Even before COVID-19, telemedicine was a growing element of health care.
But the pandemic, which restricted patients from seeing doctors in person, accelerated the process exponentially. The U.S. Centers for Disease Control and Prevention reported a 154% increase in telemedicine use in the final week of March 2020, during the pandemic’s earliest days exactly one year ago, from the same time in 2019.
Prior to the pandemic, health care experts saw telemedicine — which describes programs, including video doctors’ visits that allow health care to be delivered remotely — a way to provide medical care to rural areas underserved in comparison to urban hospital centers.
Between remote video and phone apps that can gather a patient’s vital signs, it’s fast becoming possible for telemedicine to deliver most, if not all, of the services previously available only by in-person visits to a provider. And e-medical practice is gaining traction universally, even though its greatest impact might be felt in rural areas where patients might have to travel significant distances to see a doctor in person.
New York University business professor Scott Galloway said in his 2021 book “Post Corona” that the COVID-19 pandemic has moved technological market penetration forward by 10 years in 12 months. Galloway specifically cited online shopping and food delivery, social media development, and telemedicine.
In Galloway’s estimation, telemedicine and other technology-based services are now where they would have been in 2030, absent COVID-19.
A 500-fold increase
University of Pittsburgh Medical Center has had telemedicine programs since 2006. But it was usually considered a “second option,” behind traditional, in-person visits, said Dr. Rob Bart, chief medical information officer with UPMC.
That changed, and quickly, with the COVID-19 pandemic. In February of 2020, a month before the pandemic began, UPMC had about 250 remote medical visits. From mid-March through the first week of August that year, there were over 10,000 ambulatory visits.
And the trend has only accelerated — Bart said UPMC is now doing between 4,000 and 5,000 visits a day. That’s about 500 times what the system had done a year ago.
This increased emphasis on telemedicine has begun to change attitudes among both patients and clinicians. Despite what Bart called a “blunt hammer” application of telemedicine because of the pandemic, the system will continue to offer telemedicine following the pandemic, while developing protocols to determine when telemedicine would best suit patients.
“I would say that four out of five comments we’ve gotten are overwhelmingly positive, while that one out of five is usually because of a technology issue,” he said.
But even after the pandemic is over, Bart said there are plenty of reasons that would encourage people to consider telemedicine instead of an in-person visit.
In the case of simple followups after an incident or surgery, a patient can use a device such as a smartphone to capture images of affected body parts, or apply pressure to an area to see the reaction.
That time element becomes even more crucial if a person lives in a rural area far from their health care providers. If the patient drove from Mercer County for an in-person appointment in Pittsburgh, Bart said the trip may take up to two hours one direction and up to two hours back — for a few minutes with a clinician or surgeon.
By cutting down on the time someone would have to set aside for a follow-up appointment, clinicians could schedule regular follow-up visits with patients more often than perhaps just once or twice a month. While this can increase a patient’s overall time with their clinician, having that repeated contact can also encourage patients to maintain certain practices, such as taking medications or carrying out exercise routines, Bart said.
“There are times when someone does something for a while but they start to drop off because they feel better or they’re busy, so seeing their doctor more often can be a reminder to keep up with those things,” he said.
Here to stay
Dr. Clemens Schirmer, a neurosurgeon with Geisinger said he’d used telemedicine on a limited basis for routine checkups, specifically for patients who had long distances to travel. Now, it’s almost fully replaced outpatient visits at his office.
The pandemic changed that. Almost every day-of-clinic appointment booked for Schirmer is now done remotely.
“I’m perhaps a little bit of an outlier,” Schirmer said. “I see maybe one patient in person. I’ll have the other 12 to 16 on televideo and some phone calls.”
The American Medical Association’s coverage of its 2021 state advocacy summit cited a legislative and regulatory advocate who found nearly 25 million Medicare beneficiaries received telehealth services from mid-March through mid-October last year, and another 35 million such services rendered in that same time frame to beneficiaries of Medicaid and CHIP — a near 3,000 percent surge above 2019.
Schirmer mostly conducts neurologic exams with patients remotely. Sitting, looking into the camera and responding to prompts is easy enough. It grows a bit more difficult when patients must stand up and move.
He doesn’t have much use of telemetry equipment like a stethoscope plugged into the computer on the patient’s end. If he’s measuring a patient’s pulse, he’ll ask the patient to feel their wrist and count out beats aloud while monitoring his own watch. As the exam continues, he’ll share patient’s scans or images on the screen to supplement the discussion.
Schirmer said he sees patients who are post-operation mostly in person because it’s best to examine wounds up close. Depending on its location on a patient’s body, it can be difficult to get an effective image as they stretch to hold a camera to their back, for example.
“I’d say it has gone surprisingly well. It’s mostly consultation and discussion,” Schirmer said. “I’m starting to wonder for a lot of patients if that isn’t a really good way of actually delivering care.”
Lindsay Fetterolf, a community health assistant with Geisinger, is sometimes called on to help Geisinger Health Plan members connect to a telehealth visit. Sometimes, a patient’s own phone or computer is used. Other times, she said they use Geisinger equipment. She helps facilitate the use of telemetry devices like a stethoscope or otoscope that plugs into a computer’s USB port.
“It’s a lot of the older population who may be intimidated by the technology,” Fetterolf said. “We can actually have the physician listen to the heart and lungs, see any wounds.”
The clinician collects information like weight and blood pressure in advance. A hospital-to-home program directs ambulance staff to patients’ homes to collect vital signs and draw blood, among other duties.
Dr. Ayn Kerber — of Family Medicine of Evangelical-Lewisburg, WestBranch — said this interaction and data collection is invaluable. The service is used when, for example, someone had recently been discharged. It’s not typical for routine checkups.
Kerber said she personally hasn’t experienced many problems with internet speed and access, though Schirmer said that’s very much been an issue in his own experience. Helping patients become comfortable using hardware and software for the visits, particularly older patients, is a challenge, Kerber said.
Telehealth lowers barriers for access and as a convenience, it allows greater opportunity for a relative to sit in on an appointment or, long-term care facilities, a nursing provider. It also allows providers a look into their patient’s homes and identify and potential concerns with their physical surroundings.
But, Kerber said, there’s “no substitute for the human touch,” and she thinks the use of telehealth at her practice will drop as the pandemic eases and winter turns to spring.
“We will continue to offer it as an option,” Kerber said. “I don’t think those numbers will stay where they are. I would say we probably hit our peak weeks ago.”
Reporters David L, Dye, Keith Gushard and Eric Schicchitano contributed to this article.