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Virtual Care in the New Normal

Christopher Berke
Global CCS Digital Marketing Manager

Christopher Berke

GE Healthcare

Working remote, grocery delivery, and telemedicine each existed prior to the COVID-19 global health pandemic.

To ‘slow the spread’ and ‘flatten the curve’, social distancing programs and practices helped drive wider adoption of each.

In the United States, tech companies began to embrace remote work policies,[i] consumer grocery delivery tripled,[ii] and telemedicine for outpatient was adopted so rapidly that the telehealth market is forecasted to grow 64.3% year-over-year.[iii]

Dr. Gianrico Farrugia, CEO of Mayo Clinic recently stated “COVID has enabled us to create virtual health as a new normal.”[iv]

It is clear that we are all living in a “new normal,” and that healthcare is changing.[v] While no one can say with any certainty how virtual health will transform in-patient care over the next few years, the dynamics resulting from the COVID-19 pandemic are providing indicators of what we could expect.

Broadly speaking, there are benefits of leveraging virtual care throughout a hospital: facilitate triage, supply auxiliary services, as well as “decrease the risk of communicable diseases which are transmitted by person-to-person contact.”[vi]

Prior to the pandemic, contagious patients’ exposure could be limited through virtual visits. In a socially distancing world, the benefit of virtual care is even more critical.[vii]

Current social distancing practices are driving adoption of remote operations where possible. While speculation remains as to whether or not remote or virtual operations will remain, there is consensus that if it does: it would include virtual care.[viii]

Ann Mond Johnson, CEO of the American Telemedicine Association, recently stated that “The new realities of healthcare delivery in a post-COVID-19 world will necessitate the continued use of telehealth to support social distancing and maximize health care resources.”[ix]

Virtual care solutions help reduce close contact and the chance of infection.[x]

It is well known that “[p]hysical contact with COVID-19–infected patients significantly increases the chance of illness transmission.”[xi] Virtual solutions help enable clinicians keep a continuity of care remotely.[xii]

For outpatient care, virtual care solutions helped slow the spread by “providing services by phone or videoconferencing for mild to focus personal care and limited supplies to the most urgent cases.”[xiii]

In the ‘new normal,’ virtual care solutions can be used to support social distancing for inpatient care as it enables medical teams to reduce the frequency of staff entering patients’ rooms.[xiv]

As an example, Toronto’s University of Health Network was quick to adopt clinical surveillance solutions to monitor patients remotely.[xv] While being able to help reduce the spread of COVID-19 (or other viruses) and protect patients and care teams, virtual care can also help hospitals make better use of resources.[xvi]

Most pressingly, virtual care has the additional benefit of reducing the use of scarce personal protective equipment![xvii]

The start of the outbreak in the United States underscored the ICU bed shortage and lack of bed coverage by intensivists.[xviii],[xix],[xx]

In regards to COVID-19 outbreak hotspots: demand for intensivists could exceed clinicians’ ability to treat patients.[xxi]

Through the use of a remote ICUs, virtual care has the capability to extend live ICU intensivists virtually across multiple hospital settings.[xxii] Herein, we can begin to see that virtual care solutions have the capability to “manage thousands of patients over a short period of time, and provide care at times of acute shortage in health care personnel.”[xxiii] 

Through the use of a remote ICUs, virtual care has the capability to extend live ICU intensivists virtually across multiple hospital settings.[xxii] Herein, we can begin to see that virtual care solutions have the capability to “manage thousands of patients over a short period of time, and provide care at times of acute shortage in health care personnel.”[xxiii] 

According to World Health Organization research “provider-to-provider telemedicine may improve health worker performance, reduce the time for clients to receive appropriate care or follow-up, and decrease length of stay among individuals visiting the emergency department.”[xxiv]

In the ‘new normal’, ready or not, “the reality is that virtual care has arrived.”[xxv]

As for the pandemic, we don’t know what the future holds: will COVID-19 have peaks and valleys, will there be a fall 2020 peak, or will the pandemic be a slow burn?[xxvi]

Based on the scenarios the COVID-19 pandemic could take, we can infer clear use cases and adoption of virtual care solutions: If there are peaks and valleys, then a virtual ICU could potentially be used to manage influxes of patients over short time periods.[xxvii] 

If there will be a fall peak, then a virtual ICU could be used to provide care amidst a shortage of care personnel.[xxviii] If there will be a slow burn, then a clinical surveillance solution could be used to limit “the number of team members entering patient rooms”.[xxix]

In the end, the potential of virtual care will depend on the 1) healthcare providers’ strategies, and 2) the virtual solution they select to help execute their strategies.

