Health systems across the country rapidly stood up virtual care programs to monitor COVID-19 patients from home and it proved to be a crucial tool during the pandemic.
As the country begins to emerge from the COVID-19 pandemic, these virtual tools, including telehealth, remote monitoring technologies, and wearables, will become a way of life for patients and will likely replace some in-person care, health technology experts say.
"I think we have hit a turning point. Here at Stanford Medicine, we used to see 1,000 patients a week with telehealth and now we're seeing 3,000 a day," said Michael Snyder, professor and chair of genetics at Stanford School of Medicine during a webinar hosted by FierceHealthcare.
While the current health crisis has boosted the need for virtual care as most states have stay-at-home orders, it's also been a proving ground for remote care as part of the healthcare system.
As tech giants like Apple and Fitbit improve the health monitoring capabilities of smartwatches and wearables, these devices will collect vital health data, Snyder said, "the same as your car dashboard but for your health."
Snyder is leading a research study at Stanford to explore the use of wearable data to detect the early onset of infectious diseases, including COVID.
"What’s powerful about these technologies that they can reach anyone in the world. Sixty percent of the world has a smartphone, including remote parts of the country. We’ll be able to have a heart monitor on every person in the world, including people who are pretty far away from their primary care provider. I think telemedicine is here to stay," he said.
When the Seattle area began seeing a surge in patients, Providence St. Joseph Health was able to stand up a remote patient monitoring program for COVID-positive patients in 72 hours, Todd Czartoski, M.D., Providence's chief executive of telehealth and chief medical technology officer, said during the Coronavirus Virtual Roundtable series.
Since it launched in late March, the platform has been used to monitor 2,400 patients that were either confirmed COVID-positive or under investigation, with 1,000 patients currently being monitored through remote devices, Czartoski said. The use of technology enables clinicians to "check-in" on patients daily and monitor symptoms, which is key with an unpredictable virus such as COVID.
As the country begins to emerge from the COVID-19 pandemic, remote care will play a vital role in providing care to patients who are most at-risk to get severely ill from the virus as it continues to circulate, said David Putrino, Ph.D., director of rehabilitation innovation at Mount Sinai Health System,
"Those at-risk patients are the ones who need to get to a hospital and see their doctors, that is the population we need to care for and it’s not going to be safe for them to be making in-person visits for quite some time. I think that the [Centers for Medicare and Medicaid Services] policy changes that we have been seeing rapidly adopted are here to stay because of that," said Putrino, who leads Mount Sinai's remote patient monitoring program for COVID patients.
The technology also has significant value for monitoring other conditions such as diabetes and congestive heart failure, experts say.
Putrino and his team are now working on multiple iterations of the remote monitoring platform to care for Mount Sinai patients with different chronic conditions.
"We know that there are a lot of vulnerable people in the community who are not getting the level of care that they need. With this system, we know patients are getting better care than they did pre-COVID. What we know about remote patient monitoring and why it works is that when you are making more contact with a chronically ill individual, when you are watching them more closely, you pick up on things more easily," he said.
As federal policymakers have relaxed restrictions around reimbursement for telehealth and remote monitoring, it has enabled Providence to stand up technology programs in a matter of days to weeks when it would typically take months to years, Czartoski said.
"We think remote monitoring is really here to stay. This crisis has led to so many changes so quickly and now our focus is largely on telling that story. If we can prove the efficacy of virtual care and remote care, it gives us a better chance of lifting regulatory restrictions long-term," he said.
Technologies like home monitoring and tele-ICU have been safely used for decades but, historically, individual physicians have been slow to adopt telehealth. That all changed with COVID, experts say.
"One thing this crisis has taught us, yet again, is that with the alignment of incentives, you can change behavior very quickly. In a lot of our clinics, this was, first and foremost, the way that our providers were able to continue to manage their patients. It’s amazing how quickly it was adopted and embraced," Czartoski said.
He added, "It will be interesting to see, as we come out of this, how much of that will be sustained in a real paradigm shift versus rolling back to how things always were."
Across the U.S., physicians were forced to adopt virtual care quickly to sustain their practices and their careers, according to Putrino.
"I hate to be cynical, but I think that is the impetus that was required for clinicians of all sorts to accept this technology because now it’s a point of survival. There's no question about it; unless you can find a way to see patients at a similar volume that you were previously seeing patients, you’re going to be in some trouble, you're going to see furloughs, and a reduction in wages," he said.
Going forward, most stakeholders believe that the use of telehealth and remote monitoring will continue at higher levels than before the COVID pandemic. But whether it marks a real paradigm shift will depend on whether the policy changes from CMS and commercial health insurers remain permanent, they say.
"My hope is that we will see it sustained. This does add value to patients. Being able to have multiple data points on them, literally every day, to manage patients with chronic diseases is way more effective than a patient going to see a doctor once every six months to see how their blood pressure or diabetes is doing," Czartoski said.