Seeing your doctor from the comfort of your living room might feel like a luxury. Yet what was once a convenience is now a matter of life and death for cardiac patients. Telehealth was already growing in popularity. The COVID-19 pandemic transformed it into the default option. For cardiac patients, fatality rates from COVID-19 are far higher than for the general population. They are even at greater risk than for those with pre-existing conditions like diabetes, cancer, or chronic respiratory disease.
Keeping cardiac patients safe is vital. In early March, 2020, the American College of Cardiology (ACC) recommended substituting telehealth in places with COVID-19 outbreaks. Today that means it’s the go-to in most parts of the developed world. So what exactly is telehealth and how can it work best for you?
The remote explosion
Telemedicine has been around longer than Skype, Zoom, or even smartphones. In rural communities, dialing up the family physician was an early form of telehealth. In some communities, it still is. Still, being able to actually see your provider (and for them to see you) is a huge leap forward. For doctors, visual cues offer a wealth of diagnostic information. For patients, it means you’ll know your doctor is paying attention.
The Centers for Medicare and Medicaid Services (CMS) offered a concrete definition during the early days of the outbreak. “Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health,” notes the CMS.
Although long a buzzword, telehealth’s popularity exploded in the 2010s. The main driver was growing health care costs. After five years when costs grew at an amount barely over the inflation rate, in 2014 costs jumped more than five percent. While other specialties explored the option, cardiovascular providers lagged. They were hamstrung by regulations, costs, and cultural barriers favoring in-person visits. Studies examined ways to make telehealth safe, timely, and patient-centered.
Last year, the ACC predicted that adopting the practice would transform medicine. Noting that over two-thirds of respondents in one poll were willing to use the practice, the ACC compared it to Blockbuster vs. Netflix. Driving to a doctor is usually less convenient than trekking to the local video store was in the 1990s. Yet despite the desire, fewer than ten percent of respondents had actually used telemedicine.
COVID-19 changed everything. In dense urban centers, hospitals are focused on patients suffering from the virus or immediate, life-threatening events like heart attacks. Regular office visits have been scrapped. Cardiac patients risk their health with a trip to the grocery store or the pharmacy. Entering a medical facility magnifies that risk exponentially. CMS expanded access to Medicare telehealth services and increased services which would be reimbursed. Penalties for violating the Health Insurance Portability and Accountability Act were waived “… against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health so that beneficiaries can receive a wider range of services from their doctor.”
Although the apps that consumers are most comfortable with may carry a slightly higher security risk, they are also familiar. If you are already FaceTiming with your grandchildren, FaceTiming with your doctor should be a seamless transition. Also helpful are the variety of home-based medical devices available. From blood pressure cuffs and scales to the Apple Watch’s ECG app and pricey, portable electrocardiograms, patients have access to more home-based equipment than ever before. Your doctor will be able to use data either provided by you or sent remotely from the device. This allows the doctor to follow your post-surgical recovery, monitor how well your medications are working, and make sure you aren’t displaying symptoms indicating a cardiac event.
After all, even in the best of times getting to your doctor is an almost guaranteed way to raise your blood pressure. There’s traffic, finding parking, and navigating confusing medical facilities. At the office, you may cope with a tedious waiting room and a cold examining room. All of this leads to what Nobel Prize winner Daniel Kahneman’s called “fast thinking.” Decisions are made quickly, based on prior experiences. This can of course ignore unique problems. Both the harried patient and the busy doctor start the process feeling rushed. Comfy in your living room, you may engage in “slow thinking,” carefully explaining how you are feeling and what your issues may be. Your doctor will be just as focused and less distracted.
There are challenges that remain. Because telehealth encounters are considered to take place at the physical location of the patient and not the provider, the physician can run into problems if it crosses state lines. In cities like New York, patients may be living in second, out-of-state homes during the pandemic. This requires providers to comply with professional licensing board requirements in the patient’s state.
Post-pandemic trends show that telehealth is here to stay. For many, the handshake or casual hug has gone the way of the three-martini lunch. Yet many doctors and their patients hope telehealth will endure long after shelter-in-place orders are lifted.
Written by John Bankston
- American College of Cardiology: COVID-19 clinical guidance for the cardiovascular care team
- Centers for Medicare and Medicaid Services: Medicare telemedicine health care provider fact sheet
- Recommendations for the implementation of telehealth in cardiovascular and stroke care: a policy statement from the American Heart Association
- American College of Cardiology: Telehealth in Cardiology: The Future is Today