However, it’s clear several months into the global pandemic, we are only scratching the surface of how virtual care can revolutionize inpatient care.

References

[i] Ortutay, B. (2020, May 22). USA Today. Retrieved from Working from home post-COVID-19? Facebook, Apple, Twitter and Microsoft embracing remote work: Working from home post-COVID-19? Facebook, Apple, Twitter and Microsoft embracing remote work

[ii] CHANGES IN GROCERY SHOPPING HABITS DURING COVID-19. (2020). Retrieved from C+R Research: https://www.crresearch.com/coronavirus-shopping-habits

[iii] Fernandez, M. (2020, May 13). Telehealth to Experience Massive Growth with COVID-19 Pandemic, Says Frost & Sullivan. Retrieved from Frost and Sullivan, The Growth Pipeline Company: https://ww2.frost.com/news/press-releases/telehealth-to-experience-massive-growth-with-covid-19-pandemic-says-frost-sullivan/ and “Telehealth – A Technology-Based Weapon in the War Against the Coronavirus, 2020”

[iv] Reader, R., & Harris, A. (2020, 5 21). Healthcare will never be the same: 8 experts on the future of medicine around the globe. Retrieved from Fast Company: https://www.fastcompany.com/90505983/healthcare-will-never-be-the-same-8-experts-on-the-future-of-medicine-around-the-globe

[v] Postal, E. (2020, April 27). The New Normal in the Post-COVID-19 World. Retrieved from MJH Life Sciences: https://www.diagnosticimaging.com/covid-19/new-normal-post-covid-19-world

[vi]Smith, Anthony C et al. “Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19).” Journal of telemedicine and telecare, 1357633X20916567. 20 Mar. 2020, doi:10.1177/1357633X20916567

[vii] Telehealth – A Technology-Based Weapon in the War Against the Coronavirus, 2020

[viii] Saleem SM, Pasquale LR, Sidoti PA, Tsai JC, Virtual Ophthalmology: Telemedicine in a Covid-19 Era, American Journal of Ophthalmology (2020), doi: https://doi.org/10.1016/ j.ajo.2020.04.029.

[ix] Jerich, K. (2020, May 6). Telehealth has staying power, should benefit from lasting regulatory changes. Retrieved from HealthcareITNews: https://www.healthcareitnews.com/news/telehealth-has-staying-power-should-benefit-lasting-regulatory-changes

[x] Song, X., Liu, X. & Wang, C. The role of telemedicine during the COVID-19 epidemic in China—experience from Shandong province. Crit Care 24, 178 (2020). https://doi.org/10.1186/s13054-020-02884-9

[xi] Jedrek Wosik, Marat Fudim, Blake Cameron, Ziad F Gellad, Alex Cho, Donna Phinney, Simon Curtis, Matthew Roman, Eric G Poon, Jeffrey Ferranti, Jason N Katz, James Tcheng, Telehealth transformation: COVID-19 and the rise of virtual care, Journal of the American Medical Informatics Association, ocaa067, https://doi.org/10.1093/jamia/ocaa067

[xii] Jedrek Wosik, Marat Fudim, Blake Cameron, Ziad F Gellad, Alex Cho, Donna Phinney, Simon Curtis, Matthew Roman, Eric G Poon, Jeffrey Ferranti, Jason N Katz, James Tcheng, Telehealth transformation: COVID-19 and the rise of virtual care, Journal of the American Medical Informatics Association, , ocaa067, https://doi.org/10.1093/jamia/ocaa067

[xiii] https://www.sciencedirect.com/science/article/pii/S0212656720301268?via%3Dihub

[xiv] Gadzinski, Adam J et al. “Telemedicine and eConsults for Hospitalized Patients During COVID-19.” Urology, S0090-4295(20)30419-2. 21 Apr. 2020, doi:10.1016/j.urology.2020.04.061

[xv]  Behar, J. et al. (2020). Remote health monitoring in the time of COVID-19. arXiv.

