The Covid-19 crisis has catapulted telemedicine and virtual care to the fore. The urgency of this all-consuming public health emergency has led doubters — both on the consumer and provider side — to shed old assumptions, and almost overnight, adopt tools to receive and deliver care remotely.
The numbers tell the story – where some hospitals were doing a couple of thousand video visits a month pre-Covid-19, now they are doing a couple hundred thousand. But perhaps the framework for understanding the monumental transformation still looming for the medical establishment was crystallized during a virtual event Monday — World Medical Innovation Forum hosted Monday by Partners HealthCare, the Boston-based non-profit hospital and physician network that includes Brigham and Women’s Hospital and Massachusetts General Hospital. The event is held annually in Boston but was shifted to a virtual format given Covid-prompted limitations.
In the session broadly titled, Digital Health Becomes a Pillar, Dr. Lee Schwamm, vice president of virtual care/digital health at Mass General Brigham, was talking about some of the assumptions that have not held up in the crisis — for example, that old people would not adopt video visits and weren’t adept with technology or that people who don’t speak English could not be properly taken care. He went on to add:
“I think what we have to recognize is that we were caught unprepared. As a medical system, we know that huge numbers of patients have deferred important medical care during this crisis because they are afraid to go to the hospital or their doctors are simply not available,” said Schwamm, who is also director of the Center for Telehealth and vice chair of neurology at Mass General Hospital. “We need to build this video capability, this virtual care infrastructure. We need this to be a permanent part of our health system going forward. This is the equivalent to the National Guard or the Army Reserve. We need to be able to deploy capacity at scale on very short notice for the foreseeable future because we don’t know what the shape of this pandemic is going to be like and we can’t afford to curtail our care.”
Think about what that means.
Just as for national defense and natural disasters, the National Guard is ready and available to swing into action, digital health has a similar level of import to the homeland in a medical crisis. That’s a far cry from digital health’s recent history of entrepreneurs going door to door to hospital tech committees and institutional review boards pleading for a pilot (often unpaid) to prove their technology’s value.
During the surge in early March, Mass General created a hotline staffed by nurses that concerned people could call only to find the volume overwhelming and frustrated patients dropping off in droves after interminable wait times. That led leaders at the institution to follow in the footsteps of Providence St. Joseph Health in Washington and partners with Microsoft to create an AI chatbot to help in triage and more quickly respond to people’s queries online.
“We also talked with Microsoft and they helped us, very quickly, stand up our own version of a chatbot or healthbot,” said Dr. Adam Landman, chief information and digital officer at Brigham Health, noting that the healthbot was launched in four days.
He added that it has had about 16,000 users thus far and it has helped to direct those who are severely ill to the emergency department; while directing those who need additional evaluation like testing to the hotline. Finally, for those who don’t have symptoms but need assurances, the healthbot can provide such supportive care and help to ease the load on the hotline.
“So this was a really nice example where we very quickly stood up new technology tools with our hotline and helped get patients to the appropriate site of care,” Landman explained.
Yet, without a financial engine powering the establishment of digital health into the medical ecosystem, the gains made technologically during Covid-19 cannot be sustained.
“This is the thing that really keeps me up at night, every night — without a lasting, sustainable economic model, these innovations will not be able to continue,” said Brooke LeVasseur, CEO of AristaMD, a San Diego-based startup that facilitates eConsults and a co-panelist of the virtual session on digital health. “So as an industry, we need to be really focused on working to get reimbursement models in place that reflect the value that these new innovations can deliver, so ultimately providers will have their interest aligned to continue to adopt and use these tools that do have demonstrated efficacy and that have demonstrated value.”
Landman went a step further in explaining what needs to be done to secure the “astronomical gains” in usage that Brigham Health has seen over the last few months.
“My biggest concern, the biggest risk is that we will lose this digital transformation in health and lots of that may be due to reimbursement,” he said. “It is my sincere hope that we can work with federal and state policymakers and insurers to really find the right balance to be able to offer telehealth services when appropriate and to find the appropriate reimbursement when it comes to incentivizing their use.”
Reimbursement is a thorny issue as is equity and privacy that will also need to be addressed as digital health gains ground.
Photo: Phil Feyerabend, Getty Images