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Can telemedicine survive covid-19 (originally published on Medium July 13, 2020)

In the early months of the COVID-19 outbreak as states mandated lockdowns, virtual health care was quickly looked to to keep patients and their health care providers connected and to ensure that patients maintained regular medical care. With the federal government loosening many restrictions on telehealth reimbursement, its use skyrocketed. During the week of March 15, for example, telehealth visits represented just 1 percent of all outpatient visits, according to data analysis conducted by the Commonwealth Fund. By the week of April of 19, the percentage was close to 14 percent.

That growth, however, has not been sustained, and use of telehealth actually has declined in recent weeks. Authors of the Commonwealth Fund analysis speculate that the plateauing of telemedicine volume suggests “that practices and patients may be reluctant or may still be learning how best to use it …Telemedicine cannot replace all types of visits — for instance, in-person visits are still necessary to diagnose and test certain complex conditions.”

As the co-founder and CEO of the one of the nation’s largest physician-led telemedicine groups, I respectfully disagree with this last conclusion.

After nearly a decade of delivering high acuity, inpatient specialty care through telemedicine, I know that it can indeed diagnose, test, and treat complex conditions. The more than 1.6 million patients I and my physician colleagues have cared for over the last decade….all virtually and remotely….have been high-acuity, experiencing some of the most complex conditions, including heart failure, stroke, respiratory failure requiring mechanical ventilation, fetal abnormalities, and meningitis.

Through telemedicine, we have put highly trained specialists — cardiologists, pulmonary and critical care specialists, maternal-fetal medicine specialists, neurologists, and hospitalists — in hospitals that didn’t previously have them or didn’t have enough of them to meet patients’ needs. We have increased access to specialty care, reduced wait times for care and transfers to other, more distant hospitals, and improved patient outcomes. Providing “code blue” cardiac arrest management via telemedicine, for example, reduced relative mortality rates by 17 percent and absolute mortality rates by nearly 2 percent.

However, I do agree with the report’s assessment about physicians’ comfort with and ability to use tele-technology to effectively deliver medical care and to be successful at the diagnosis, testing, and treating of complex conditions. Telemedicine is not simply the replacement of in-person care. There are practices and behaviors unique to telemedicine that must be learned, practiced, and honed. Our model calls it “breaking through the screen.” All our physicians are trained in providing care and consultation through virtual means. Our “break through the screen” curriculum teaches physicians the importance of connecting emotionally and personally with patients, their families and caregivers, and other health professionals. It teaches how to minimize the physical barriers to interpersonal connection and to maximize the integrity and effectiveness of the patient-physician relationship.

Our model also prioritizes the ongoing collegial relationship between the virtual physician(s) and the on-site health care professionals, whether that’s other physicians, nurses, respiratory therapists, or pharmacists. Our telemedicine model dedicates a group of physicians to each hospital we work with so that these physicians become part of the care team, even though they are not physically present. The success of our model is the result of this purposeful team-based approach.

As COVID-19 continues its stranglehold on the nation, hospitals and outpatient practices will have to evolve and adapt so that patients get the health care they need. For telemedicine to be a long-term part of that strategy will depend on viewing it not as a commodity or as just a technology but as a holistic model of care with its own distinctive set of skills and attributes.