The use of telehealth services has skyrocketed in recent months, due to the COVID-19 pandemic. In 2019, just 11 percent of Americans had received healthcare via electronic communications and videoconferencing technology. As of April 2020, that number had risen to 46 percent, according to a survey by the consulting firm McKinsey & Company.
But for many people with bleeding disorders who live hundreds of miles away from a hemophilia treatment center, telehealth services have been a part of their care for several years.
In rural Michigan, for example, children and adults with bleeding disorders can have virtual visits with Roshni Kulkarni, MD, director of Michigan State University’s Center for Bleeding and Clotting Disorders in East Lansing, a hemophilia treatment center (HTC) as well as her colleagues on the comprehensive care team.
These telehealth sessions often start out similar to a traditional office visit. The patient is seen one-on-one by their local primary care provider. Then, the patient and the in-person primary care provider connect to Kulkarni virtually, using a two-way, real-time telehealth videoconference.
During these virtual visits, “I go over the patient’s history and physical,” Kulkarni says. Together, the group (the in-person primary care provider or the patient, the remote specialist and the patient) discusses the patient’s diagnosis, treatment plan, any issues that come up and the results of lab work. The telehealth video session can also include consultations with a social worker and other comprehensive care team members as well as specialists at the HTC. The group then confers, making any required decisions as though they were in the same room.
Ever since the pandemic began, Dr. Kulkarni says, many patients have been directly connecting to the HTC from their home by clicking on a zoom link sent by the HTC. “Currently patients have a choice of a ‘virtual’ telemedicine visit or a physical in-person ‘face-to-face’ visit, and they also have a choice of having a telemedicine /virtual visit at one time and then opting for an in-person visit at another time,” says Dr. Kulkarni. “For children who are afraid of doctor visits, this combination seems a feasible solution.” She adds that this flexibility may help to increase the frequency of patient contact or visits. Services such as telegenetics, telephysical therapy, telemental health services, can be offered. Pregnant patients can be seen by virtually by multiple specialists such adult and pediatric hematologist and obstetrician during a single tele- visit for pregnancy and delivery recommendations.
In addition to improved access to care, especially in rural areas where there is a shortage of specialists, there are several other advantages to telehealth services:
- Decreased travel for patients. Patients travel about one-tenth as much, says Michelle L. Witkop, DNP, FNP-BC, a former bleeding disorders nurse practitioner at the Northern Regional Bleeding Disorders Center at Munson Medical Center in Traverse City, where patients have videoconferences with Kulkarni. And those shorter distances mean savings of both time and money. During pandemic, patients can maintain physical distancing and prevent risk of exposure to themselves and others. Rates of “no shows’ to the clinic also decreases.
- Care delivered within a patient’s “medical home.” A medical home is essentially the physician’s office that is at the center of a patient’s care. Delivering specialty care to patients in their medical home integrates the primary care physician in the process, but there are also nonmedical benefits. “When patients get care at local facilities, their support systems are better,” Witkop says. “It’s just better for them all the way around.”
- Ease of sharing educational materials. Kulkarni shares her screen with patients and providers, pulling up online resources such as the National Hemophilia Foundation website, hemophilia.org, where she frequently refers patients for quality information, resources and support.
- Improved quality of care. Providers say the quality offered through telemedicine can be better, because the primary care provider and specialist are in the room with the patient at the same time, planning and discussing everything as a team. After every telemedicine visit at Munson Medical Center, patients are surveyed on a scale of 1 to 5 about their satisfaction. The results indicate that patients perceive the quality as very high. Many comment that they had the provider’s full attention and that they were seen faster.
There are some challenges to delivering care virtually through telehealth visits:
- The specialist can’t feel the patient’s organs. “I cannot feel the tummy or any swelling,” Kulkarni says. For that, she depends on the local provider’s examination. However, cutting-edge teledevices, such as teleotoscopes and telestethoscopes, allow specialists to see and hear what’s going on in the patient’s ears, nose, throat, heart and lungs.
- Inevitable technical difficulties. Connection problems or issues with audio or video quality occur. Many primary care providers who connect with Kulkarni have an IT support person from the affiliated hospital in the office on telemedicine days to ensure the equipment is set up successfully.
Other challenges include lack of digital access, visual impairment, making it difficult to see the screen, language barriers and risk of breach of privacy.
Despite the challenges in Kulkarni’s view, telemedicine is here to stay and is the future. “The days of having the patient visit the ivory tower are gone,” she says. “People in the ivory tower need to get out there and care for the patient in their own environment.”