[xvi] Jercich, K. (2020, May 19). Hospitals should prepare now for future telehealth demands. Retrieved from HealthcareITNews: https://www.healthcareitnews.com/news/hospitals-should-prepare-now-future-telehealth-demands?mkt_tok=eyJpIjoiTTJVNFlqTTFNakkzWlRZeCIsInQiOiJrR3JSSHRrNWJTOXBaMmtKaGZ5VXpCQTZIaEMycGp6NUY1bnY4TEVETzRxb0FCd1NUZHp6dzJRWXFJK2dRSEQ2VStYSHJEeTM2Zm4zdDFBK2U4STdaa3

[xvii] K. (2020, May 11). Mount Sinai using Google Nest to monitor patients, reducing in-person contact. Retrieved from HealthcareITNews: https://www.healthcareitnews.com/news/mount-sinai-using-google-nest-monitor-patients-reducing-person-contact?mkt_tok=eyJpIjoiWkROa01HWXpPR1JoTldRNCIsInQiOiJLWVNBeXk0XC96V3pkZkhaWk94elErMjFVMTA1TGxaRm9kdmF6U2dnQlVOY3cxYTZEek9SRVo0OWtpXC9XVU1PRElSQStvNloxTk

[xviii] Ellison, A. (2020, Apri 6). Retrieved from Becker’s Hospital Review: https://www.beckershospitalreview.com/patient-flow/20-states-to-face-icu-bed-shortages-when-covid-19-peaks-analysis-finds.html

[xix] Definitive Healthcare: US Beds Dashboard. ArcGIS. https://www.arcgis.com/apps/opsdashboard/index.html#/8c4dcccd9e3845eb89f6401f919007f2 Accessed April 21, 2020.

[xx] GE Healthcare care internal research / estimation of 52% based on https://www.sccm.org/Communications/Critical-Connections/Archives/2019/The-Multidisciplinary-Critical-Care-Workforce-An

[xxi] Jedrek Wosik, Marat Fudim, Blake Cameron, Ziad F Gellad, Alex Cho, Donna Phinney, Simon Curtis, Matthew Roman, Eric G Poon, Jeffrey Ferranti, Jason N Katz, James Tcheng, Telehealth transformation: COVID-19 and the rise of virtual care, Journal of the American Medical Informatics Association, , ocaa067, https://doi.org/10.1093/jamia/ocaa067

[xxii] https://www.gehealthcare.com/article/the-rise-of-virtual-icus

[xxiii] Devin M Mann, MD, MS, Ji Chen, MS, Rumi Chunara, PhD, Paul A Testa, MD, Oded Nov, PhD, MS, COVID-19 transforms health care through telemedicine: evidence from the field, Journal of the American Medical Informatics Association, , ocaa072, https://doi.org/10.1093/jamia/ocaa072

[xxiv] WHO guideline Recommendations on Digital Interventions for Health System Strengthening. Geneva: World Health Organization; 2019. 3, Evidence and recommendations. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541898/

[xxv] Jedrek Wosik, Marat Fudim, Blake Cameron, Ziad F Gellad, Alex Cho, Donna Phinney, Simon Curtis, Matthew Roman, Eric G Poon, Jeffrey Ferranti, Jason N Katz, James Tcheng, Telehealth transformation: COVID-19 and the rise of virtual care, Journal of the American Medical Informatics Association, , ocaa067, https://doi.org/10.1093/jamia/ocaa067

[xxvi] Moore, K. A., Lipsitch, M., Barry, J. M., & Osterholm, M. T. (2020). COVID-19: The CIDRAP Viewpoint. Minneapolis: Center for Infectious Disease Research and Policy, University of Minnesota.

[xxvii] Devin M Mann, MD, MS, Ji Chen, MS, Rumi Chunara, PhD, Paul A Testa, MD, Oded Nov, PhD, MS, COVID-19 transforms health care through telemedicine: evidence from the field, Journal of the American Medical Informatics Association, , ocaa072, https://doi.org/10.1093/jamia/ocaa072

[xxviii] https://www.gehealthcare.com/article/the-rise-of-virtual-icus

[xxix] Katz, Jason N., et al. Disruptive Modifications to Cardiac Critical Care Delivery During the Covid-19 Pandemic: An International Perspective.  J Am Coll Cardiol. 2020 Apr 15. Epublished DOI:10.1016/j.jacc.2020.04.029