Why telehealth will be part of post-pandemic health care ecosystem

As the surge in telemedicine caused by COVID-19 has leveled off, Baptist Health Kentucky recognizes that as patients are excited about using the technology, it needs to continue to refine its offerings and ensure the connection tools that patients use to communicate with their doctors are available use, rather than exacerbating health inequalities.

“This isn’t going to go away,” said Brett Oliver, MD, chief medical information officer of Baptist Health, Kentucky, a member of the AMA Health System Program.

“Patients got a taste of it and whether you’re in a small practice or an organization it would be really easy to just say ‘boy glad this is over’ and move on,” said Dr. Olivier. “But I think that would be a mistake.”

Non-traditional healthcare players are showing patients what’s possible with telemedicine and other remote digital healthcare tools. So if one doctor or healthcare system doesn’t offer these options to their patients, many others will find that they do.

“If patients choose that, they better learn to play the game.” explained dr. Olivier.

Telemedicine support is an integral part of the AMA Recovery Plan for America’s Physicians. You took care of the nation. It’s time for the nation to take care of you. It’s time for a rebuild. And the AMA is done.

Telemedicine is critical to the future of healthcare, which is why the AMA continues to take the lead to aggressively expand telehealth policy, research, and resources to ensure sustainability of physician practice and fair pay.

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Baptist Health’s telemedicine evolution has paralleled that of many other healthcare systems. Prior to the COVID-19 public health emergency, the percentage of system visits conducted virtually was below 0.1% as Dr. Oliver and his colleagues slowly built their skills.

“Sure, we had some urgent pre-COVID video visits available,” he said. “They were staffed – let’s say less than optimal – and we literally had a designated (non-medical) contractor for it Monday through Friday 9-4. That was really the only availability.”

In late 2019, Baptist aimed to introduce video visits to GPs who were willing to try it.

“Then, obviously, when COVID hit, like probably everyone else, it just went through the roof,” said Dr. Oliver, with telemedicine at one point peaking at 58% of all visits.

“We launched something in a weekend that would have taken us literally nine, 12, 15 months to test,” he said.

The pandemic forced the postponement of a newly launched pilot project aimed at using remote patient monitoring devices to reduce readmissions of patients with congestive heart failure or chronic obstructive pulmonary disease. The pilot was stopped to allow the devices to be used on COVID-19 patients.

Baptist Health’s telehealth capabilities were bolstered by an $873,982 Federal Communications Commission grant that was part of the $200 million COVID-19 telehealth program mandated by the CARES (Coronavirus Aid, Relief , and Economic Security).

The grant helped fund equipment to remotely connect critical care physicians and caregivers with COVID-19 patients at any of the system’s eight hospitals or those monitored at home. In addition, all Baptist Health Medical Group offices have been equipped with a video camera and loudspeaker to conduct video visits to their patients.

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Regarding the advancement of telemedicine, Dr. Oliver, Baptist Health recognizes technology’s ability to both reduce and exacerbate health inequalities.

“We already have inequality here – if you don’t have access to broadband – there are a lot of things you don’t have access to,” he explained.

“So this is a problem for us because it undermines our plans to achieve justice,” said Dr. Olivier. “Some of your patients with fewer resources are going to face greater challenges — and that’s where you want to put your resources, but you can’t reach them.”

Baptist Health’s efforts in this area include advocating continued payment for audio-only visits and working with providers to try other technologies when high-speed broadband Internet access is not available. This includes setting up cellular “hotspots” for remote patient monitoring over a cellular connection, or installing fiber optic internet “hubs” to create spaces where patients can connect with their doctors for a video visit.

Baptist Health is also working to avoid creating a digital divide with older users, for whom telemedicine can mitigate inequalities exacerbated by transportation issues.

“We have a bell curve where 20- to 40-year-olds will definitely use our digital services more, but we have patients up to the age of 100 who use video visits,” says Dr. Oliver said.

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Initial video visits can be challenging regardless of the patient’s age. Therefore, Baptist Health reaches out to new users the day before a scheduled visit and guides them through the process.

“Once they’re set up, they’re some of the more productive users,” said Dr. Olivier.

Baptist Health offers three types of virtual visits: scheduled video visits, unscheduled emergency care video visits, and e-visits, where patients fill out a questionnaire that can help them assess their status for 25 different medical conditions.

“We learned that 52% of our employees who made an electronic visit in the last 90 days had made one before – I was blown away,” said Dr. Olivier.

“It exceeded my expectations,” he added. “We’ve only been active with this for a little under a year, so it would have been great to have 15% returning users. So if half the people using it are repeat users, that means telemedicine is about to explode again.”

The AMA supports increased funding for telehealth infrastructure, such as broadband internet and internet-connected devices, and continues to encourage research into the impact of telehealth on health equity, quality and cost of care, patient satisfaction, implementation science, and clinical appropriateness.

The AMA Telehealth Immersion Program offers a comprehensive curriculum to help physicians navigate the world of telehealth alongside colleagues through a series of webinars, interactive peer-to-peer learning sessions and boot camps.

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