Telemedicine is a part of our practice that’s ready for revolution and evolution because patients clearly want it. —Erika Woodson, MD
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November 2020
“The physician satisfaction was a little bit lower across all of those features compared to in-person encounters,” she said. “But the patient satisfaction [data] were really no different across the board from telephone and video encounters compared to those in person. Certain subsets of patients were actually more satisfied with the telemedicine encounter—for instance, those who have difficulty physically accessing the healthcare system for a variety of reasons.”
The researchers also looked at subgroupings and found areas in which progress in telehealth might need to be strengthened, said Dr. Voelker. “It looks like the weak points are elderly patients, because their technology literacy is lower, and patients who have a language barrier and need a translator.”
The Keck School has been addressing these weak points as they are noticed. Through a simple phone call, for instance, an on-demand translator service for telemedicine has been added at USC, to help accommodate the ethnically diverse greater Los Angeles area.
Overall, Dr. Voelker said, the virtual experience has run counter to her expectations. “I thought patients would be really disappointed—I can’t examine them, and I can’t have an intimate connection with them in person,” she said. “But surprisingly, the emotional connection that I felt with the patient, and vice-versa, was very strong.” Patients and physicians have been brought more intimately into each other’s worlds, especially during visits conducted at patients’ homes, she said, and telemedicine has opened up access to healthcare in a novel way to those who have had the most difficulty accessing it in the past.
Adaptation and Success
At the otolaryngology department at the Cleveland Clinic, a virtual-visit platform had been created before COVID-19, but not many providers used it.
“Most of our providers hadn’t been trained on it, hadn’t on-boarded to it, and certainly the platform wasn’t able to pivot to quickly accommodate the volume that we needed,” said Erika Woodson, MD, section head of otology–neurotology, one of telehealth’s early adopters at Cleveland Clinic, and a member of the committee that helped adapt the system for increased use when COVID-19 arrived.
My hope is always that we’re providing at least the same level of care or higher through virtual visits. —Patrick Barth, MD
With too little bandwidth, the platform couldn’t connect well and kept crashing, she said. “You would fight to just get connected with the patient and then the visual and video would be so stilted that you would have to abort the video and use a back-up communication method,” she said. “Much of the time allotted for a visit would end up with our physicians trying to be their own personal help desk.” Across Cleveland Clinic, about 15% of virtual visits couldn’t be completed due to technology issues, she noted, and physicians simply hadn’t been trained to use the system yet.
But it turned out to be a story of adaptation and success. Bandwidth was increased, and physicians and technology officers banded together to ensure that physicians received the training they needed to offer patients the proper care. “We had multiple meetings each week with people from each department,” she said. “It was completely new for most of the doctors and providers—and questions came up every day: Can we prescribe or renew controlled substances? What about patients who are across state lines? How do we bill this? It was a tremendous amount of work on the physicians’ side to translate what we had available into what our doctors, our colleagues, needed to know.”
And despite the initial bumpy road, said Dr. Woodson, surveys have found that patient satisfaction with Cleveland Clinic telehealth was “very, very high.”
“I think patients were relieved to be able to get care,” Dr. Woodson said. “Telemedicine is a part of our practice that’s ready for revolution and evolution because patients clearly want it.”
Physicians have found that not every visit type is suitable for virtual visits. Patients with ear fullness, for example, might need to be seen regardless of the ability or willingness to provide virtual visits, Dr. Woodson said.
“Is it wax, is it fluid, is it sudden hearing loss?” she said. “You don’t know unless you can look in their ear.” Physicians have frequently preferred to not do these types of visits virtually, even if patients like telemedicine appointments, she said. But for other types of visits, such as a scan review, physicians and patients alike have been satisfied with virtual communication.
Dr. Bradley has been surprised at how effectively certain types of cases can be handled virtually. A patient with swallowing dysfunction, for example, will likely need to be seen in person eventually, but much can be done virtually to make it a more efficient experience for both the provider and patient. “The thing that will guide me more than anything else is that patient’s history as well as some type of swallow study,” he said. The first visit for a new telemedicine patient can be used to gather medical history and gauge what type of study should be done, making any in-person visits shorter and more efficient.
A colleague of Dr. Bradley has used telehealth appointments for tonsillectomy cases, with no in-person visits until the day of surgery. “She took a quick look at the tonsils just to make sure there was nothing untoward before going back, but the surgery was booked off the virtual visit,” he said. “In the end, both she and the patient were incredibly pleased with how it went.”