Are We on the Verge of a New Era?

A year and a half ago, I introduced myself to a speaker at a local health technology conference. As we concluded a thought-provoking discussion about the future of medicine, he leaned in and said to me “Imagine a virtual pediatric hospital!” Admittedly, I was inspired by the challenge. Although as much as I tried, my imagination wasn’t conjuring anything up. Until now.

Telemedicine, the practice of caring for patients remotely when the health care professional and patient are not physically present with each other, just became mainstream….overnight. Hospitals and practices who typically only see patients in person have started conducting audio and video visits, including our outpatient subspecialists.

As our team was in the process of developing strategies to protect our community from the encroaching virus, the government announced that telemedicine regulation would be temporarily loosened (e.g. HIPAA requirements, tort liability limits) and insurers were agreeing to reimburse video visits at the same rate as in-person visits. Because the technology has been in existence for decades, it took about a week for the team at Nunnelee Pediatric Subspecialty Clinics to figure out a process and start offering virtual visits.

Initially, it involved some adjusting and took a little time for everyone to become comfortable using telemedicine. Although we found that being able to see the patient in their own environment adds a lot to our overall assessment. The patients seem comfortable with the technology and the parents seem very pleased with the visits. It took some creativity to figure out the best way to schedule telemedicine visits in with regular clinic visits, but we figured out a great process and things are running very smoothly.

Megan Peedin, NP, Pediatric Neurology

We initially triage the patients that we have seen previously or have been recently referred to us and substitute an at-home video teleconference (or telephone conference if internet access is not available in the patient's home) when it seems suitable. While some patients still require a clinic evaluation for procedures such as echocardiography, we can perform some testing, such as holter monitoring, completely remotely. We have reduced the number of in-person office visits by more than 50% and hope to diminish that number further in the future. Many thanks to Susan Boyd for all of her fine work in bringing this important project to fruition.

Jim Loehr, MD, Pediatric Cardiology

The rate of mass adoption is fascinating. This week, we were informed that all UNC Children’s specialties now have the ability to perform video visit consultations. Telemedicine companies like Teladoc and Doctor on Demand are racing to recruit physicians and improve bandwidth to meet the abrupt increase in demand. Swedish-based Kry International, one of the biggest telemedicine providers in Europe​, announced that registrations for its app are up 200%. Big technology companies, like Microsoft are launching new services and tools to get in on the game. Telehealth seems to have reached its tipping point.

Is this a new frontier or will we resume to business as usual once the pandemic passes? If the temporary deregulation by the federal government during this time of crisis results in lower costs and improved access, the health care system may be on the cusp of a revolutionary transformation. Reimbursement rates will certainly be a big factor in determining whether the flurry is a short-term response to the crisis or a more lasting shift in health care. The longer we all do it, the more it will become ingrained, including for patients. Consumer demand is powerful.

The answer, like most things, is probably somewhere in the middle.

We will always need brick and mortar for certain medical services, like exams, procedures and immunizations. Amidst the rapid innovation on the fly right now, an image of a virtual pediatric hospital is beginning to crystalize for me.

  • Video visits with physicians, nurse practitioners, dieticians, social workers, etc

  • Remote patient monitoring (at-home holter monitoring and spirometry, wearables like, Apple Watch that can generate an ECG, fitness trackers that measure heart rate, etc)

  • Drive through testing centers deploying facial recognition software

  • Test results sent quickly via text messaging

  • Algorithms in the smart phone speaker to analyze a cough

  • Artificial intelligence, like chatbots for screening and triage

People keep saying, “I can’t wait until things go back to normal.” Can we ever really go “back”?

Elizabeth Harris, MEd, SPHR is the Director of Strategic Development at Coastal Children's Services.

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