Pandemic Fosters Useful Practice: Telehealth

Although medical centers are well into resuming typical operations and activities, the coronavirus pandemic seems to have opened a door that can’t be shut — telehealth.

A practice necessary to maintain the distancing necessitated by the coronavirus, telehealth — or telemedicine — was also lauded as the pandemic raged for its efficiency in getting patients to their doctor visits. Its remote nature means, provided there is a good internet or mobile data connection, that patients can communicate with doctors at appointment time, instead of hurrying up and waiting in the lobby for ages.

“I think both hospitals and private practices have moved to telehealth rather quickly,” said Dr. Shant Shirvanian, a pulmonary disease and critical care specialist at Adventist Health Glendale. “Adventist has had a telehealth system in place prior to COVID, in terms of serving underserved communities. Surely the assessment of patients can [continue to] be done remotely, and is also supported by insurance companies.”

Via telehealth, patients are able to “see” doctors for relatively minor ailments or concerns. The doctors will typically ask them to describe their symptoms and self-perform simple examinations or movements to help the physician determine the issue. Being able to handle such an appointment remotely — via a tablet, phone or webcam — saves time for patients who might otherwise need to make a commute for an in-person visit.

And it frees up time for physicians to handle more pressing matters that require an in-person visit.

“For the hospital, certainly some things require inpatient care but telehealth is becoming an option for patients who don’t want to go in to see a provider,” Shirvanian said. “Just like Zoom meetings — before COVID, Zoom was not a widely known entity, and now many corporations have incorporated Zoom in lieu of in-person visits.”

Jessica Thomas, an associate nursing administrator at USC Verdugo Hills Hospital, said the institution found a way to use telehealth — inside the hospital. Throughout the pandemic, USC-VHH divided emergency room patients by those with respiratory symptoms and everyone else. The patients with respiratory symptoms were sent to a room and given an iPad, and had their examination completed by a doctor in another room.

The hospital plans to begin using a stethoscope attachment so that patients can check their heart rate and breathing themselves, with the information then sent to their doctor.

“We were able to see those patients very quickly, get them assessed very quickly and diagnose them very quickly,” Thomas said. “Within the building, the use of telehealth was very innovative and we were able to treat and get patients in and out much more quickly that way. 

Thomas added that her family has lived the benefits of telehealth. She said bringing her son, who uses a wheelchair, to a doctor’s visit was an onerous task, and the risks presented by COVID-19 made it more so. Telehealth, she said, adds an element of equity to the situation.

“Getting him to the doctor has been a real challenge,” Thomas said. “Telehealth has allowed us to stay in touch with his physicians without having to arrange transportation and get him in and out of his wheelchair. This is something that will improve access for a lot of people.”

Dr. William Wang, chief medical officer at Glendale Memorial Hospital, said his institution repurposed existing technology to be used principally for “telepsychiatry,” in which the hospital has had the most success with telehealth, and also to utilize consultant physicians for emergency patients when time was a factor.

The hospital’s psychiatrist was able to work from home throughout the pandemic this way, while inpatients used Glendale Memorial’s devices to make appointments and others used the usual methods.

“This has allowed the psychiatrist to actually be more efficient,” Wang said. “He’s actually seen a lot more patients with this and gotten better access to patients. And he’s still on it right now.”

Still, Wang said, there is still an equity gap to fill moving forward. Attending a telehealth appointment obviously necessitates having the right technology and internet connection.

Lack of strong internet access in denser and poorer communities had become magnified as a problem during the height of the pandemic, when remote schooling was the norm.

“Some of these people we’re really trying to reach don’t have broadband access at their homes,” Wang said, “so that is still part of the problem.”

In any case, it seems that medical centers will continue to build upon one of their success stories from this world-bending crisis and try to smooth out the wrinkles.

 “COVID allowed us an opportunity to accelerate innovations, especially with telehealth,” Thomas, at USC-VHH, said, “so that’s going to be something that stays with us.”