HOUSE CALL
Houston’s health care systems turn to telemedicine in post-pandemic time shift.
In the span of two short months, getting to a doctor’s appointment has changed from ducking out of the office at midday and fighting traffic to launching a video app on a computer or smartphone for a consultation.
The coronavirus pandemic, as it has with shopping, office work and socializing, is accelerating the adoption of technologies in the health care industry that allow people to conduct business and connect without leaving their homes — or wherever else they happen to be. While telemedicine has been around for years, the necessity of providing medical care over the internet to comply with social distancing measures has eroded resistance to it.
In other words, both doctors and patients have tried virtual medicine and found they liked it.
“COVID-19 has absolutely created a new opportunity for the health care sector,” said Ashish Chandra, a health care administration professor at the University of Houston-Clear Lake. “They’re more receptive to it than they were six months ago because they’ve now done it.”
Long after the outbreak of COVID-19, the disease caused by the coronavirus, subsides, providers and health care experts expect virtual medicine to play a large and expanding role in delivering care. Some doctors plan to administer follow-up appointments and check-ups over the internet by working with patients to get technology for blood pressure and heart rate measurements into their smartphones.
Doctors’ groups are also upgrading videoconferencing software and equipment and setting aside space for banks of computer screens to conduct virtual visits.
Hospitals are doing more than just video calls with patients. Houston Methodist has adopted a virtual intensive care unit that allows doctors to beam into ICU rooms to check up on recovering patients — which has proved especially useful when caring for COVID-19 patients.
The hospital system initially planned to introduce the $5 million program gradually, starting with a pilot this spring. But as COVID-19 patients began to fill the ICU, Houston Methodist decided to roll out the project in its entirety to protect doctors and patients from the virus.
“We went from 0 to 100 in terms of speed,” said Roberta Schwartz, Houston Methodist’s chief innovation officer.
The rush to get online
Telehealth visits are expected to exceed 1 billion in 2020 due to the pandemic, according to researchers at
Forrester, a technology research firm based in Cambridge, Mass. That’s up from about 36 million general visits Forrester analysts initially forecast for 2020.
Major health care systems, such as Houston Methodist, offered some form of telehealth prior to the rush to get online during the pandemic, but the rapid spread of the virus drove hospitals and clinics that didn’t use telehealth to quickly build and buy software to get doctors onto patients’ screens. In March, Harris Health System moved its patients in six days to MyChart, a virtual health care platform that allows video, phone and chat-style visits.
UT Physicians signed a contract for telehealth software last year. The system’s developers had just spent two weeks fine-tuning the programs and preparing a 12-cubicle hub for doctors to make virtual visits when the coronavirus outbreak came to Texas, said Andrew Casas, chief operating officer for UT Physicians, which has more than 2,000 doctors.
About 1 in 5 visits in May occurred remotely, even as doctors’ offices began reopening, Casas said. Many see 20 to 30 patients daily on the telemedicine platform.
Dr. Erin Furr-Stimming, a neurologist who specializes in movement disorders and associate professor at UTHealth’s McGovern Medical School, was skeptical at first that the telemedicine program would benefit the entire system. She didn’t see how virtual visits would work for most of her patients who have Parkinson’s and Huntington’s diseases.
But given mobility issues that some patients have because of their illnesses, telemedicine has offered an unexpected benefit in reducing their stress getting to appointments.
“I get to visualize patients in their home,” FurrStimming said, “and I really have a better idea as to what their challenges are at home.”
Doctors said one of the most pressing concerns about the spread of telemedicine is the digital divide between those who can afford the smartphones, tablets, laptops and internet services and those who can’t.
“Would patients have access?” Furr-Stimming said. “It’s not within our control.”
Avenue360, a community health clinic system that serves Houston’s poor, has run into similar problems with patients who may not own smartphones or computers and don’t have easy access to the internet or stable Wi-Fi connections. As a result, many patients are doing without medical check-ups, follow-up visits and other services during the pandemic because they fear exposure to the coronavirus, said Dr. Charlene Flash, president of Avenue360.
To overcome that, Flash and her staff received a $297,000 federal grant to build mobile telemedicine clinics at public housing in the city. The money will fund computer rooms at low-income apartment complexes and grants for staffers to teach computer literacy and how to use the software.
“If we don't implement them very intentionally,” Flash said, “instead of narrowing health care disparities, you can unintentionally widen them even as you do new and innovative things.”
Telemedicine offers several advantages to providers, particularly during a pandemic. It allows doctors and hospital systems to see patients and conserve face masks, surgical gowns and disposable gloves.
It also puts patients in a more comfortable environment, making them more likely share information about their conditions with their doctors.
But some physicians remain skeptical, unsure that virtual care can replace inperson visits, said Clinton Phillips, founder of Medici, an Austin telemedicine software company.
Researchers and doctors agree telemedicine is not a replacement for face-toface contact. Some visits can’t be conducted over a screen. Houston Methodist oncologist Jorge Darcourt said he worried he would not be able to monitor the size of tumors and other growths in breast cancer patients.
“I was concerned about the quality of care you could provide without being able to examine your patient,” Darcourt said.
Doctors also worry about reimbursement rates for telemedicine, which can be half what insurers pay for in-person visits. Establishing comparable rates for telemedicine would make it more attractive to providers, Phillips said.
“To push virtual health care,” Phillips said, “you need to have some strong incentives.”
The new normal
Although some longtime physicians were hesitant about providing medical advice and care over a video call, telemedicine visits have continued to climb at Houston Methodist.
Houston Methodist doctors conducted an average of fewer than 200 patient visits a day in January and February. In recent weeks, it’s been closer to 4,000 patient visits a day, said Schwartz, the hospital’s chief innovation officer.
Doctors appreciate the ability to see more patients in a day, and in the future, many may take a hybrid approach, conducting tests and physical evaluations in person while going over test results and conducting routine check-ups via the internet.
“Physicians who used to hold up a phone and tell me phones are not doctors are now telling me they'll never return to the way they practiced before,” Schwartz said.