Shift Towards Telemedicine Amid COVID-19 Crisis

In the midst of the COVID-19 crisis, the use of telemedicine has virtualized medical care.

By Janie Hu, BSc, MD Candidate

Telemedicine, the practice of virtual care, has been thrusted to the forefront of medical discourse amid COVID-19. Traditionally used by remote and underserved communities, it has recently shifted into overdrive. Virtualized care has been heavily adopted in urban areas, where patients may have only used the service in the setting of mobility and transportation constraints. In light of social distancing measures, health care services via phone or video call seem to be specifically made for this pandemic. 

According to CNBC, telemedicine usage has increased by 50 per cent in March 2020 alone. If the trend continues, analysts predict 1 billion telemedicine interactions by the end of 2020. What may be shocking is that 900 million of these visits are estimated to be COVID-19-related. This is likely the result of hospitals and clinics encouraging patients to use telemedicine and hotlines. 

“COVID-19 has shown that telemedicine has a much greater role to play in today’s medical field. It is more convenient for patients a lot of the time,” says a Canadian physician resident, who wishes to remain anonymous.

“It provides physicians with an alternative to monitor these patients and prevent flare-ups.”

They add that the College of Physicians and Surgeons are now funding previously unpaid phone calls. 

“This has allowed family medicine to continue to take care of their patients despite not being able to see patients in person and have their work remunerated,” they say.

As hospital beds and personal protective equipment are limited, telemedicine preserves these resources for unstable, acutely ill patients. Curtailing non-essential emergency room and office visits also alleviates the strain on COVID-19 hotspots such as New York, where there has been a strain on the healthcare system. 

Aside from COVID-19 patients, individuals suffering from chronic diseases such as congestive heart failure and chronic obstructive lung disease may experience exacerbations if not properly managed. These flare-ups could require in-patient treatment, meaning these high-risk patients would be placed alongside contagious COVID-19 patients. While telemedicine cannot replace face-to-face clinical encounters, it provides physicians with an alternative to monitor these patients and prevent flare-ups. 

Although telemedicine is rapidly becoming the mainstay of health care, it comes with its limitations and challenges. Telemedicine is not a substitute for objective physical examinations and diagnostic investigations. Instead, it relies on a subjective account of the presenting illness by the patient which cannot be confirmed with tests. For instance, a chief complaint of chest pain may stem from a cardiac, gastrointestinal, or pulmonary etiology. A series of tests would normally be performed to rule in and rule out differential diagnoses. 

“There are obvious downsides, one being the inability to do a physical exam yourself.”

Eric Topol, the director of the Scripps Research Translational Institute, cautioned that telemedicine may not deliver the required standard quality of healthcare. 

“It’s inexpensive and expedient, but it’ll never be the same as a physical examination with all of its human qualities of judgment and communication. But with COVID, this is a trade-off we have to accept,” he said.

The Canadian physician resident echoes these sentiments: “There are obvious downsides, one being the inability to do a physical exam yourself.”

“Phone calls also have their own problems including phone lines not being 100 per cent secure, and not being able to even see the patient’s face, facial expressions, or body language, which play into the clinical picture,” they add.

Another challenge that physicians are facing is the regulations surrounding telemedicine. However, in the face of COVID-19, there are changes underway to counter this barrier. 

“The regulatory barriers that have held virtual health care back for all these decades were never justifiable. COVID-19 is an opportunity to blow all these barriers away,” said Alex Jadad, founder of the Centre for Global eHealth Innovation at University of Toronto.

In March, the Ontario Ministry of Health approved physician billing codes that enabled health care to be provided through phone and video calls. Shortly after, the Centers for Medicare & Medicard Services (CMS) of the U.S. issued an “unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic.”

These regulatory changes are temporary, but it seems that telemedicine is here to stay. As the medical sector embraces virtual care, it will likely remain prevalent as the world recovers from this crisis.

Copyright© 2020 by Janie Hu 

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