Telehealth in a time of pandemic- Let's give it an "A"

A virtual telehealth clinic from 7 PM- Midnight every day of the week was started after urgent care closed, just to create further access for patients in the community and also to drive down unnecessary emergency department utilization. Telehealth has been piloted to improve transitions of care from the hospital to the community, rehabilitation centers, and skilled nursing facilities. Care remained local, accessible, and trusted due to this new tool.

AI – As telehealth has been widely adopted for access, it now must be further adapted to augment human intelligence. Digital transformation and monitoring of health conditions has been catapulted ahead by the pandemic and must go further to promote value-based care transformation and to help manage upstream and downstream risk of chronic disease conditions that have long foiled our best clinical efforts. “Hospital at home” programs and care transition management of patients to home from the hospital, to and from rehabilitation centers, and to and from skilled nursing facilities, will rely on digital tools that are both medical grade and consumer grade. They will help patient and caregiver alike. Artificial intelligence programs and algorithms will not take the place of trusted primary care physicians and specialty colleagues alike but will instead augment those individual skillsets to better manage and mitigate risk and provide the safest and highest quality outcomes for patients. This will be critical for the successful transformation of the US health care system to one of wellnessand prevention from sickness and chronic disease.

Advocacy – Finally, the role of advocacy has never been so important as in the present moment. We cannot allow state by state and federal barriers to stand in the way of telehealth across state lines. The example from my region of the country is that we have 4 states in our primary and secondary service areas of care here at Meritus Health. Care should remain local when possible and in the hands of the trusted providers and teams with whom the patient has had an established relationship over time. Insurers should work with health systems and providers who have established excellence in telehealth and digital transformation rather than create structures of their own which further confuse patients and take care away from local sources. For this to work well, accountability must be guaranteed on both sides of the equation and payment should be based on quality outcomes and not on work RVU’s. We can now do that by analyzing the data and using it to drive clinical excellence and evidence-based decision making. In conclusion, Telehealth has performed well during the COVID-19 Pandemic. It has expanded the traditional walls of the exam room out into the community. Augmented intelligence and digital tools will enable this expansion further. The tools of telehealth, my tablet computer, my cell phone, and some associated digital monitoring tools, all fit into my doctor’s black bag, just like my stethoscope. The stethoscope, in 1816, was controversial in that it “removed” the physician’s ear and direct auscultation from the patient’s chest; It was thought to be important but never expected to be widely deployed and successful as an instrument of diagnosis. The same is true of telehealth in this moment. Telehealth has received an “A” and much effort has been expended toward getting everyone to understand it, if not to love it. Can we ever go back to the way things were before and expect to create a more accessible and equitable health care system in the United States for all?