A discussion about telehealth’s ongoing role in COVID-19, and how virtual care is reshaping Healthcare.
This interview with a former U.S. Military physician who is board-certified in family medicine and clinical informatics shares insights on seeing patients virtually, how telehealth is helping care for patients during the COVID-19 pandemic, why telehealth lends itself well to Military doctors, and telehealth’s role in the future of Healthcare.
Can you Provide some Context Related to Your Medical and Military Experience?
I attended medical school on an Army scholarship and did my training in the U.S. Army before spending several years both on active duty and in the Army Reserve. I’m what they consider Reserve Retired now, but I’ve been working as a civilian for Army Medicine since 2002. The first half of my career was spent doing full-service family medicine as a faculty member at an Army residency training program, and for the last nine years I’ve been working for Army Medicine providing informatics expertise on how we can improve the patient experience using virtual tools. Patient engagement technology is really where my interests lie.
What have You Seen with Telehealth Related to COVID-19?
Telehealth has been instrumental in responding to the COVID-19 crisis. It has been the canary in the coal mine for me. I was seeing patients across multiple states and recognizing community spread long before the usual monitoring systems caught it, because brick and mortar practices are local community-based systems. No other method allows providers to see patients across a large geographic area, so you see trends materializing much faster than with the local brick and mortal facilities.
We are currently treating two groups: those with your typical medical issues who are trying to avoid brick and mortar facilities to prevent exposure, and those with COVID-19 symptoms who we are helping to triage and advise. For the second group, we’re advising on who needs to stay home, who needs to self-quarantine, who needs testing and who needs urgent referral to care. No other method exists to do this at the scale that’s required. It’s all hands on deck, but we’re helping people stranded at home that the regular Healthcare systems are unable to help.
How are You Able to Uphold High Clinical Quality Standards During Virtual Visits?
With AMG, we have the full support of the medical directors around adhering to evidence-based practices and antibiotic stewardship. We don’t change standards just because we’re virtual. Sometimes patients have different expectations and we have the freedom and the expectation to say, “No, I am not going to prescribe you this antibiotic,” and explain to the patient why that is and to feel fully supported in those decisions. I feel very comfortable that we are practicing high-quality care and I do feel like the policies are in place and the medical directors are supporting that. From the perspective of COVID-19, the AMG medical directors have done an amazing job and we have a chat board that has proved invaluable for guidelines and updates as we work through this crisis.
I’ve also always been a believer that data transparency is a good way to change behaviors. Amwell Medical Group provides monthly reviews and physician scorecards that show through data how you compare to your peers with things like antibiotic use percentage. Through those scorecards you can see if you are out of the norm, which helps change behavior.
AMG physicians also have the support of the Network Operations Center (NOC), which is a 24/7 support team. Fortunately I haven’t encountered this scenario yet, but if I’m seeing a patient virtually and detect a crisis — whether it’s a mental health crisis or someone having chest pains — I can easily and immediately contact the NOC and they can call 911 for me and do a lot of other things in the background while I stay with the patient. That support network makes you feel like you’re not out there on your own, which is critical to making the experience a pleasant one for the providers.
What Type of Geographic Freedom does Telehealth Give You?
While I’m no longer a uniformed physician, one of the things about the Military is that you’re allowed to hold a license in any state as long as you’re practicing in a Federal Military Healthcare facility. One of the great challenges is that Military providers move every several years, and if they move to another state and want to do any off-duty employment, they must change their state license. The beauty and power of telemedicine is that they can use whatever license they have and regardless of where they’re living, they can treat patients from that state. As a mobile individual with Military requirements, you don’t have to deal with the limitations of brick and mortar facilities. That’s huge.
How will Telehealth Change the Future of Medicine?
We’re in this “now” economy where people want things when they want them. The old model of having to schedule an appointment, take time off work or school, travel to a location, and sit in a waiting room is becoming unlikely in today’s world. Patients are demanding convenience.
From an economic and patient demand standpoint, the cost of Healthcare today is unsustainable. When you combine a burdened Healthcare system that is unsustainable from a cost perspective with an aging population and a shrinking physician workforce, that’s a recipe for disaster. I see an opportunity for us to expand significantly what virtual health can do through a hybrid approach. I see a future where patients can go to an urgent care center staffed by trained, registered nurses, and be able to have a virtual encounter with a remote provider. In this type of hybrid model, the nurse facilitates a physical exam and can provide ancillary testing, and remote providers can come in and care for patients when appropriate. This type of model can expand the scope and quality of care provided and increase the accuracy of diagnoses.
What will it Take for the Healthcare Industry to Adopt this Type of Hybrid Model to Care?
When you realign incentives, behaviors will follow. The good news is, CPT codes are beginning to change and attitudes are beginning to shift—that’s a big part of it. The second part is cultural resistance to change. There are certain providers who have always done things a certain way and believe that you can’t provide the same quality of care virtually as you can in person. That’s true for some things, but it’s not true for everything. A hybrid model really gives you the best of both worlds. Demand is going to increase dramatically over the next 10 to 20 years and there is no way you’re going to have enough providers in every brick and mortar facility to see all these patients. We must have economies of scale by leveraging people wherever they are. This COVID-19 crisis is going to change the game. Patients and health systems will never go back completely to the old model.
This interview is with a former U.S. Military physician who is board-certified in family medicine and clinical informatics. In addition to his current position within the U.S. Army Medical Department, he is also a physician with Amwell Medical Group (AMG), a physician-owned and operated medical group that provides care virtually through telehealth.