Virtual care provided a necessary link between providers and patients as the COVID-19 pandemic pushed nonemergency appointments and procedures online. Even now, with a tentative return to in-person visits, virtual care options have proved useful for follow-up appointments, specialty care consultations and chronic disease monitoring.
How can healthcare systems maintain and improve their virtual care options for the future?
“I think the watchword is integration — integration with the electronic record, but also integration with your general service delivery mode,” Dr. Joseph Kvedar, senior adviser for virtual care at Mass General Brigham in Boston and board chair of the American Telemedicine Association, told HealthTech in a recent interview. “Every other service you and I consume has a digital-first component, whether it’s telephone banking or setting up a reservation on OpenTable — the list goes on.”
As healthcare systems focus their virtual care offerings, they need to consider their security protocols, relevant privacy regulations and how they can mature their capabilities to benefit providers and patients.
Moving Toward Secure Virtual Care
Healthcare systems rushed to move much of their operations to a virtual care model when widespread pandemic restrictions hit the U.S. in March 2020. When federal waivers made it easier to adopt videoconferencing solutions for telehealth, access seemed to take priority over security. However, with sensitive patient information on the line, healthcare organizations turned to platforms that provided key safety features and better workflow integration.
Though Phoenix Children’s Hospital in Arizona implemented Zoom for telehealth before the pandemic, like many hospital systems, it still had to rapidly expand its offerings. “First and foremost, the platform had to be secure and compliant,” David Higginson, executive vice president and chief innovation officer at Phoenix Children’s, tells HealthTech.
The hospital largely relies on key Zoom features, such as password generation, to ensure secure sessions with patients. “The security in the platform itself was surprisingly robust,” Higginson says.
Before the pandemic, he added, one family had to travel across the state three times a week for appointments. Now, 75 percent of that family’s appointments are virtual. The patient’s mother told the hospital staff, “We got our life back.”
At the height of the heath crisis last year, Rapid City, S.D.-based Monument Health conducted 600 to 800 telehealth visits each day, accounting for the majority of all outpatient visits. The organization is now transitioning to Microsoft Teams after its initial rollout success, which will provide better integration with Monument Health’s electronic health records system.
“Early on in the pandemic, people were using platforms that were not necessarily confirmed to be HIPAA-compliant,” Dr. Stephanie Lahr, chief medical information officer for Monument Health, tells HealthTech. “I totally get why people were doing that; we were all looking for fast and easy. But because we went with a solution that had encryption and authentication built in, we knew we were meeting our compliance burden.”
Keeping an Eye on Regulations
The federal waivers first enacted last year allowed U.S. healthcare systems to quickly respond to the pandemic, and it was a game changer for virtual care. The authorization is expected to last through the end of 2021.
When full HIPAA compliance enforcement returns, healthcare organizations need to be prepared ahead of time so that they’re not caught off guard. But if a longer-term solution has not been reached when authorization ends, it could lead to a “telehealth cliff,” with a major regression in virtual care usage.
In April, Congress saw the reintroduction of the CONNECT for Health Act of 2021, signaling some sustained interest in expanding telehealth coverage beyond the pandemic. The removal of originating site restrictions from Medicare guidelines on a permanent basis would help virtual care expansion.
Policymakers are also re-evaluating the lack of standardized reimbursement policies around telehealth, which has prevented its widespread use in previous years. If Medicare makes long-term changes on telehealth reimbursement, it will permeate through the private payer industry, says Elliott Wilson, director of virtual care for CDW Healthcare, in a recent MonITor blog post.
Strengthening Virtual Care Through Hybrid Use
One area where hybrid care has seen recent growth is with the burgeoning “long-haulers” clinics healthcare systems have established to help patients with lingering COVID-19 symptoms. The National Institutes of Health calls this “post-acute sequelae of SARS-CoV-2 infection” (PASC) or “Long COVID,” which can include symptoms such as fatigue, shortness of breath, chest pain and palpitations, brain fog, anxiety, depression and gastrointestinal disorders.
Providers have turned to telehealth and other technologies, such as EHRs and mobile apps, to help these patients with their recovery, delivering specialized care where needed.
For instance, in March, Cleveland Clinic announced the opening of its reCOVer Clinic to help COVID-19 long-haulers. An integrated EHR keeps track of patient-entered data from questionnaires and launches a firewalled version of Zoom. An in-person initial evaluation is followed up with a 30-minute telehealth session, where a physician may then recommend a specialist from one of 18 different clinical areas, such as a cardiologist or pulmonologist.
“While we don’t currently have treatments for it, we have the ability to help patients with their symptoms and try to understand it better,” Dr. Kristin Englund, an infectious disease specialist at the Cleveland Clinic, told HealthTech last month. “Not until we get even more robust data on what these patients’ look like and what things they’re going through can we really make that clear of a statement, so I’m looking forward to getting this data.”
Virtual care also offers a more immediate connection between a patient and provider. “Telehealth-delivered care services allow patients to meet with their provider sooner to be able to expedite care and decision-making,” said Albert Ferreira, director of telehealth operations at MetroHealth, also in Cleveland.