Katie the Intern 12/4/20

Howdy, HIStalk readers! I hope you all had a fantastic Thanksgiving and are looking forward to Christmas and the rest of the holiday season. As always, thanks for reading my columns and I greatly appreciate every comment and email (I’m behind on those replies, but thank you!)

This column will cover a great interview I had with Nick Wanner, MPAS, PA, a physician assistant who serves as a clinical advisor for a healthcare vertical team at Avtex. Our discussion surrounding telehealth and its advances was eye-opening to how fast telehealth has moved forward. Nick has been practicing medicine for three years, but he said his clinic used telehealth relatively often even before the outbreak of COVID. He worked on a project to bring telehealth into his practice early on in his career.

“I had a capstone project for our PA program,” Nick said. “My focus was on bringing a telehealth program into a bigger organization.”

The program aimed to bring telemedicine to a primary care facility and eventually into a specialty care program. In early 2017, Nick was put on a design team for formulating a telemedicine program at work and helping install the formal telemedicine program. By 2018, phone visits were a regular occurrence at the clinic.

As a consumer of medical care myself, I found this interesting, as I had never really heard of seeing a doctor online or over the phone before COVID. It’s highly possible this is because I’ve always been healthy and also have no issues going into doctors appointments. Still, I found it fascinating that telehealth was on the market way before COVID.

I asked Nick about his experience with telehealth before the pandemic, how often he used it with patients, how usable it was, and how much experience he had with it. Outside of his experience with designing a telemedicine program, Nick said that the clinic he works at was already leaning towards virtual and online video visits before the pandemic. His clinic had plans to push for more telehealth usage beginning in 2020.

“Video was on the docket for us as a group this year,” Nick said. “We basically had the infrastructure ready, we knew what video service we were going to use, and we had all the marketing. So it just got pushed forward.”

Nick said that before COVID, the average telehealth appointment was for college students who were away from home or people who wanted to stay home and use a virtual visit. He said telehealth was limited in use, but since COVID, it’s become more common.

“Since COVID has come around, [telehealth] has been more of a mainstay at our practice,” Nick said. “We’re kind of advocating between 30-35% of our visits as telemedicine, both video and phone.”

When I first heard 30-35%, I’ll admit I thought that was low for COVID’s impact on the necessity of telehealth. Nick clarified that year to date through November, his group has completed over 500,000 video visits alone, assuming closer to 750,000 for a more up-to-date number. He used the words “rocket ship takeoff” to describe the trend.

We all could have guessed that telehealth would be heavily used during COVID as safety has become such a large part of slowing the spread. But what are the other benefits of telehealth? And where is it falling short?

Nick said that as far as the benefits of telehealth, the major pros are lower costs and more transparency for phone and video visits, patient satisfaction in relation to being able to talk to a doctor long distance, reduced overhead for providers and fewer staffing issues, and the general overall comfort that this trend won’t go away.

“Once people buy into this, we’re seeing that people keep coming back to it,” Nick said. “We’re seeing a huge portion of patients that really are enjoying these visits.”

As far as the cons, Nick said that one of the biggest is “managing that fine line between convenience and ease of access at appropriate clinical quality.” Clinicians and providers have voiced this concern often, Nick said, along with a lack of physical touch for examinations and hands-on care.

“There’s nothing that can replace that,” Nick said. “I think that is part of the art of medicine.”

Nick also said that just because telehealth aids in lessening the amount of in-person care initially, it can still lead to physical, in-person follow-up appointments and hospital visits. Nick said that it is important to teach patients how to appropriately use telemedicine and only when physical care is not an absolute need.

“We don’t want to miss those big, bad wolves out there just at the expense of convenience,” Nick said.

I found the pros and cons useful to hear from a provider, but I also wanted to know where providers need it to go from here to continue its growth and its ability to treat people with high quality care.

Nick focused on the need for a software / telehealth system that provides high quality and ease of access to both patient and provider. He said having a system that could allow patients to upload their own numbers and pictures without going through texts and messages would help.

“I think that if there’s a group that came on that provided a really great experience for both the patient and the clinician, and that could integrate information from an electronic health record … I think would be a really awesome thing for a lot of clinical providers,” Nick said.

Overall, Nick said that having options for patients that are safe and quality-driven but still promote revenue for the health system is where telehealth needs to go. He said that, so far, he has seen this as a trend and hopes that it continues to develop with those needs in mind.

That’s it for today’s column! I enjoyed talking with Nick and learning about the provider side telehealth. Next week I am hoping to speak with someone about how cancer trials and telehealth have overlapped throughout COVID. Until then, have a great week!

Katie The Intern

TLDR; Katie interviewed a PA who discussed to pros and cons of the rise of telehealth. Pros include access and lower costs, while cons include a lack of physical examination capabilities. He also said that healthcare needs to continue to grow with a focus of providing quality care that also promotes revenue.

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