By Nasim Rezanejad, MD, MS, Physician Solutions Informaticist, The University of Texas Health Science Center at Houston
Necessity has been the mother of invention throughout this pandemic, and in the field of healthcare has meant a shift to Virtual Medicine- the likes of which apparently was impossible until it was not! The critical turning point has been the pandemic. Now that we have gotten it, will it change healthcare forever?
Virtual Health has changed where we work, how we work with one another, with our patients and their families, with the broader community, including researchers and clinicians. Creating a system that will ensure that virtual care is equitable, regardless of where you live and how much bandwidth you have, should be the focus.
Creating a system that will ensure that virtual care is equitable, regardless of where you live and how much bandwidth you have, should be the focus.
Virtual Health is care that is provided through any variety of technologies that allow interaction over distance. It does not have to be like a traditional physician and patient encounter. Neither does it have to be either/or; virtual care can be used in combination with traditional care. It can be any member of the circle of care, including caregivers and family members. Virtual Health is the use of information or the transmission exchange of information between physicians, a healthcare system and individuals, so we have to ensure the integrity of the information in order for it to be a safe quality of care.
Virtual visits have many benefits for patient care:
1. Patients are better able to keep their appointments
2. Patients do not have to take off work
3. It is fast and efficient for patients instead of flying, driving, and sitting in traffic
4. Patients do not have to book hotel rooms- they can have visits from across the country
5. Patients do not have to arrange child-care
6. More access and more patients to connect and stay connected
7. Connection and collaboration of army of physicians to benefit patients
8. Patients are able to include family members or other loved ones in their visit
9. Patients will get the care without making themselves vulnerable to infection during a pandemic
10. Patients can have a virtual family, with different educational and support groups; which leads to more staying connected in their own care
Convenience of care for patients is always important in the engagement. EHRs offer many capabilities; such as sending links to results or for patient education, that can be leveraged to allow patients to be part of the process of their own care and to be collaborative in their own care. To have that contact with your patients in a time when other contact is risky or just not possible. In addition, patient education is important to familiarize them with this new tool to get excellent medical care without making themselves vulnerable to infection or exposing themselves to other inconveniences.
We should never lose sight of remote communities and their access to virtual care. There is a lot of potential here, but also a lot of room for improvement here. Virtual care offers tremendous value as a means of addressing care in remote and rural areas. However, it requires adequate broadband access, which is also often lacking in rural areas. Some of these services can be virtualized so they can get access to care. Of course, it is necessary to use clinical discretion to establish when it is appropriate to use virtualization as it differs depending on each scenario and location. If a rural patient has an initial triage visit virtually, then is scheduled for an in-office visit with appointments for required testing, and then has a series of follow-up visits remotely.
Patients want easy access to care and physicians are interested in continuity of care, quality of care, the safety of care, and the hybrid model: what kind of issues can be seen virtually and what types have to be seen in-person. In some cases, virtual care is ideal to be used where there is a doctor-patient relationship established already. At the end of the day, there should be a relationship that you can actually see the patient and care for them in person, in the office. At times, the physicians know that they are not hitting the mark and do not know what is wrong with their patients. Not knowing the full background; especially in episodic care, can pose issues. In these cases, the physicians will have to bring them in, see them, touch them, and lay their hands on them to make the diagnosis and develop the appropriate treatment plan.
There is a healing aspect that the physicians have to be cognizant of that might not be addressed virtually. Technology is great, but laying hands on the patients and treating them with empathy we do not want to lose. This should be how the physicians will determine how to engage with their patients and not lose sight of this aspect while visiting their patients virtually.
There are safety concerns around the use of virtual care. The issues between interface and care such as; labs, x-ray, and communication can be lost. The physician caring for the patient will have less information to work with, errors can be made based on incomplete information, or the patient will not get the follow-up for a sensitive case. Therefore, there will be a risk of potential misdiagnosis. It is essential to ensure and maintain the integrity of information, privacy, quality, and safety of care in the process.
Customer is the patient and user is the physician. We need to look outside of this box, look at the marginalized population and ask them: How can we serve you? What are your needs? Equitable access in terms of the use of technology, so people with disabilities of some sort are challenged now. How is this technology-friendly and helpful to them? How about the patient population that is housing deprived? What is the value for them? Equity in healthcare is not only access to care but also social determinants of health. With virtual health is the digital determinant of health- how do we build an infrastructure of a digital system to support different patient populations?