What Doctors Need From Telemedicine; Healthcare Use Down Despite Virtual Visits

Welcome to Telehealth Roundup, highlighting news and features about emerging trends in telemedicine and telehealth.

What Doctors Need From Telemedicine

Well before the telehealth explosion, doctors were experiencing what “neuroscientist Adam Gazzaley called a ‘cognition crisis,’ with excess screen time and corresponding information overload leading to digital fatigue and stress,” said radiologist Ashwini Zenooz, MD, chief medical officer of Salesforce in San Francisco.

While physicians have grown more comfortable with telehealth, “many remain wary of virtual care and the potential for adding to their already weighty technological and administrative burdens,” she wrote in Harvard Business Review.

The last time physicians experienced a massive digital acceleration in healthcare was the national drive to adopt electronic health records (EHRs). “While much good ultimately came from this push, the same EHRs that were meant to liberate doctors from the tyranny of paper instead emerged as the top cause of physician burnout,” Zenooz said.

To avoid replaying this scene, the healthcare industry needs to take steps to ensure telehealth augments a physician’s experience of providing care, she argued. A recent review showed providers were satisfied with telemedicine when they had input into its development, administrative help, reliable and easy-to-use technology, and adequate reimbursement.

Telehealth providers also need ongoing support, Zenooz pointed out. Video consults may seem simple to master, but they can be like “a new language demanding different clinical and communication skills,” she observed. “As one new-to-digital pediatrician conveyed, ‘I am learning to listen for when it is my turn to speak, to diagnose rashes on a phone screen, to identify emotions from words and tone as much as from facial expressions.'”

EHR technology wound up focusing more physician attention on screens and form fields and less attention on the patient in front of them, Zenooz said. “In one study using eye pupil data to register digital fatigue, over a third of physicians in an ICU experienced fatigue in just the first minute of EHR use,” she noted. Most telehealth takes place over cloud-based platforms “designed with more modern, human-centered experience standards,” but the potential to add to fatigue and digital overload remains.

While much of the rapid growth in telehealth has been in virtual visits, digital technology also can connect longitudinal data from wearables, remote monitoring devices, and self-care apps to EHRs.

“As the flow of data from virtual visits, remote monitoring devices, and wearables increases, we must be sure providers don’t shoulder the cognitive burden of swiveling among even more screens and data feeds to manage patient care,” Zenooz said.

Healthcare Use Down, Despite Virtual Visits

Telemedicine use skyrocketed during the COVID-19 public health emergency, but it wasn’t enough to account for the drop in face-to-face primary care visits, two new studies showed.

In the early months of the pandemic, patients skipped diagnostic procedures and elective care that could be done only in person, reported Christopher Whaley, PhD, of the RAND Corporation in Santa Monica, California, and co-authors in JAMA Network Open.

“The COVID-19 pandemic has upended care patterns for many patients and providers [and] created an unprecedented shock to the U.S. healthcare system,” Whaley told UPI in an interview.

Claims from more than 5 million commercially insured patients showed the number of mammograms and colonoscopies performed in March and April 2020 dropped more than 67%, relative to March and April 2019. HbA1c tests dropped by 51%, vaccinations of children under 2 declined 22%, and chemotherapy treatments fell 4%. Cataract surgeries fell by nearly 60% and MRIs by 45%. Overall healthcare use declined by 23% in March 2020 and by 52% in April 2020.

Telemedicine services grew 1,270% in March 2020 compared with March 2019 figures, and 4,081% in April 2020 compared with April 2019, Whaley and colleagues noted. In April 2020, 48% of healthcare visits were delivered virtually.

“However, the increase in telemedicine use offset only approximately 40% of the declines in in-person office visits, suggesting that many primary care needs may be going unmet,” they wrote. “If the current trends continue, innovative approaches to ensure patients receive timely access to important care will be required.”

In JAMA Internal Medicine, an analysis of 16.7 million commercial or Medicare Advantage insurance patients from January to mid-June 2020 found that telemedicine offset approximately two-thirds of the drop in in-person visit volume during the pandemic period.

“Although some deferred care may have represented discretionary care that could be postponed without harm, these results also substantiate concerns that patients may fall behind in chronic illness management or face complications from deferred acute medical issues,” wrote Michael Barnett, MD, MS, of Harvard T.H. Chan School of Public Health in Boston, and co-authors. “This would be consistent with evidence from natural disasters resulting in decreased access to care associated with greater morbidity and mortality not directly related to the disaster itself.”