Telemedicine key tool amid COVID-19 crisis expected to enhance future health care options
In the world of the coronavirus, everything is different, even arranging a routine doctor’s visit.
Telemedicine is the new normal for doctors and patients as personal safety dictates patients and doctors find ways to stay connected without contact in confined spaces.
Most doctors assure this technology — be it a phone call or video conference — will never replace the healing power of touch or a “dandruff to ingrown toenail” physical exam.
Yet, it is a tool now employed to keep patients, staff and physicians safe from a highly contagious, and deadly, virus to those with weakened immune systems unable to thwart its attack on vital organs.
“The COVID-19 pandemic has really forced a lot of rapid changes of regulatory burdens so we can have more flexibility,” admitted Dr. Robert Thompson, executive medical director for the Yavapai Regional Medical Center PhysicianCare that operates 27 area clinics and employs some 85 providers.
At this time, Thompson said he believes primary care providers are relying on virtual patient visits and telephonic care for the bulk of their practice. That does not mean doctors and other medical practitioners’ ignore “clinical judgment.”
“There are no knee jerk responses,” Thompson said.
Primary care by its very nature is about relationships between patient and provider, Thompson said. So the move to telemedicine during this period for everyone’s safety has required careful deliberation and “tough calls” about how to best respond to patients’ immediate needs.
YRMC PhysicianCare now has one clinic designated strictly for potential COVID-19 patients and one for acute care; illnesses that require treatment but do not warrant an emergency room visit, he said. The hospital also now provides drive-up testing for first responders who are first screened by telephone, he said. Most test results are now available within 48 hours.
“How do we balance this and still do the right thing at the right time in the right venue?” Thompson said are the standard queries medical professionals are making each and every day. For most, the answer is “case by case.”
Dr. William Thrift, a retired Prescott family practitioner for more than three decades, said these times have called for new ways to care for patients while at the same time maintaining personal connections.
Telemedicine may not be the answer in all cases, but it can be a powerful tool that enables doctors and patients to stay in contact so that if a face-to-face visit is needed that can be arranged, he said.
For years, Thrift said, doctors wanted to offer this option but were thwarted by the inability to be reimbursed through Medicare and private insurance.
COVID-19 has pushed the envelope such that many family practitioners are relying on telehealth to offer care they might otherwise be forced to postpone for everyone’s safety, he said. In time, he suggests this could be a game changer, particularly where primary care doctors are at a premium.
Telemedicine will never replace certain clinical contacts — think prostate exam — nor does it replace people’s needs to a doctor’s “healing touch,” Thrift said.
AHEAD OF CURVE
The Prescott VA has long employed telehealth by necessity as its 29,000 veterans reside in rural communities across northern Arizona, many more than 30 miles from the closest clinic.
Amid the crisis, the VA is still open to patients who need to be seen by their primary care doctors, with the necessary precautions, but some of the new, protected health technology is offering patients care that is almost as good as being in the same room with their primary provider, said VA Chief of Staff Dr. A. Panneer Selvam.
One of Selvam’s favorites is Video Connect, a high-resolution and encrypted video conference application that enables a veteran and his doctor to privately convene wherever they happen to be. Even some of his older patients find this option almost as comfortable as visiting in the office, he said.
The VA, too, is relying on two new telehealth protocols, one for stroke victims and one for intensive care patients, Selvam explained. Both enable physicians to connect with those specialists in the emergency room, he said. The local VA does not have an intensive care unit or full-time neurologist. He added that with this technology, however, the attending physician and patient can communicate with specialists on a 24/7 basis.
In consultation, the patient can then be given on-the-spot, life-saving drugs that might otherwise be unavailable, or many miles away, he said.
For the past 15 years, the VA has offered as a staple service its MyHealthyVet program, one that electronically enables veterans to make appointments, refill prescriptions and leave messages for their primary care team.
“It’s amazing how well this all works,” Selvam said. “Most people underestimate it, but once they use it they realize it’s a great complement (to traditional medicine). If there is a silver lining in all this, the advanced use of technology will be one of those benefits.”
At Thumb Butte Medical Center, Dr. Hojat Askari, the medical director, said primary care and specialty doctors are offering a combination of care, including telemedicine.
Like Thrift, Askari views telemedicine as a means to keeping people safe at home with illnesses that do not require a face-to-face visit. He does not, however, want telemedicine usurp the patient/doctor bonds that are often the key to diagnosis and treatment.
When this virus threat is over, Askari said he can see telemedicine platforms becoming a standard for after hours or weekend care. Otherwise, Askari said his doctors prefer in-person visits with patients.
“There is real healing power when we hold a patient’s hand,” Askari said.
MENTAL HEALTH CARE
Local psychologist Elaine Hodge is concerned about the stresses imposed by this virus, be it an elderly person living alone or a family struggling to pay bills after a job loss. She said she and other colleagues are relying on technology to break the isolation.
With most private insurances and Medicare willing to foot the bill, Hodge said people can connect with licensed practitioners offering privacy-protected video counseling sessions.
“It bothers my heart that there are people out there who are hurting,” said the therapist with an associates degree in Holistic Psychological Services. “They might feel all alone and don’t know where to go to get help.”
The Community Health Center of Yavapai is also offering telehealth counseling appointments in its clinics in Prescott, Prescott Valley and Cottonwood for low-income individuals with limited, or no insurance.
“Social distancing rules and the state’s stay-at-home orders affect everyone differently, however, many are struggling with similar feelings of loneliness, fear and worry,” said a center news release. “It’s important to stay connected with family and friends in these times and keep those lines of communication open.”