After a full year of the coronavirus pandemic, one of the clear victories for health care providers and patients alike has been the rise of telehealth, or virtual care. Forced early on by COVID-19 to rethink health care delivery, providers everywhere had to undergo rapid operational change to fulfill patient care needs, and in many instances – some surprising – virtual care became the practical and effective solution, a way of doing “house calls” that likely won’t go away anytime soon.
UT Southwestern was already equipped with telehealth technology when COVID-19 hit – but, with a few exceptions, it was mainly as a small pilot program in the pre-shutdown environment. A handful of early adopters were ahead of the curve before the pandemic. One was the UTSW Department of Neurology and Neurotherapeutics, which was prepared to expand telehealth due to ongoing efforts that began in 2018 to improve access. Similarly, UTSW psychiatrists and psychologists began a program several years ago to launch telepsychiatry to serve patients with transportation challenges throughout Texas, including even in the Metroplex. Some of our specialists have been providing mental health support via virtual care for more than a decade.
But in the spring of 2020, aided by the quickly changing regulatory environment, even those departments took things to the next level. Through incredible team efforts, telehealth was expanded across the institution within days, bringing with it benefits for both the Medical Center and patients. UT Southwestern deployed telehealth options within the ambulatory environment, within the Emergency Department, and within all patient rooms at Clements University Hospital. Not only did it have social distancing built in, providing a safer option both for patients and providers by reducing potential infectious exposures, but it helped to minimize patient demand on facilities and reduce the need for PPE while still preserving the patient-provider relationship.
The benefits for telehealth patients include reductions in stress, missed work, the number of hospital visits, travel time, and exposure to pathogens, in addition to improving access to care with the option for out-of-state consultations.
Unforeseen benefits
On the surface, virtual care makes immediate sense in fields such as psychiatry and psychology, where patient-provider consultations can be remarkably similar to in-person care. Likewise, it is easy to see how patients with disabilities, limited transportation, or chronic conditions such as epilepsy, dementia, or headache are benefiting from having an in-person office visit converted to a virtual care visit for follow-up appointments. Someone who needs to discuss medication adjustments or symptoms is also a good candidate.
But prior to COVID-19 it was not clear if virtual care would meet the standard of care in highly specialized clinical practices such as oncology and plastic surgery. Yet what we have found is that it is actually a good fit and has several unanticipated benefits for patients and providers alike.
Last summer, we published our initial findings in the Aesthetic Surgery Journal, illuminating not only the unexpected benefits that telehealth has had during the pandemic but also what they might mean for the future of medicine in the United States. Our study found that patients were more likely to show up for their telehealth visit with decreased cancellation and no-show rates. In addition, UTSW began seeing many new patients through telehealth visits, establishing new patient-provider relationships at a time when receiving care in-person was very limited. This resulted from a combination of relaxed regulations and an increasing comfort level with telehealth visits among physicians and patients.
The study also found that even within a niche field such as plastic surgery, the implementation of telehealth has been incredibly successful, demonstrating the tractability of virtual care to a wide range of practices. From April to mid-May, plastic surgery completed 340 telehealth visits in areas such as breast cancer reconstruction, hand surgery, and wound care, with completion rates similar to the whole of UTSW. Likewise, plastic surgery also saw a large number of new patients, who comprised 41 percent of the telehealth visits.
As reported in the article, the benefits for telehealth patients include reductions in stress, missed work, the number of hospital visits, travel time, and exposure to pathogens, in addition to improving access to care with the option for out-of-state consultations. Indeed, by the summer of 2020, patients from 43 states and Puerto Rico had participated in virtual care visits at UTSW in more than 36 specialties, and the Medical Center as a whole was sustaining 25 percent of its practice virtually, which we saw as a major win for our patients based on their feedback.
At UT Southwestern, we’re working toward making the interface easy to use, regardless of our patients’ level of tech-savviness, through the development of a patient app focused on delivering a best-in-class digital experience for patients.
Foreseen challenges
As we have seen, the numerous benefits that telehealth has to offer are accompanied by several challenges, such as the practicality and risks of remote diagnostic medicine. Though technology is starting to address some issues with the development of tools such as electronic stethoscopes and consumer-facing apps that can measure blood oxygen levels and perform electrocardiograms, for example, some argue the value of the in-person physical exam cannot be replaced.
Aside from patient-facing issues, other challenges need to be included in discussions of the future of telehealth, including federal, state, and local laws; privacy concerns; and Health Insurance Portability and Accountability Act (HIPAA) regulations. Many statutes and restrictions were loosened relatively quickly during the pandemic, allowing institutions like UTSW to implement telehealth rapidly and effectively. But the future of telehealth will necessitate the development of long-term regulations, and now may be the best opportunity for health care providers and governmental agencies to address these challenges and set out guidelines for the practice of telehealth going forward.
The future of telehealth
Forthcoming technology will make telehealth even more accessible for patients via mobile devices. At UT Southwestern, we’re working toward making the interface easy to use, regardless of our patients’ level of tech-savviness, through the development of a patient app focused on delivering a best-in-class digital experience for patients.
The bottom line is that for many health conditions, research shows virtual care visits with a professional can be as effective as in-person visits, and, equally as important, patients like the platform. Whether current trends continue into the post-COVID-19 world remains to be seen, but, either way, it is clear that telehealth has become a useful tool for health care providers and patients alike.
About the Author
Alan Kramer, M.P.H., is the Assistant Vice President for Health System Emerging Strategies at UT Southwestern. He is leading efforts to design and implement a digital health experience that engages and activates patients to play a proactive role in the management of their overall health and wellness.
Make a Referral
To schedule a consultation or referral for virtual care at UT Southwestern, call 214-645-8300.
