Pam Koman-Podolak is immunocompromised, with multiple health conditions, including rheumatoid arthritis. She falls squarely into the category of people most at risk during the COVID-19 pandemic. When New Jersey, where she lives, issued stay-at-home orders, she says, “I was so sad, thinking I had to cancel appointments. And I was scared to go in because my rheumatologist works in a big medical center and I’m on immunosuppressant meds. But I really needed to talk to him and see him.”
Koman-Podolak is lucky: Her rheumatologist is “really into technology,” so she was able to talk with him via computer. While this was her first experience with telemedicine, it turned out to be a good one. “It was immediately obvious that he was comfortable using this technology,” Koman-Podolak says. “It felt very personal and professional. I was impressed that he noticed my knuckles were swollen by examining my hands through the app!” Her rheumatologist (she calls him a “rheumy rockstar!”) “saved the day for me by offering this wonderful solution.”
But despite 20 years of real-life experience and growing popularity, telehealth and telemedicine (which is usually defined as clinical interactions) still aren’t as widely used as might be expected. According to Definitive Healthcare, an analytics firm, only one third of inpatient hospitals and 45% of outpatient facilities provide telehealth services. Iowa, Utah, and South Dakota—which have large rural swaths—have the highest implementations, with 64% or more of the state’s hospitals reporting a service. Northeastern states reported the lowest level.
That’s changing, as the COVID-19 pandemic has wrought changes in everything from routine care to triage. Between erratic supplies of protective equipment for practitioners and patients who don’t want to risk their health, telemedicine is proving a boon.
Last year, the Infectious Diseases Society of America updated its position statement to educate its membership on the use of telemedicine and telehealth technologies to provide “evidence-based, cost-effective, subspecialty care.” (The list of established-use cases for infectious diseases includes infection prevention and control.)
IDSA notes that a patient’s comfort level with their healthcare provider affects their health outcomes and quality of life. “The practice of medicine has a tradition of establishing a trusting, therapeutic relationship with patients,” the IDSA statement says. “There can be a perception amongst inexperienced providers and patients that technology lacks intimacy.”
There are ways around the lack of in-person interaction. Brook Calton, MD, MHS, Nauzley Abedini, MD, MSc, and Michael Fratkin, MD, of University of California, San Francisco, and ResolutionCare Network, offer some practical pointers on making the virtual visit more “lifelike.” Based on their experience, they advise clinicians to, among other things:
· Create “a therapeutic telemedicine environment,” with a quiet, private, well-lit space. When possible, choose a space with a professional, neutral, and uncluttered background.
· Use a laptop or desktop computer if possible, to avoid the distracting—or even nauseating—sensations of a moving handheld smartphone.
· Look at the camera to ensure good eye contact and foster rapport and trust.
· Reassure the patient that the conversation is private by showing them the room, and asking the patient to do the same.
· Pay close attention to subtle comments made by patients and caregivers and their body language.
Practitioners, too—even those who might have been anti-telehealth or on the fence—are acknowledging the benefits, particularly now. Haider Warraich, a Boston cardiologist, for instance, was a skeptic at first. But now he hopes that one thing that comes out of the COVID-19 pandemic will be an increased reliance on telemedicine, “something that should have happened long ago.” In an opinion piece in the Los Angeles Times, Warraich says, “Physical exams are the bedrock of how doctors and nurses assess patients…. Physical contact, I’d always thought, was at the heart of how doctors and patients communicate.”
His mind has been changed, though, not only by experiences with telemedicine, but by practicality. “Hospitals have been notorious petri dishes for deadly bugs since long before COVID-19,” he notes, “and this pandemic has brought that risk into crystal-clear focus.”