Roger Sanford is trying to play it safe. The 56-year-old resident of Slone, Iowa, about 75 miles north of Omaha, has faced “one thing after another”—a brain aneurysm, kidney failure, liver cancer, and a heart valve in need of replacement. His doctors want to keep COVID-19 off that list.
“They really do not want him out at all,” said Amy Cain, his girlfriend and caregiver. “They are afraid he was so sick that they don’t want him out and about.”
So, when Nebraska Medicine suggested Sanford meet with his doctors using telehealth, they jumped at the opportunity.
"It’s so much easier,” said Cain, who attends Sanford’s appointments with him. “It is like talking to them in person. They’re right here in the living room with us, basically.”
Many patients have discovered that telehealth—using video or telephone conferencing technology, also called telemedicine or virtual care—is a convenient way to get questions answered, learn about test results, and other visits that don’t require a direct physical examination or access to specialized equipment.
Telehealth visits nationally peaked in mid-April as the coronavirus pandemic spread across the country, according to surveys by the Commonwealth Fund, but they have grown to about 6% of overall patient visits.
Children’s Hospital & Medical Center in Omaha has dramatically grown its use of telehealth over the past year.
Dr. Jennifer McWilliams, medical director for virtual care at Children’s, has used technology to visit remotely with patients for more than a decade. She joined the hospital six years ago to improve access to mental health support for children in rural parts of the state.
“The hospital itself really started to look at how we could develop a virtual care program,” McWilliams said.
The program in behavioral health had been growing at a “pretty good clip,” with talks of expansion underway in early 2020. “And then COVID hit,” she said.
“Almost literally overnight, we switched our entire department from seeing kids face-to-face in our office to seeing kids via telehealth in their homes,” McWilliams said. “We’re continuing to see the vast majority—probably 95% of our kids—via telehealth.”
Now there’s little desire to go back to the way things were, she said. Among the detractors are patients who lack sufficient access to technology and a handful of patients who don’t respond well to sitting in front of a screen and are better served in person, McWilliams said.
Language barriers have been overcome using interpreters via Zoom.
“We really have gone from, not zero to 60, but maybe 5 miles per hour to 60 in a very short time,” McWilliams said. “Across the organization, there were other little pockets of telemedicine brewing, but those have all really exploded."
Rebecca Ohlinger, manager for virtual care at Children’s Hospital & Medical Center, said the public health emergency last spring grew telehealth by 1,900%. Post-visit surveys found the vast majority of patients—about 95%—reported feeling comfortable using virtual care.
Ohlinger said 97% said they were satisfied with their virtual visits, and 88% said virtual care improved their family’s access to health care services.
How broadly telehealth continues after the pandemic subsides depends on many factors, including whether those services remain viable for health care providers and a demand remains for them among health care consumers.
Regulation is likely to follow the emergency measures adopted during the pandemic, as the federal government provided discretion for compliance with patient privacy rules. That allowed providers to use Apple FaceTime, Facebook Messenger, Google Hangouts, Zoom, and Skype, among other platforms, according to the U.S. Department of Health and Human Services.
Limits on online pharmacies could also play a factor, depending on whether a patient was still making regular trips outside their home. McWilliams said state-by-state differences pose another regulatory challenge. She said bringing the states into uniformity would help extend the future reach of health care providers outside of public health emergencies.
The pandemic also spurred health insurance companies to encourage telehealth visits by dropping copays—the cost-sharing portion that can discourage patients from choosing to use their insurance—and increasing their provider payments to match in-person visits. Some of those insurers have since restored copays, and it’s an open question how telehealth will be handled by health insurance companies in the future.
“We’re really advocating and hoping that that barrier doesn’t go back into place,” McWilliams said.
Telehealth does have its drawbacks, and it’s not suitable for every visit—including those annual checkups that are the cornerstone of health care.
“It does not allow for the capability of us to do a hands-on exam, which we need for a lot of diagnoses,” said Dr. Ashley LeGrand-Rozovics, a physician affiliated with the Methodist Health System. “It definitely can cause some limitations in diagnosis.”
LeGrand-Rozovics recommends telehealth visits for anyone suffering from an upper respiratory condition, unless it involves severe shortness of breath or chest pain, which may require immediate intervention.
Telehealth is also suitable for anxiety, depression, and other mental illness, as well as follow-up consultations for chronic conditions such as high blood pressure and diabetes, so long as patients are able to monitor their numbers at home.
“Obviously, it’s still better to see your physician in person when possible and when it’s safe to do so,” LeGrand-Rozovics said.
Even so, she said she’s “thoroughly enjoyed being part of telehealth with Methodist,” and she praised the technology for allowing care to continue in the midst of a pandemic.
“Patients have really appreciated it as well,” LeGrand-Rozovics said. “We still want to make sure that we’re able to provide that access.”
Children’s has more than 32 specialties providing virtual care, Ohlinger said, and the sky is the limit for providing those services—even if the pendulum swings back toward more traditional methods of delivering health care.
“I think the genie is out of the bottle,” Ohlinger said. “We’re at a point, too, where a lot of our families are going to demand it stay this way.”
Avoiding long commutes and waiting room queues are among the reasons that families may continue to choose telehealth options. McWilliams said providers appreciate being able to go into patients’ living spaces using video conferencing.
Seeing into a home environment allows physical therapists to see what patients are trying to navigate in their physical landscape. It allows behavioral specialists to see where children are spending their time. It allows nutritionists to see what food choices are available to patients.
“Being able to see kids where they are is a huge advantage,” McWilliams said.
The technology also expands health care professionals’ reach anywhere broadband can be found. Ohlinger predicts that as technology becomes a regular part of how students go to class, how groceries appear in pantries, how checks are deposited into bank accounts, and many other facets of everyday life, the same will hold true in medicine. She said the pandemic has “really transformed what we know as modern life.”
Health care providers see that telehealth could accelerate a shift away from a fee-for-service business model and instead place their focus to keeping families healthy, however that ends up being delivered.
McWilliams expects that Nebraska will never have enough primary care providers to meet its demands, but telehealth can improve access to specialists and aid family practice doctors, particularly outside of the Omaha metropolitan area.
As for access to technology, she compared missed telehealth appointments due to internet outages or lack of a device to patients who face flat tires, can’t pay for gas, or otherwise have transportation problems that keep them from in-person visits. Both create barriers to access health care, but both are relatively limited problems that can be addressed.
Having the flexibility of telehealth can overcome some obstacles, too. Finding the time to drive Sanford 75 miles to and from Omaha is a challenge for Cain when she works an overnight shift. But a telehealth visit just requires setting an alarm while she takes a nap after work.
“That makes it easy for us,” Cain said.
Sanford said that he felt less anxious about a recent telehealth visit before a procedure, and that a virtual visit avoided feeling rushed through the appointment.
“It was great,” Sanford said. “I felt even more confident.”
That sentiment is unlikely to change when masks are no longer needed in public. For Cain and Sanford, and many patients in similar situations, telehealth is their new standard of care.
“I think it will be the normal,” Cain said.
Visit childrensomaha.org and bestcare.org for more information.
This article was printed in the January/February 2021 edition of Omaha Magazine. To receive the magazine, click here to subscribe.
