Last month, we discussed what telehealth is, who it is helping, and the benefits it is providing in the midst of a global pandemic. In this month’s blog, we asked Melissa Lim, MD, FCCP, FAASM, Somnology’s Chief Medical Officer and a board-certified sleep physician in ICU at Sequoia Hospital what is like to be on the front line fighting COVID-19 and her own opinions on telehealth and the role it plays in healthcare treatment. Read on for an in-depth interview to see how this pulmonologist views telehealth.
Q1: What is telehealth and how does it help you and your team do your job better?
“Telehealth” is a broad term that encompasses the ways providers and patients interact through digital technologies, and includes videoconferencing, private email, texting, mobile apps, and phone calls. Some wearable technology even provides health data that can be incorporated into telehealth services. The term “telehealth” also includes healthcare providers such as therapists and psychologists. Sometimes “telemedicine” is used interchangeably with ‘telehealth’, but I tend to view ‘telehealth’ as a broader term.
As we have seen in dramatic fashion due to COVID-19, telehealth has allowed healthcare providers to stay in touch with their patients and continue to oversee treatment plans for a wide variety of conditions. Covid-19 has forced many people, both patients and providers, to adopt this platform despite possible reservations in the past. For our practice, telehealth has allowed us to expand our clinical services and home sleep apnea testing, which has resulted in more people with sleep disorders being tested and treated.
Q2: What technological changes in telehealth have you seen recently that help you better connect with patients?
I think there have been improvements in the transmission quality of audio, video and images, and also in privacy/security features. In addition, more and more people of all ages and backgrounds are becoming comfortable communicating with healthcare providers through digital means1Science Daily: Between March 2 and April 14, 2020, virtual urgent care visits at NYU Langone Health grew by 683 percent and non-urgent virtual care visits grew by an unprecedented 4,345 percent in response to COVID-19. – https://www.sciencedaily.com/releases/2020/04/200430150220.htm.
Q3: How would you compare telemedicine to in-person visits? Do you feel the patients get the same level of treatment?
I view telemedicine/telehealth visits as complementary to in-person visits and not necessarily a replacement for them–except in situations where in-person visits are not possible or are extremely difficult to achieve. Through videoconferencing, one can establish a good personal connection with the patient but, of course, the human touch is missing which may be the key component to a healing interaction. For patients, telehealth visits are probably seen as complementary too and not a replacement for an in-person visit but can still be very high quality. Patients who need assistance quickly and conveniently are especially appreciative of having a telehealth option.
Q4: What is it like being on the frontline fighting COVID-19 and has telemedicine made that easier?
My experience as an intensive care unit physician results in ”frontline” care of patients suffering from the most severe forms of COVID-19, while most physicians are participating heavily in direct care or the planning of care for patients with this disease, so it really takes a collaborative approach to be successful in combating it. Most of my physician colleagues are seeing patients now through telemedicine, which helps to keep patients without COVID-19 compliant with their treatment plans and provides advice for people who may be suffering from this disease.
Q5: What are some aspects patients like about telehealth and what are some concerns they have? How do you address those concerns?
Patients certainly appreciate the convenience of telehealth visits, not having to get stuck in traffic, find parking, take time off work, etc. For well-established patients, it allows them to stay connected with their providers. Some patient problems are best evaluated by physical exam and may require listening to lung sounds, heart sounds, feeling the abdomen, etc. To reassure patients who cannot be seen in the office for physical exam, objective tests such as chest x-rays and CT scans help reassure them that we are able to assess the condition of their lungs. There are digital wearable devices that can assist the telehealth evaluation, but not all patients are comfortable or familiar with these devices.
Q6: You have partnered with the VA in transitioning their sleep health services to virtual consultations. What challenges did you face during that transition and in what areas have you seen the largest benefits?
Transitioning to telehealth sleep health assessments allows more military veterans to be evaluated at their own convenience and in a timely fashion. There are certainly logistical challenges to verifying telephone numbers, email addresses, and time zones when scheduling these kinds of appointments nationally. We have been able to reduce the time delay between referral and assessment and assessment to sleep testing, and we have reduced costs by two thirds over traditional laboratory sleep testing. For the individual veteran, we have become their “sleep advocates” who can facilitate care within the VA system.
Q7: How successful have these programs been?
Although we have been successful so far administering sleep apnea assessments for veterans nationally, after starting the program in mid-2019, we are still learning logistical challenges with each step upward in adoption of the program. We have reduced turnaround times and costs but have yet to measure clinical outcomes such as successful long-term compliance with treatment, reduced trips to the emergency department, and reduced hospitalizations. These longer-term data points will be important to measure.
Q8: Does everyone offer telemedicine? Should everyone have these services?
Sources estimate that as of 2018, 22% of physicians tried telemedicine, although there is a fairly rapid adoption rate by physicians year to year. The COVID-19 pandemic has pushed many reluctant providers into utilizing various technologies to continue treating patients. And those of us who were already comfortable utilizing telehealth have expanded those services significantly. Not every specialty, especially surgical specialties, are appropriate for telehealth treatment, although most specialties can have some facet of what they do aligned with a telehealth solution. The development of these solutions may be prompted by patients themselves, as the demand for these types of services increases.
If you are interested in learning more about telehealth and how it can help you or your company, please contact Somnology at info@somnologymd.com.