go in locally and see the same provider that operated on them. It’s via video, but we get a good look at the ear and we can save them that time in travel and still give them the high-quality care that they deserve.”
Telehealth also makes it easier to receive a specialist or second opinion right away. Traditionally, many of Dr. Atanda’s orthopedic patients first visit a primary care doctor and then urgent care or the ER before finding themselves in his office. Telehealth, however, now allows him to talk to PCPs or urgent care doctors about a particular case before the patient has even left the clinic.
“The beauty about orthopedics is most of the decision making and the discussions are all based on X-rays, MRIs and CAT scans, which in this day and age, can be transferred very, very easily virtually,” he says. “So, when patients show up to those places, we can then work with the doctors there. We do a lot of provider-to-provider consultation to help guide the treatment.”
This type of collaboration addresses a common and serious inequity in healthcare: access to specialists. For patients in remote locations or without access to transportation, telehealth has the potential to reduce serious disparities in care. “What we’re trying to do is bring the specialists to the community where the patients are, as opposed to the reverse,” Dr. Atanda says.
Using Telehealth to Reduce Healthcare Costs
Telehealth, among other benefits, costs less than inpatient care and uses doctors’ time more effectively. Those advantages could help lower patients’ bills in the long run. “If the institution is providing care in a more efficient manner, the cost of healthcare will go down,” Dr. Barth says.
Both virtual and provider-assisted visits have the potential to reduce not only financial expenditures but opportunity costs as well. “It allows the families to stay in their homes and their communities, so they no longer have to drive two hours for a 10-minute visit,” he adds. “The families love it and the providers have come to the conclusion that there are some real benefits to providing it.”
The intent is to make high-quality, affordable healthcare accessible to all. “We really have to think about how we utilize resources—the cost associated with bringing people into the hospital and the time and opportunity costs that the families have to pay to navigate the healthcare system,” Dr. Atanda adds. “Telehealth has the ability to help remedy and mitigate a lot of those issues.”This is a paid partnership between Nemours Children's Health and Philadelphia Magazine