Hospitals should prepare now for future telehealth demands

Current patient deferral of nonurgent services could lead to a "care debt" down the line, say Duke researchers. To meet those needs, health systems should be building out a robust telemedicine infrastructure.
By Kat Jercich
09:17 AM

In an article published in the Journal of the American Informatics Association this week, Duke University researchers examined COVID-19's effect on transforming the telehealth landscape.

"Whether healthcare enterprises are ready or not, the new reality is that virtual care has arrived," researchers said

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As federal and state governments evolve in messaging around COVID-19, healthcare facilities have responded accordingly. These responses have included ramping up support for telehealth services to minimize in-person contact in both inpatient and outpatient care.

After examining a number of examples reported by U.S. healthcare organizations, researchers noted the advantages and limitations of a variety of telehealth platforms during multiple phases of the novel coronavirus pandemic.

"Telehealth is ideally suited to meet the demands of inpatient care while at the same time reducing virus transmission, stretching human and technical resources, and protecting patients and healthcare workers in the inpatient care setting," said researchers in the article.

The researchers divided telehealth encounters into several categories: e-consult, in which providers asynchronously communicate with other providers; remote patient monitoring via connected device or patient self-reporting; patient-initiated chats with automated or live agents; and patient-provider communication using video or telephone messaging.

Some methods, they noted, require tight electronic health record integration to be useful. This was the case with patient-initiated chats, which could otherwise lack the context necessary for effective services.

Although video-based communication showed improvement in clinical care and favorable payer reimbursement when compared to telephone-based communication, the article authors noted that it requires technology some patients may not have access to – particularly the sickest patients or those with the most complex cases. 

Much of the messaging around telehealth has highlighted its advantages for high-risk patients. 

Researchers also pointed out, however, that "telehealth approaches allow staff – including those in quarantine, those in high-risk groups (older, immunosuppressed), and those with childcare responsibilities – to work remotely, supplementing in-person clinical services during the surge."

Given the high numbers of patients being admitted to the ICU with COVID-19, researchers paid particular attention to the necessary considerations for executing a tele-ICU service.

When developing and deploying tele-ICU services, health systems should consider key stakeholders, such as physicians, potential vendors and IT departments; changes to processes; and any technology adaptations or upgrades.

"Healthcare enterprises may already have in place technologies that can be employed to accomplish telehealth," researchers observed.

"New devices, such as tablets, can be secured with an adjustable clamp on mobile structures such as intravenous medication poles and moved to locations as needed," they continued. "These are ...  relatively inexpensive and quick alternatives to traditional telehealth carts."

THE LARGER TREND

Patient telehealth visit numbers have skyrocketed since the COVID-19 crisis began, with some health systems reporting staggering amounts of growth

Providers have frequently turned to virtual services for outpatient care. Some hospitals, such as Mount Sinai Health System in New York City, have also begun streaming live footage from inpatient units to reduce the frequency of in-person visits. 

Even after the crisis subsides, researchers predict that the demand for telehealth could increase sevenfold - particularly as technology advances and regulations are overhauled.

Analysts at research firm Frost & Sullivan forecast the development of more practical applications of AI and robotics, along with more user-friendly sensors and remote diagnostic equipment.

ON THE RECORD

Researchers warned that the effects of COVID-19 may materialize beyond patients seeking care for the disease - and proposed telehealth as a potential solution.

"A growing 'care debt' or deferred medical or surgical treatment may lead to increasing demand on a constrained healthcare system," they wrote. "This may include COVID-19 patients, as well as those with other forms of acute and chronic disease."

"Cancelled elective surgical cases and treatments during the pandemic can add to this 'care debt' that both patients and health systems may face," they continued. "Along with the economic uncertainty of many healthcare organizations, further constraints to care capacity may be present during the post-pandemic recovery phase."

"Proactive patient engagement through telehealth may help a healthcare system to effectively manage these contingencies," they said. 

"Specifically, health systems should work to create a strong, sustainable telehealth infrastructure now that will allow for more efficient use of hospital space and staff."

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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