Telehealth: Top 5 Surprising Outcomes Hitting the Phone Lines to Support the Front Lines
Author: Elizabeth Moran, MSN, RN, CPNP
For healthcare professionals in the United States, the past month has been fraught with fear, anxiety, and radical changes in the model of healthcare delivery. In response to the COVID-19 pandemic, hospitals and clinics had no choice but to jump into action. Resolutions to mitigate transmission of the virus demanded a rapid change from in-office visits to virtual care. And yet as quickly as the change took place, a resounding opinion amongst healthcare providers was whispered: “Why don’t we always do this?”
Thomas H. Lee, MSc, MD, primary care physician at Brigham and Women’s Hospital and member of the Editorial Board of the New England Journal of Medicine (NEJM), is asking the same question. In a recent commentary released on March 17th, Creating the New Normal: The Clinician Response to COVID-19, he explores how health care delivery will be forever changed. “The COVID-19 pandemic is going to be one of those dichotomous events that divide life into before and after,” he writes .
Patients and providers around the country are echoing similar sentiments.
Telehealth is Providing Focused Care
Rima Gemayel, FNP, a Primary Care Provider (PCP) at Charles River Community Health Center in Greater Boston, is one of many healthcare providers across the nation who has recently flipped the majority of her routine office visits to telehealth. At first, she worried. “Will I miss something over the phone? Shouldn’t I have objective data as part of my visit? How can I talk to my patients about hypertension without a blood pressure measurement?”
But as she began trialing telehealth, Rima was quickly reminded of the crucial role of conversation (or, as we document it: the HPI) in her clinical decision-making. “So much of what I’m doing is just providing reassurance. Patients want to be heard and whether that happens in the office or over the phone makes no difference.” Without the distraction of a checklist of tasks (routine labs to be ordered, immunizations to be administered, pre-visit questionnaires), with no objective or physical information, we’re listening better. In the words of Dr. Lee: “We’re learning new skills while we care for patients in this epidemic,” . Visits still include discussion of medication changes and side effects, follow-ups on prior concerns, education and counseling, and teaching on supportive care measures for possible COVID-19 symptoms—it’s just the environment that has changed.
Telehealth is More Efficient for Patients
Patients, too, are welcoming the change. At the end of one of her calls, Rima thanked the patient on the other end for her understanding of the need to change her appointment to telehealth. Without pause, the patient exclaimed back: “No—thank you! You have no idea how much more convenient that was then dragging my three young children along to the clinic for a few hours!”
Telehealth just saved this patient over an hour on public transport, four bus passes, the frustration of waiting for a provider who is running behind schedule, precious time from her day. As providers, we must learn from this. We must consider telehealth as a viable option for patient delivery even long after Covid-19 is a nightmare of the past.
Telehealth Provides Increased Access to Care When Demand Spikes
Yet, of course, not all outpatient providers can rely on telehealth. Urgent visits require direct attention and feasibility varies by specialty. Cancer patients still need to receive infusions. Elective valve procedures for cardiac patients and all other procedures need to happen in a healthcare facility in today’s environment. And yet, while there are certain limitations to our new virtual reality of care, there are boundless opportunities where it can be beneficial.
We’re seeing this already when it comes to mental health care. Governor Cuomo of New York asked mental health professionals to volunteer to provide online services. Immediately, 6,000 signed up to work for free . For the first time ever in a pandemic, mental health is at the forefront.
Without missing a beat, Psychiatric/Mental Health Nurse Practitioner Kelly West and her colleagues switched all visits to telehealth in mid-March to support patient and provider safety. She welcomed the change while cautiously acknowledging the flaws: “While the importance of physical presence and non-verbal communication in psychiatry can’t be understated, telehealth has given us a great way to continue to provide quality care.”
In the immediate aftermath of the tragedy, survivors of COVID-19 and loved ones of victims will need Psychological First Aid. Grief, anxiety, depression, and PTSD are inevitable sequelae. Kelly knows that her patient volume may expand in the months to come and she’s ready to be a resource when it does. “The ability to access mental health services, especially now in the midst of what is a very scary and stressful situation, is incredibly important.”
Telehealth Keeps Providers Safe During a Pandemic
Despite the crisis we are facing, it’s humbling and remarkable to witness the rapid pace at which healthcare professionals across all disciplines are adjusting care—rising to the occasion.
None of us were at all prepared for this, but have no choice but to respond.
Perhaps we as providers find solace in telehealth, too. From the phone lines, we are protected from the dangers of the front lines. We can worry less than our inpatient colleagues about bringing the virus home to our families. Yet, we cannot diminish the importance of this work in fighting the crisis at hand. “As a PCP, I see my job right now as to keep people out of the Emergency Departments so that our hospital systems don’t become overwhelmed,” Rima stated.
Though the halls of our outpatient clinics are quieter these days, we still feel the magnitude of what is happening around the world.
Providers are Adaptable and Demand for Services Will Remain High
Recently, a stark text from a wise man warned me about the lasting impact of the COVID-19 pandemic. “What we are experiencing now is only the preview, not the movie. Tough, tough times are coming. Our country will emerge stronger, but this is surely going to be a generation-defining event that will shape society for decades (emotionally, societally, economically). Seat belts, please.”
It’s already dismantled our healthcare system. Deeply ingrained systemic weaknesses have been exposed, the need for sweeping federal response paramount. Telehealth is a crucial first step, but we will need to remain flexible and creative in the months to come. Devastation, grief, loss, and financial ruin will wreak havoc in the lives of many of our patients, and our own. Our jobs as we know them will change, but our patients will need us more than ever. This crisis will be an uphill marathon, not a sprint.
Hang in their healthcare workers—you are our Heroes!!
If you want to discuss adding telehealth services or hiring telemedicine providers, let’s talk, please contact Jill Gilliland 303-803-4470 or firstname.lastname@example.org
- Lee, Thomas H. “Creating the New Normal: The Clinician Response to Covid-19.” Innovations in Care Delivery, New England Journal of Medicine, 17 Mar. 2020, catalyst.nejm.org/doi/full/10.1056/CAT.20.0076.
“Governor Cuomo Commends Mental Health Professionals Working as Volunteers to Address Mental Health Needs Related to Coronavirus.” Governor Andrew M. Cuomo, New York State, 25 Mar. 2020, www.governor.ny.gov/news/video-audio-photos-rush-transcript-governor-cuomo-commends-mental-health-professionals-working.
Elizabeth Moran joined the Melnic team in 2019 as a Copy Editor Contractor. She uniquely holds a Bachelor of Arts in English from the University of Connecticut and a Master of Science in Nursing from Boston College. She is currently working fulltime as a Pediatric Primary Care Nurse Practitioner in Boston.
Prior to becoming a nurse practitioner, Liz worked for a number of years in clinical research where she participated in the writing and editing of grants, protocols, and scientific articles for publication. She also has experience copy editing and proofreading for a nonprofit. Liz is excited to now blend her English and healthcare background at Melnic Consulting Group.