In early April I had a routine consultation with my electrophysiologist at Nuvance Health via telehealth. Nuvance uses telehealth technology from American Well. In preparation for the consult, I took my blood pressure with a Qardio cuff and my iPhone, weighed myself on the Fitbit scale, and took a 30-second ECG with the Apple Watch. A nurse called 15 minutes before my appointment and took the information for input to the Electronic Health Record. The consult went very smoothly between the iMac and FaceTime camera at my home, and the doctor with a Windows computer with a camera. No drive to the Medical Arts building where the doctor is located. No crowded waiting room with other senior citizens during flu season during a pandemic.
A week later, my wife had a routine consultation with her primary care physician using Apple FaceTime. Other providers use Zoom, WebEx, or Skype. Hospitals and larger groups use more clinically oriented video platforms such as AmWell and Teladoc.
Why did it take a pandemic to be able to use telehealth? One thing I learned in the early years of my study of healthcare was a very simple concept: follow the money. It answers most questions about why and how things in healthcare are done. Providers did not like telehealth prior to now for a number of reasons. The main reason was they were not compensated. I agree with them. Telehealth reimbursements have been in place for years, but only for patients in very remote areas. Part of the executive orders related to Covid-19 eliminated the remote areas provision. Telehealth is now booming, although there are some consumers who may not have access to good Internet connectivity.
Telehealth is going to get better and better. In my first example, I described how the nurse called me for information which she then entered into a system. In time, the patient will be able to enter the data directly themselves. Another big change to make telehealth more comprehensive will be the integration of mHealth devices. (See peer-reviewed paper about mHealth I wrote in 2015). For example, one mHealth device allows a mother to insert an iPhone camera attachment into a child’s ear and enable a telehealth doctor to see whether there is an infection.
A hospital in Israel shows how mHealth can be applied to diagnosis of a Covid-19 patient who is at home but being followed. The hospital sends a small package to the patient. The patient schedules a telehealth consult with the doctor. First he or she logs in with a computer or mobile device. The telehealth app guides the patient to use two devices which were delivered in the package. The first device is a small handheld wireless scanner which can take the patient’s temperature from the forehead. The device also has a camera which can look at the patient’s throat. The other device is a small handheld wireless stethoscope. The app guides the patient to the places on the body where they should place the device. After the doctor has received the inputs, he or she can tell the patient how their progress is with their Covid-19 infection. Watch the 2-minute video above and you will see how all this works.
When we return to “normal”, I expect we will see telehealth continue to expand. There still will remain a number of scans and other diagnostics which cannot be done at home. However, I believe we will see a large percentage of cases which will be handled by mHealth devices and telehealth. The docs will be reimbursed. The patients will be happy they don’t have to drive to a crowded waiting room.
