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Everything old is new again: Telehealth takes center stage in pandemic

April 7th, 2020

Despite its high-tech sounding name and implications, telehealth is not new. Our own organization was using it years ago for a very challenged subset of society – teens who had urgent and ongoing mental health needs living in rural areas underserved by behavior health specialists. The grant-funded program was offered with the assistance of Michigan Medicine and I strongly believe it was a lifesaver for some teens. Despite relatively early adoption in this and other select cases, though, I certainly can’t brag that all of our practices were using – or even remotely interested (pun intended) in – telehealth. It was a continuum from zero awareness to occasional use. But what a difference a pandemic makes!

Interestingly, one of the earliest adopters of telehealth in mid-March 2020 was a ‘senior’ internal medicine physician in our organization who still uses paper charts.  He saw 30 patients in one day using telehealth. Moreover, many of these patients were elderly. The practice team, frequently the receptionist (thank goodness for high performing teams), walked patients who were amenable to it through the relatively easy telehealth set-up process.  

Wait! Doesn’t a practice need an EHR to use telehealth? Surprisingly no. Any device can be used for “video chat” in a pinch, although it’s not advisable long-term, for reasons I’ll explain later. In the absence of telehealth, I actually know physicians in SE Michigan primary care practices who were laid off due not only to a decrease in patient visits, but also a lack of personal protective equipment that prohibited them from safely seeing patients. I think it’s safe to say these practices (assuming they survive) will be eager to get HIPAA compliant telehealth services added to their practice once the immediate pandemic needs have eased.

When an established EHR/telehealth vendor relationship exists, assistance is available at the time of need, eliminating days of frantic searching for interim solutions. Further, while Facebook live, facetime, Google Duo and other public services worked in the throes of a pandemic – and HIPAA-compliance was eased to accommodate access to the unusually high demand for care -they are merely temporary and risky telehealth bandages. With thousands of patients sharing patient information over unsecured networks, and no clear understanding of how the various platforms will use these phone numbers of confidential patient information, they are not viable options as we move past, or at least adjust to, the current crisis. Moreover, they do not present a mechanism to easily track the patient visit for electronic medical record documentation purposes and reimbursement. An actual telehealth program, connected with an EHR system, does both. I must add here, though, that an EHR, telehealth or not, doesn’t automatically equate to a well-run practice.

While I am a strong advocate for EHRs, I have seen physician offices without them who have better organized workflows and, hence, are more efficiently run, resulting in better quality metrics and more profitable practices. Technology is not a substitute for effective practice management. It’s a tool that must be appropriately applied to already sound practice operations.

Back to telehealth, I need to give a shoutout here to CMS, BlueCross Blue Shield of Michigan, HAP, Priority Health and other health insurers, including Medicaid payers, who stepped up early in the healthcare crisis to put patients first and waive co-pays on telehealth services, while guaranteeing reimbursement for providers. They join our healthcare community, first responders, physician leaders, public health experts and key government officials as heroes in the collective and valiant effort to conquer COVID-19.

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