Peter Antall, MD

Consumer interest in telehealth is steadily growing. But, because of reimbursement concerns, many physicians are choosing to test the waters slowly with telemedicine, one use case at a time, rather than adopting the technology as a full-scale solution. The true value of telehealth doesn’t always reveal itself when we’re testing the waters but rather, when the waters test us. Literally.

Natural disasters wreak havoc on everyone in their path, not only because of the immediate dangers they possess, but because of the healthcare access issues they trigger. 

 estimates that one-third of Hurricane Maria attributed deaths in Puerto Rico were due to delayed or interrupted healthcare services. Fewer deaths, roughly one in 10, were caused by the Category 4 hurricane itself.

The response among telehealth providers in the wake of the recent Hurricane Florence, which impacted thousands in North and South Carolina was overwhelmingly positive. Thousands of patients benefitted from virtual care services rendered. Even better, the experience offered new insight into best practices around telehealth that physicians can employ in time of crisis before, during, and after a natural disaster. Not all disasters can be planned for, but physicians can still plan for them.

When hurricanes strike, power outages and flash flooding renders patients homebound and without means to travel safely to a physician’s office, urgent care center, or hospital. The only advantage is that the National Oceanic and Atmospheric Administration (NOAA) can give us advance notice for a hurricane, affording us time to prepare.

One of the earliest pioneers of telehealth, 

, with locations in Delaware, Pennsylvania, New Jersey, Georgia, and Florida, learned that early intervention can benefit families. In 2017, the organization offered free access to its 

 direct-to-consumer telehealth app to patients impacted by Hurricane Irma. The app was available through any mobile device, and telehealth expedited necessary care for patients who needed immediate help.

In analyzing its response to 2017 events, the organization realized that it could do more to help patients prepare in the days before a hurricane hits. Namely, to help them to access board-certified physicians who could issue refills for much-needed prescription drugs or pursue other needed preventive strategies.

Physicians should encourage patients to plan ahead and help them to fill prescriptions early in the event that transportation issues will arise. Physicians should also encourage patients to download and familiarize themselves with a telehealth app in advance. Likewise, physicians who are unfamiliar with using a telehealth app should take time to practice, so they can move through visits more efficiently when disaster strikes.

While meteorologists can track the hurricane’s location and intensity, no one can be certain of its impact. Even if physicians have done their best to prepare patients by urging them to seek care or fill prescriptions in advance, charge their phones, and stay vigilant, unexpected problems can arise anytime.

The time between when a hurricane makes landfall and the first three days after its peak represents a critical period for physicians. In 2017, during Hurricanes Irma and Harvey, telehealth was a first line of care for treating urgent care needs such as sinus and respiratory infections, urinary tract infections, asthma, rashes, and waterborne illness. Providers were also sought for therapy for depression, anxiety and panic attacks.

 noted during the first week post-hurricane, it was more common to treat people impacted by the natural disaster via telemedicine than those who were not impacted, particularly for chronic conditions, advice, counseling and refills, and back and joint concerns, including injuries.

Rand researchers also found that use of telemedicine peaked three to six days after the hurricanes made landfall, although most people who use such services did so for routine matters rather than disaster-caused illnesses.

Some physicians may find their demand peaks not in the immediate hours but in the days and weeks that follow a hurricane, as first responders work to repair infrastructure and help those who were displaced by a natural disaster.

When physicians are available to patients in their most critical time of need, it leaves a lasting impression. Nemours Children’s Health System, for example, reported that its satisfaction ratings were higher following the 2017 hurricane season than they were a year prior.

The months following a disaster are a good time to evaluate your response, review lessons learned, and adjust plans for the future. Were you able to address every patient’s needs in a timely manner? If you relied on a telehealth app to help patients, did it give you the ability to triage patients based on need? What would you have done differently? How might this translate into other aspects of your patient care across the organization?

Disaster relief is just one example of how telehealth can fill the gaps of care, but it is an important one as we look at new ways to expand access to care to all patients.

And while caution is a good thing when it comes to investing in the latest technology, caring for patients in a serious time of need is something that physicians should be equipped to do well. If technology can help us practice better medicine, it’s worth serious consideration.

