Telemedicine should be used more in hospitals

The COVID-19 pandemic has led to a sea change in how medicine is practiced. Each surge in cases creates capacity issues across healthcare systems. The emergence of the omicron variant has health systems across the globe bracing for the dual threat of widespread transmission and inadequate immunity from vaccines.

I believe an extended utilization of telemedicine options might help improve efficiency of care delivery as well as personal safety of medical staff.

Telemedicine is underutilized in the inpatient setting. Outpatient clinics have shown that telemedicine appointments can meet the health-care needs of patients while maintaining social distancing. Well before the pandemic, telemedicine was being utilized for care delivery in rural areas, where it was considered a cost-effective way to improve access to specialty care.

When hospitals are operating at or above capacity, a situation simulating scarcity of medical care and resources is created even at institutions that would otherwise be considered well-staffed. In such circumstances, there may be subsets of patients that can be evaluated via videoconferencing as opposed to in-person visits.

Stanford hospital systems assessed the feasibility of use of telemedicine across diverse inpatient populations during 2020. While that was an across-the-board implementation, perhaps a more balanced approach might be appropriate in non-surge settings, that can potentially be scaled up or down as the situation demands.

Video calls have permeated modern life. Many members of the public have worked remotely or connected with loved ones using Zoom, Teams, FaceTime and the like. It is highly likely that the average patient is somewhat familiar with video conferencing. Currently commercially available electronic stethoscopes can also be incorporated into telemedicine encounters to further widen the scope of utilization.

As a hospitalist, I have long noted that I spend more time preparing for patient encounters by reviewing their electronic chart, addressing abnormal test results, discussing and coordinating care with other specialists, and completing documentation than on in-person visits with individual patients.

My routine rounds might not involve a comprehensive physical exam for every patient, in particular those who I have already seen before. Consider, for example, someone hospitalized for an asthma flare-up. If they are feeling poorly, I can often tell how they’re feeling by just hearing them talk and attempt to draw deep breaths every few words. I can tell from reviewing their records if they have run out of the inhalers that are supposed to prevent flare-ups. Once they start feeling a little better, that is when I need to listen to their breath sounds using a stethoscope, and visually assess how much they are exerting themselves to breathe and talk.

Now imagine if the same patient had COVID-19, and yet, without being encumbered by extensive personal protective equipment, I could still gather the same information, and take the same steps to help the patient get better?

There are many more aspects of my day-to-day work where I believe some use of telemedicine can be helpful. As an example, discussing a patient’s home medications could be so much faster and more accurate if I could also utilize a screen-share option to show them their previous medication fill lists as a visual aid.

All too often, patients with a fracture don’t realize how severe their injury is until they see X-ray images. I would argue that a device the patient can handle at their preferred reading distance and angle would work a lot better than awkwardly attempting to use a computer on wheels that would then need to be cleaned between each patient.

Patients admitted to the hospital are rarely straightforward. But for many patients, telemedicine can be used for delivering the same level of care as in-person evaluations, with many additional benefits.

The currently available vaccines, when optimally utilized, seem to provide at least some protection against the highly contagious omicron variant. How long though, until we face a COVID-19 variant that evades immune responses, is highly contagious, and causes severe disease? It would be prudent to prepare while we have the time, to develop methods of care delivery that integrate meticulous measures to reduce in-person patient contact and therefore, transmission risks.

Telemedicine, if properly implemented, can be one of many tools to help with reducing exposure risks while providing appropriate safe, effective, patient-centered medical care.