Then Along Came COVID: An Opportunity to Reimagine Healthcare Delivery

When it comes to the consumer experi­ence and the needs and desires of pa­tients, the healthcare industry has been behind the times for too long. As a re­sult of the COVID-19 pandemic and vast transformations in telehealth, healthcare providers and sys­tems have an opportunity to reimagine traditional methods of care and refocus their efforts on patient-centered services.

Healthcare has not focused enough on “patient-centered care,” or care that emphasizes the specific needs of the individual, and the purchasing power of patients has long been limited by the way in which care has been historically delivered – in-person. But those of us in healthcare have longed for the industry to stop relying on reputation or narrow contractual agreements with health plans to maintain a patient base. Instead, the desire is for healthcare to embrace the technological innovations that have transformed other businesses, such as the travel and banking industries, and leverage mobile, online and video technologies to provide more personalized, timely care.

Telehealth, which is the delivery of healthcare services over a distance using telecommunications and other digital health technologies, has had the potential to create new models of care that are more patient-centered. Unfortunately, because of healthcare payment models, difficulties in change management, a lack of incentives, and hesitancy from health care providers, telehealth adoption was painfully slow.

"The Time Has Come For Healthcare Delivery To Focus More On Patient-Centered Care And For Us To Utilize Existing And Newer Technologies To Ensure That Care Is More Timely, Effective, Efficient, And Equitable"

THEN ALONG CAME COVID…

With the onset of the COVID-19 pandemic, physicians and healthcare systems had little choice but to adopt telehealth given the public health emergency. The stay-at-home and sheltering recommendations meant that patients could only see their primary care and urgent care providers using telehealth. Restrictions limiting telehealth use were lifted by federal and state agencies to make it an effective and financially sustainable model of care. For many healthcare systems, including UC Davis Health, the use of telehealth for outpatient or ambulatory visits rose in early 2021 from 1-2 percent to approximately 70 percent during the first waves of the pandemic. The percentage of care encounters that are delivered using telehealth has since vacillated with different surges, but has settled between 15 percent and 30 percent

Recent advancements in electronic health record systems, patient portals, videoconferencing technologies and apps makes it even easier to get care. Patients can message their physicians and healthcare teams by text, phone, or video about all types of issues, including urgent and non-urgent needs, and physicians and other providers can easily respond using these same methods. Physicians can consult with other specialists or provider teams behind the scenes and these eConsultations can result in more rapid advice and education compared to a traditional in-person referral to a specialist. Telehealth can also be used to see physicians in the convenience of their own homes (these are commonly referred to as provider-to-patient encounters or video visits). For those visiting their primary care providers in rural or distant communities, telehealth can be used to “beam in” a far-away specialist during an office visit, as opposed to sending the patient to the specialist’s office (these are commonly referred to as provider-to-provider consultations).

EXTENDING THE USE OF TELEHEALTH

Telehealth is also being increasingly used to access specialists in hospital settings such as the emergency department, inpatient ward, or intensive care unit. UC Davis Health has been providing these consultations for many years in a variety of circumstances, including “tele-neonatology” for sick newborns born in community and rural hospitals, “tele-emergency” for seriously ill pediatric patients presenting to general emergency departments, “tele-stroke” for patients suffering an acute stroke that do not have access to specialized stroke neurologists, as well as other connections where UC Davis Health subspecialists provide virtual bedside consultations to patients in hospitals without these types of specialized services.

In addition to these more common models of telehealth care, there are increasing opportunities to implement remote patient monitoring, where patients can be monitored both actively and passively for whatever types of medical conditions they may have. For example, patients with diabetes can have their glucometers or insulin pumps near continuously monitored through wireless connections and secure patient portals. Patients with heart failure can have their oxygen, heart rate, and blood pressure monitored with lower-cost home medical devices. Patients with depression and other behavioral health disorders are able in input their mental health status into a monitoring system through mobile devices. All of these examples help engage patients in their personal healthcare, help providers identify concerning trends early, and in the long-term help reduce complications, improve patient outcomes, and reduce overall healthcare costs.

The time has come for healthcare delivery to focus more on patient-centered care and for us to utilize existing and newer technologies to ensure that care is more timely, effective, efficient, and equitable. For each encounter or request for healthcare services, physicians and hospitals need to take advantage of the many new telehealth tools in their toolbox. Rather than just scheduling an in-person office appointment, we need to consider where the patient lives, what resources and patient supports are available (or not available), and the urgency of the medical issue. Then, the provider team needs to work with the patient to select the right modalities of care and consultation to best meet the patient’s individual needs.