Peter Antall, MD, is president of the Online Care Group (OCG), which supports 24/7 online doctor availability for telehealth platform 

. Peter is a pediatrician by training and a long-time telehealth innovator who works with physicians to implement and build out quality telehealth programs as well as regulators to define safe and effective practices.

Articles

The true value of telehealth doesn’t always reveal itself when we’re testing the waters, but rather when the waters test us.

Telehealth helps physicians brace for landfall

As a former full-time pediatrician and current part-time practicing telehealth doctor, I often get asked by my brick-and-mortar peers, why should I consider practicing telehealth?

Physicians typically raise a few common concerns about practicing telehealth regarding payment, workflows, as well as a general discomfort with the notion of not being able to touch a patient when examining them.

While I understand these concerns, the bottom line is that telehealth has many advantages.  Moreover, telehealth is here to stay - consumers want it, health systems are adopting it, health plans are reimbursing for it, and frankly, there’s already a lot of great work being done by innovators like Cleveland Clinic, Avera Health, Nemours Children’s Health System, and others to use telehealth to manage much, much more than acute care.

At the same time, there are a few, specific reasons why you’d want to practice telehealth. Here are five:

1. Get paid for things you’re probably already doing for free

A lot of doctors spend time throughout the day making phone calls or answering secure messages to patients, as follow-up or regarding new conditions. What’s great about telehealth is that you can conduct this type of outreach over video, have a more robust visit, and get reimbursed for the care that you deliver. Why not monetize these phone or text-based interactions through telehealth while providing a service that your patients want and need? You should be getting paid for the hard work you do and with telehealth, you can.

The use of telehealth allows you to offer improved access for acute problems both during and after office hours. You and your colleagues can provide the staffing, or you could work with an online medical partner to augment your services. Patients who are unaccustomed to the experience of being able to see a board-certified physician in the wee hours of the night when dealing with a sudden issue will be thrilled to have on-demand care, provided by you. This also improves continuity as these acute conditions are all cared for under your practice and brand, rather than by the ER or local urgent-care center. This naturally builds loyalty to you and your practice, and more importantly, keeps your patients with minor conditions out of the ER.

3. Make better use of mid-level and support staff

Telehealth can vastly improve your triage services – video can be utilized by your nurse or medical assistant when assessing new complaints. These patients can then be triaged to home care, a telehealth visit with a provider or a brick and mortar visit. Telehealth can also be used for pre- and post-procedure consultations. A good example is a conversation I recently had with a pediatric surgeon. When the surgeon asked me, “Why should I do telehealth?” my answer to him was easy - you can do more procedures. You can let your physician assistants and nurse practitioners do the pre- and post-op follow-up by video, leaving you more time in the operating room.

4. Enjoy real care coordination without all the hassle

Telehealth can also be used to show specialists and other allied providers right into your office. Increasingly telehealth is being used for provider-to-provider consults or to facilitate team-based care. Instead of giving a patient a referral to go see a certified diabetes educator, dietician or specialist in the area, hope they follow your guidance and hope that you will  get a report back. With telehealth, you can invite these providers to see the patient right in your office.

5. Make your patients' lives easier (and improve compliance) by eliminating unnecessary in-person visits

Visits for medication management are particularly amenable to telehealth. These visits are not reimbursed when performed by phone and it seems silly to drag patients into the office - with transportation, parking, and the usual wait in the waiting room - when these visits can easily be done through telehealth. Why bring in an ADHD patient to talk about how school is going when you can see them remotely, in their home, on their couch? Elderly patients who may suffer from limited mobility can have a visit for medication adjustment without having to make travel arrangements.

Other more obvious benefits to practicing telehealth in and outside the clinical setting include better work-life balance, differentiation for your practice, the ability to take on disease management, increased geographic range, and the ability to build new programs.

Dr. Peter Antall is a physician, healthcare entrepreneur and physician manager. He has a track record of disruptive innovation in the areas of care delivery, medical management, telemedicine and telehealth. He is chief medical officer of 

, and founder of a national telehealth physician group, the Online Care Group, where he manages hundreds of physicians, has developed a credentialing program, and has developed tools to measure and manage clinical quality in telehealth. He received his MD from The George Washington University School of Medicine and Health Sciences.

Physicians who are skeptical of telehealth, here are five reasons that you should try out the technology and give it a chance.