NEW ORLEANS – The COVID-19 pandemic has caused a massive spike in the use of telemedicine services nationwide – and New Orleans is no exception.
Neurologist David J. Houghton, the medical director of Ochsner Health’s digital medicine program, said Ochsner conducted less than 4,000 home-based virtual visits in 2019. Now the health system is handling almost that many every day. So far there have been 120,000 virtual visits in 2020 and Houghton said he expects many patients to continue using the service despite stay-at-home rules loosening up.
About 10 percent of Ochsner’s virtual visits this year fall in the category of urgent care. Those were mostly people worried about possible COVID-19 symptoms. The vast majority, however, were patients with chronic illnesses such as heart disease, Parkinson’s, diabetes or dementia who needed to check in with their docs for their “routine maintenance.”
“Telehealth works best for patients with a chronic condition that is well recognized by the patient and the provider,” said Houghton. “For example, a Parkinson’s patient has an exam that we can largely visualize. You can see a tremor, you can see someone’s stooped posture. It also works well for a patient being followed for his diabetes or hypertension or chronic kidney or liver disease.”
Video visits don’t work as well, of course, for a patient with an acute issue that needs to be evaluated in person: chest pain, shortness of breath or signs of a stroke, for example.
“These are situations where telemedicine is not able to manage someone directly from home,” said Houghton, “but if someone were to call in with those complaints, they would get sent to an emergency room – just like if they visited an urgent care facility.”
Houghton said patients and doctors both seem to appreciate the convenience of virtual visits.
“Several of my patients are going back to work now and see me during breaks,” he said. “I’ve got one patient who was an essential worker at Walmart during the crisis and when I needed to see her, she’d take a break and go out to her car to see me. It really is seamless and so much more accessible and convenient for the patients. It’s greatest value is maintaining that patient-doctor relationship while being able to cover the vast majority of issues the doctor needs to cover.”
Houghton and his team and devising new systems to collect data in advance of a virtual visit to expand the possibilities for care. Ochsner, for instance, is working on a dermatology program that allows patients to take pictures of a skin lesion, upload it and forward it to their dermatologist prior to the appointment so the doctor can comment on it.
Overall, Houghton thinks the surge of telehealth visits will help mitigate a potential crisis caused by people with chronic illnesses putting off their healthcare because of stay-at-home orders.
“What’s happening with everybody’s chronic diseases right now? Some people with diabetes, hypertension, cancer haven’t been going to their appointments,” said Houghton. “People aren’t getting their usual colonoscopies and mammograms. There is a potential for a second avalanche of chronic disease complications that may come in the summer because of this. Think of blood pressure patients who weren’t being adequately managed and then they have a stroke or heart attack. Our efforts have been to prevent that.”
If necessity is the mother of invention, then the pandemic has achieved the impossible: It forced older people to figure out technology.
“I need to write a Mythbusters paper at some point because what we’re learning right now is the older generation and Baby Boomers have converted to virtual visits as seamlessly as the younger generation,” said Houghton. “And in my own experience, my mother and mother-in-law are as attached to their iPads as my kids are. There’s really been a remarkable leveling of people’s comfort using this. There’s also the benefit of multi-generational households; I’ve seen patients when their son or daughter is in the background helping and the reality is that it’s no different than it would have been in my clinic.”
In other words, now that we’ve broken the seal, telehealth is here to stay.
“We are really trying to reinvent healthcare to focus on wellness, meet the patients where they are and take advantage of a digital community that we are all living in,” said Houghton. “Since we have online banking, ride sharing, Instacart and Amazon already, why would healthcare lag behind?
“The vast majority of our patients have been remarkably pleased with this and we often hear why haven’t we been doing more already. I think that sentiment from both patients and doctors tells us that we’ve gotten over the hump and that we’re not going back.”
‘Virtual House Calls’
Dr. Katie Taranto, a primary care physician at St. Tammany Health System, agrees with Houghton’s sentiment.
Taranto said St. Tammany started offering telemedicine last year and and saw little interest from patients. Then when the stay-at-home order went into effect, suddenly she and her colleagues were seeing 95% of their patients that way.
“I wasn’t doing any telemedicine visits before COVID-19 and then all of a sudden I was averaging 15 to 20 video visits per day,” she said. “And we’re doing about five video visits a day now that people are coming back into the office. There are certain things we can’t do via telemedicine – like if we want to check a patient’s blood pressure here – so people are coming back into the office for those.”
One of the benefits of the video visits, said Taranto, is how much they resemble an old-fashioned house call.
“It’s not often that we get to see what patients live their life like outside of the walls of our clinic,” she said. “On a video call, we see their family members and their living situation and that was one of the pluses. We can see what kind of hygiene they keep up at home and certainly any hazards to their safety.”
Taranto said St. Tammany doctors see an average of 22 patients per day. Going forward, the plan is to aim for 25% of those to be telemedicine appointments. Since the video visits tend to be faster than in-person sessions, that could free up doctors to see more patients per day. It also will cut down on the number of people in waiting rooms, which is an added benefit during the pandemic.
“There are certain medical problems – such as mental health, certain rashes, simple upper respiratory infections, urinary tract infections – that can be treated remotely and we are incorporating them into our daily schedule,” she said. “It will certainly become something that we do as a network. As for me, that was my goal before all this started and then we just dove head first in when the pandemic started.”
Taranto said her colleagues at St. Tammany and elsewhere understand that telemedicine is the “wave of the future.”
“It’s a matter of keeping up with the rest of the country, because there’s always competition in healthcare and now everybody wants to have immediate access to doctors on their phone,” she said. “Telemedicine is here to stay and from a business perspective if you don’t provide it they’re probably going to go someplace else.”
