Telehealth is improving access to health care; digital interactions emerge as a silver lining to the pandemic’s dark cloud

Max Coyne does telehealth. (Photo provided to the University of Kentucky)
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By Shannon Clinton

The Lane Report

Amy Coyne noticed her 9-year-old son Max wasn’t feeling well and booked a doctor’s visit a week after his Georgetown school closed due to the coronavirus outbreak. The exam not only produced a diabetes diagnosis, but Max spent two nights in the intensive-care unit of the University of Kentucky Hospital.

A diabetes educator said Max needed a follow-up visit within days, but by that time the pandemic outbreak was dominating the headlines, and the Coyne family feared venturing back to Lexington and the main facility treating covid-19 patients in the region.

So, for the first time, the Coynes tried a new way of connecting with health-care professionals — a video visit with a diabetes-education professional. And it enabled the whole family, including out-of-state grandparents, to be updated about Max’s new health needs.
Health-care systems have had to quickly increase their use of telehealth options for patients like Max to keep both staff and patients safe in the pandemic.

The U.S. Centers for Disease Control and Prevention touts telehealth as the best method when in-person visits aren’t necessary. It also helps patients who may lack reliable transportation or who live in rural areas with limited health care provider options, particularly specialists.

The U.S. Centers for Medicare and Medicaid Services and state officials greatly facilitated telehealth by issuing waivers expanding how it may be used and paid for.

The Coynes sought care for Max at UK’s Barnstable Brown Diabetes Center, where Shawn Crouch is administrator. He and Dr. Carol Steltenkamp, a pediatrician, have led efforts to scale up UK’s use of telehealth in the pandemic. Steltenkamp has been a leader in the implementation of electronic health record systems in Kentucky.

Steltenkamp said UK Healthcare had about 100 telehealth visits in April 2019, and 25,000 in April 2020. By June, there were fewer than 20,000, and about the same in early July, when in-person care visit numbers had begun to rebound, Crouch said.

UK plans to ensure that telehealth visits remain an option. While there aren’t many silver linings attributable to the pandemic, Steltenkamp said, “The fact that this really ignited enthusiasm around telehealth is definitely a plus.”

Stressors abound during the pandemic. Aside from those actually battling the virus, along with their worried families, there’s unemployment; homeschooling children, often while juggling at-home work responsibilities; and the widespread fears of contracting covid-19 while adjusting to sweeping new safety regulations.

Tack onto that society’s existing mental-health challenges, and the importance of maintaining mental health care access, even in a pandemic, is obvious.
Kentucky Medicaid, which covers almost 1.5 million people, began covering mental health via telehealth last year and piloted it at Lexington-based New Vista, which has a staff of about 2,000 in 25 locations to provide care for mental health and substance-use disorder.
Before the pandemic, in-person visits were overwhelmingly the norm at New Vista, said Don Rogers, its chief clinical officer. The transition to video visits took four or five days and has gone smoothly, Rogers said. Moving forward, he expects a 50-50 mix of in-person and video visits. For now, treatment staff still work from home and in-office on a rotating basis.
Natasha Painter, a New Vista outpatient clinician and telehealth provider, said telehealth has decreased cancellations of appointments by removing barriers such as transportation and child care and enabling treatment within the comforts of home.

“Clients who have transportation issues have definitely been able to come to appointments more often than they had in the past because they’re just a phone call away,” she said.

As virtual visits become more commonplace, patients will be able to contact doctors at times that are most convenient for them, using familiar technology, says Dr. Thomas Coburn, a family physician in Wilmore who’s also medical director of application and information technology for the ambulatory market of CHI St. Joseph Health Lexington.

While telehealth may never replace having a physical exam or the desire to shake a physician’s hand in-office, Coburn said he hopes Medicare, insurance and others will continue reimbursing virtual visits as they become a fixture in American health care.

“There’s a learning curve, and we’re in the middle of that learning curve, but I do see that this will be the wave of the future for health care,” he said.

Coburn said he had used Zoom for internal videoconferencing for years, but not for seeing patients. Covid-19 necessitated exploring that option, which was rolled out in about five days at St. Joseph. They’ve even helped providers in other markets in Tennessee begin providing video visits.

During the height of covid-19 concerns this past spring, about 65% of visits were virtual. That figure has since dipped to between 15% and 20%, which Coburn says is sustainable for the future.

He said patients who want a virtual visit, or are recommended to have one, receive a link to click at their appointment time, then wait in a virtual waiting room until time to video chat with a physician.

Afterward, prescription orders can be sent in electronically, and follow-up visits scheduled as needed. If a physician realizes during a video visit that an in-person appointment is warranted, one will be set up. If it’s on the same day, Coburn said, a patient is charged for only one visit.

Health-care providers are also experimenting with technology that enables them to listen to a patient’s heart with a stethoscope that transmits the heartbeat sounds online to a cardiologist, he said.

Even now, Coburn said, if he has concerns about a patient who he knows also sees a cardiologist, “I can actually consult with the cardiologist in my office through Zoom and they can see the patient while they’re in my office.”

Brent Baldwin, chief information officer for Lexington Clinic, said patient feedback about telehealth has been positive, and he believes it will remain a long-term option.

“The telemedicine genie is out of the bottle,” he said. “Regardless of whether [a vaccine] comes out, we’re going to have to meet the patient’s needs.”

Nick Sarantis, system director for digital health at Louisville-based Baptist Health, agrees. “I think it’s going to be hard for people to just put (telehealth) away” and go back to the way things were before, he said.

There’s been more of a learning curve for some providers, he said, as digital health care delivery isn’t typically taught in medical school. But patients seem to be embracing the changes. “As consumers, we’ve been going down a digital path in our lives for a long time,” he said.

Sarantis predicts telemedicine will be routine in three to five years, and investors will pour money into digital health companies, startups and new products. He said that in about six weeks, Baptist Health advanced its time frame for implementing telehealth by five years.

Much like retail companies such as Amazon have thrived by making access to merchandise easier for customers, Sarantis said, health care will be able to identify what gaps prevent patients from accessing health care and use telehealth methods as part of the solution, especially now that more patients and providers have been exposed to this new way of care.

The Coynes’ telehealth experience continues to expand, as other follow-up visits have been done by telehealth. Amy Coyne said she’s glad to have the option, and now even sends in Max’s blood glucose numbers remotely to his physician.

“Overall it was a really great experience,” she said, “and we were really grateful that we could do it that way.”

This is a condensation of a story that originally appeared in The Lane Report. The full story is at https://www.lanereport.com/129106/2020/07/telehealth-is-improving-access-to-health-care/.