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Remote Care 

Telehealth shapes work flows and patient care for practitioners during COVID-19. 

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“It’s a virtually perfect solution.” 

This is how Vimal Mishra, a Virginia Commonwealth University physician, describes telehealth or telemedicine — a combination of digital and telephonic tools that allow patients to remotely access health services. Beyond phone chats and web-based visual assessments, telehealth can include tools such as smartphone applications that take readings and machines that monitor patients with chronic diseases.  

At first seen as a way to serve patients in remote areas with limited access to primary care, in the last few years telehealth has become commonplace due to convenience and scope of care, says Mishra, who heads the university’s telemedicine program. During the pandemic, Richmond hospitals and mental health practitioners have joined others nationwide to employ telehealth as a strategy to ensure continuity of care, while keeping patients out of waiting rooms that could easily become disease transmission hot spots.  

Mental health practitioners are seeing many more patients via telecounseling, says Walter Fritz, a counselor licensed in North Carolina, Oregon and Virginia. Fritz, who lives in Raleigh, North Carolina, says 80% of his clients are new patients he sees digitally, who report anxiety due to COVID-19. In March alone, Fritz saw 20 clients who live in Richmond.  

“I am getting 30 or 40 new clients per week,” he says. “Anxiety is fear of the what if, and people are asking themselves ‘What if I get COVID?’ ‘What happens if a family member has COVID?’ and ‘What if I just gave someone COVID?’ The big one is ‘What am I going to do without a job?’” 

For Richmond physicians preparing for COVID-19 transmission to surge in May as predicted across the state, it’s anticipated that telehealth will reduce the burden on emergency rooms. The move has changed work flows and redeployed staff not directly utilized in efforts to fight the outbreak and has the added convenience of enabling providers to safely screen possible cases of COVID-19 for testing. 

Post-pandemic, telehealth will remain a front-line choice to address nonacute outpatient care, many public health policy analysts say. Telehealth’s reach is bolstered by changes to Medicaid, Medicare and employer-based insurance during COVID-19 to remove cost barriers. 

In anticipation of the virus, VCU Health recently surveyed providers for a list of patients scheduled for outpatient, elective visits, who may be good candidates for telehealth. Staff reached out to these patients to reschedule for digital care. A telling statistic: VCU Health now digitally sees 1,000 patients daily, up from roughly 25.

The Bon Secours Mercy Health and HCA systems also have expanded telehealth care. Additionally, like many hospitals nationally, VCU Health and Bon Secours Mercy Health have announced they are reducing elective surgeries, while HCA Virginia says it’s considering procedures case by case.  

Telehealth is part of staff redeployment efforts, as some hospital systems nationally have furloughed staff not directly related to front-line COVID-19 efforts, due to factors such as declining revenue from elective procedures. 

In Richmond, Bon Secours Mercy Health has redeployed or temporarily furloughed employees “unable to work due to temporary closure, cancellation and low census in primary care, outpatient and surgical services,” says Jenna Green, a Bon Secours Mercy Health representative, in a statement to Style.

Across seven states and 12 markets, the hospital system has furloughed 700 full-time workers out of a total workforce of 60,000. At the same time, Green writes that Bon Secours Mercy Health has expanded its video visits platform to ensure continuity of care.  

Both VCU and HCA systems say they currently are not considering staff furloughs. Mishra adds that VCU clinic staff who ordinarily facilitate in-person check-ins, are being trained to serve the influx of digital appointments.  

But telehealth does have limitations and shortcomings, practitioners say, including the dilemma of how to handle medical testing. Fritz adds that telecounseling is great for addressing a number of conditions, such as mood and substance-use disorders, but may not be ideal for monitoring symptoms of schizophrenia or patients with recent episodes of suicidal ideation or intent. Some public health experts are also raising concerns about maintaining patient privacy, as the U.S. Department of Health and Human Services announced a looser approach to regulations for video platforms in health care during COVID-19. 

But as governments, patients and practitioners navigate telehealth changes, Mishra says the pandemic is a public health nightmare that, moving forward, could help them adapt the new technology.

“And it will create a conversation nationally, which will help us create a paradigm of care.” 

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