When the next storm hits, telehealth could be a lifesaver
At hospitals, workers spent the night to avoid being stranded, scrambling to care for patients in dire conditions.
For people who already have trouble accessing healthcare services – due to geography, socioeconomic factors, transportation difficulties or other hurdles – a weather crisis like the freeze can spell disaster.
"When it comes to climate events – huge, natural disaster kinds of events … all the issues are compounded," said William Kiefer, CEO of Chambers Health, a community-based system in southeastern Texas.
During the storm, many patients and providers alike were unable to make it into health facilities. Chambers' health clinics were where the telemedicine program that the system had spun up in response to COVID-19 played a new role.
"When COVID started, and we got all of the providers onboard and trained on telehealth, we had some [Health Resources and Services Administration] funding to purchase additional webcams and sound bars," said Kaley Smith, executive director for Chambers' federally qualified health clinics.
"We purchased enough for each of the providers to have some capability, so we were ready when the freeze came along," Smith continued.
She explained that some of the nurse practitioners had not lost Internet accesses at their houses, so they were able to see patients from home.
Across the country, the team at NYC Health + Hospitals/Bellevue also emphasized the usefulness of digital health tools during weather crises.
Before the pandemic, Bellevue had been "dipping our toes into video telemedicine," said Dr. Andrew Wallach, clinical director of ambulatory care. But as with other health systems, Wallach said, the COVID-19 crisis pushed the facility into being able to offer telemedicine for ambulatory care "literally overnight."
"I could not imagine getting through this past year without that capability of telemedicine," said Wallach. "It's been wonderful how we've been able to leverage that technology."
That telehealth program came in handy when New York got a snowstorm of its own.
"We want to keep patients safe," said Wallach. "In years past, we tried to make robocalls," urging people to reschedule appointments in inclement weather.
"What we did differently this year was reach out to say, 'You have an in-person visit scheduled for tomorrow and there's a storm coming. Instead, would you like a televisit?'" Wallach continued.
"We were able to pivot in real time," he added. "Our patients were safe at home. They didn't have to travel in ice and snow."
During Hurricane Sandy nine years ago, the Bellevue team relied heavily on the tools it had: electronic health records, email, intranet communications and telephones. Since then, it's implemented a wide range of other strategies to help respond to disaster.
"We have a great team from an emergency management perspective," said James Carr, chief information officer for EITS at Bellevue. "We spend a great deal of time looking at our hazards-and-vulnerability analysis on a regular basis, and what we think the next year's going to look like. That helps prepare us as we escalate things upward or across the system.
"We have the tools in place to address today's needs and meet the initial surge of anything that presents itself going forward," Carr added. "And we have the trust that if asked, we can deliver."
Wallach and Carr pointed to the importance of communication in a disaster, both with patients and with workers. Wallach noted that three-quarters of patients have activated their MyChart accounts through Epic, making it easier for the health system to get in touch with them about any changes to care.
Bellevue also uses Alertus notifications to keep employees apprised of necessary information – which, most recently, it used to flag COVID-19 vaccine availability.
Of course, some digital health tools won't be appropriate or accessible during crises. If a patient doesn't have power, for instance, they're unlikely to be able to use their laptop to chat with a doctor.
Wallach points to his experiences as a clinician during 9/11, when the cell phone network was overloaded, as an example of the importance of having a wide range of responses.
"One of the things that's really great is that they've built in redundancy," Wallach said about the hospital's tech team. "We have phone numbers. We have email addresses. There are multiple modalities to keep our staff and patients updated, minute by minute."
"It's just a matter of using all the tools at your disposal," said Carr.
It's also important to note that digital health tools are not necessarily going to work for everyone.
"We as a health system need to be nimble and meet patients where they want to be met," said Wallach. He noted that not everyone has access to broadband in New York, and that unequal insurance coverage of telehealth in the future could lead to some patients being shut out.
The same is true in Texas, where Chambers patients may need to drive an hour to get access to care.
"When you talk about disparities and social determinants of health, individuals who don't have access to broadband – that's a healthcare disparity that we have to overcome and prepare for," said Kiefer.
"A large number of people have smartphones," he continued. If stakeholders pushed to create phone-friendly software rather than relying on synchronous video chat, he mused, "that opens up healthcare via the web."
Setting up connected health, he continued, "will allow homebound people the opportunity to get care."
Unfortunately, more weather and climate crises are inevitably on the horizon. So it's best to be prepared now.
"If there are natural disasters, which we're seeing more and more of because of global warming, we're hoping we'll be able to continue to provide care [via telehealth] through more weather events – like the freeze, like the hurricanes, and things of that nature," said Kiefer.
"Rising to the challenge of a storm or a pandemic, or any adverse situation that affects the city, from an IT perspective, is part of what our mission statement includes," said Carr.
Healthcare Everywhere, Every Day
The onset of the COVID-19 crisis a year ago, with its widespread quarantines and lockdowns, offered telemedicine its moment to shine after years of under-fulfilled promise. As states look toward a post-pandemic world it's time to build on that promise.