New Uses for Telehealth: How Virtual Care Has Extended Its Reach

From physical therapy to dentistry, a wide range of specialties are being delivered with a click.

by Kevin Joy

Telehealth isn’t just for urgent care. Consumers’ growing comfort with the platform — coupled with the demands of a public health emergency — has helped broaden the use of virtual visits to support a wide range of specialties that manage chronic illness.

Some connections may seem surprising.

Clinicians who practice endocrinology, rheumatology and gastroenterology are among the top users of telehealth in 2020, according to a report published in September by Doximity, a network for medical professionals. The report’s authors cite a “clear overlap” between those and other specialties increasingly using telehealth for patients with ongoing needs.

“The pandemic has essentially required each specialty to rethink how they conduct appointments,” Dr. Peter Alperin, vice president of product for Doximity, tells mHealth Intelligence. The report also notes that video visits offer particular benefit for high-risk patients or those with mobility or transportation issues.

Still, many others are interested: 60 percent of people who used telehealth during the pandemic want to continue doing so, according to an Accenture report released in July.

The report, which reflects data from a study of cardiology, immunology and oncology patients across six countries, including the United States, also revealed that 9 in 10 reported the quality of care was as good or better than in-person visits before COVID-19.

As healthcare facilities work to reimagine their interiors with data-driven design and enhanced screening protocols, there’s no doubt videoconferencing tools will remain.

Over time, some organizations may look to a hybrid model that gives patients and practitioners flexibility to use telehealth when needed, as a recent article from global think tank Rand notes. Others, such as Danville, Pa.-based Geisinger, grew the number of specialties providing virtual care — and plan to keep it that way.

“For an appointment where a physical exam isn’t necessary, it really is a great option,” Tejal Raichura, who directs Geisinger’s Center for Telehealth, says in a company blog post. Geisinger has more than tripled its virtual care roster to support 70-plus specialties.

Here are some of the new and evolving ways telehealth is meeting the needs of patients.

Telehealth for Physical Therapy, Cardiology, Dentistry and More

Many aspects of chronic disease prevention and management can be handled via video from a patient’s home or from rural hospitals connecting with larger healthcare systems, according to guidelines from the Centers for Disease Control and Prevention.

They include telehealth programs for diabetes management, smoking cessation, epilepsy follow-up care and cardiac rehabilitation. These efforts, the CDC notes, can serve audiences that historically have faced barriers to receiving in-person care — and many efforts achieve the same results as offline visits, according to cited research.

After all, patient empowerment and engagement, no matter how it’s delivered, can lead to better outcomes.

This is critical in telecardiology programs such as the one offered at Grand Rapids, Mich.-based Spectrum Health, whose cardiologists can give full exams via telemedicine for patients at regional hospitals. Nearby, patients at Detroit’s Henry Ford Health System may complete their important cardiac rehab — outpatient exercises and counseling that have historically seen low in-person participation — virtually.

In some cases, physical therapy can be delivered from a distance. “Even though we can’t put our hands on the patient, we can ask them to perform actions, and looking at the action, we can make a determination about muscle strength,” Alice Bell, a senior payment specialist for the American Physical Therapy Association, tells MedPage Today. She adds that online therapists can prescribe strategies, manage exercises and assess whether a patient’s walker or a cane has the proper fit, just as they would face to face.

Video can also be crucial to wound care: The medium allows clinicians to evaluate for infection — the major cause of wound-related hospital admission — provide care guidance, and facilitate an antibiotic prescription if needed, note the authors of a special report in the July 2020 issue of the journal Wounds. Some telehealth software programs can calculate the area of the wound, they add, which is helpful in monitoring the healing process.

There are even some applications for dentistry, for example, allowing a patient history to be gathered via asynchronous communication methods. Consultations can be held online, reducing exposure and easing the decontamination process in an office setting. The practice also can be used to acquire new patients, the American Teledentistry Association says.

Telehealth in the ER Changes Onsite Care Delivery

As the fight against COVID-19 continues, other serious ailments and emergencies don’t stop, nor does the need to preserve bed space and protective equipment.

This is why some emergency departments are equipping themselves with teleconferencing tools to register, triage and even discharge some patients without a face-to-face meeting. By reducing exposure and expediting care for nonurgent cases, clinical teams can still order vital labs and X-rays

These “tele-triage” models leverage videoconferencing and mobile devices for efficiency and safety.

“Now, we can evaluate a patient that may or may not have the flu or a cold or COVID, and you don’t have to put a provider in there with them,” Dr. Judd Hollander, senior vice president for healthcare delivery innovation at Thomas Jefferson University, tells HealthTech.

Established before COVID-19, the organization’s tele-triage practice greatly reduced the amount of time patients spend in the emergency department.

The concept is new for Renown Health in Reno, Nev. The organization set up outdoor treatment tents to provide onsite telehealth in response to COVID-19. After getting their vital signs taken in person by a nurse, patients speak via video with an emergency medicine physician, who determines whether they needed testing, treatment or another next step, Modern Healthcare reports.

That arrangement is also now being practiced in treatment areas at Aurora St. Luke’s Medical Center, where patients are separated into “hot” and “cold” zones based on symptoms that could indicate COVID-19. In either space, a telehealth cart with videoconferencing is deployed to connect with a physician assistant — a workflow that’s likely to remain at the Milwaukee organization beyond the pandemic, the publication notes.