The Covid-19 health crisis accelerated the wide-spread adoption of virtual care to quickly get care to the patients while keeping physicians, staff and patients safe. But after many months of some patients being seen “virtual only”, the question is asked: Is virtual care worsening outcomes?
A Simple 4-step Care Process
I’ve been working in telehealth since 2003 and have been involved in the launch and implementation of telehealth services for over 10 years. My prediction was always that by 2030 we’d be seeing a use of telehealth for up to 70% of all visits. Obviously this timeline was accelerated from 10 years to just 10 weeks, if even, though the numbers certainly didn’t stay at the 90% level of the April and June.
My anticipation was that over the next 10 years, we’d also be developing additional mobile and remote testing capabilities to catch up to the reliable feature set of video chat solutions. The rapid push into virtual care in response to the health crisis actually may end up hurting the telehealth industry for that reason.
While quite a few patients are seeing their doctor in person, still, a large number of patients have opted to only be seen virtually and may even be afraid to come into the clinic for a number of good reasons. Yet it is those patients who the clinicians can only see over video (or even worse, only hear over the phone), trying to manage this patient’s health, while, essentially, operating in the dark.
The delivery of care, when viewed through the eyes of a systems engineer, becomes a quite simple 4-step process: an assessment (1) leads to a diagnosis (2) followed by the development (3) and implementation (4) of a treatment plan.
We need better tools to aid with the assessment and (as part of the implementation) the adjustment of the care delivery strategy.
Insights vs. Intuition
Over the years, fewer and fewer diagnoses, except for the most common ailments, are being made without consulting a test: whether that’s a blood count, a radiological examination — such as an x-ray or CT-scan — or a specialists’ evaluation, such as an ECG by a cardiologist. Just looking at the patient and taking their weight and blood pressure typically does not yield the information necessary to make a confident diagnosis. Oftentimes a more intensive or invasive test is needed to make a confident diagnosis and/or decisions on the care plan.
Tests and exams are not just good for diagnosis. They are also important when it comes to ensuring the engagement by the patient to follow the care plan and to make adjustments, especially to medications, to ensure the best outcomes.
Therefore, in the absence of convenient ways to exam and test patients, physicians may not be able to provide as good as care as in-person visits, potentially leading to worse health outcomes for some patients.
The Limitation of Virtual Care
As people are evaluating the pros and cons of virtual care, there has been a lot of talk lately about vaccines or procedures that obviously need to be done in person. The question being raised is:
Does telehealth help keep patients on track to get in-person care,
or does it actually hinder outcomes because patients take
a telehealth appointment and then forego things
that it takes an office visit to deliver?