The story below is from our July/August 2021 issue. For more stories like it, Subscribe Today. Thank you!
Telemedicine takes hold in the Roanoke Valley.
Aaron Spicer
This past winter, it was time for a follow-up with my primary care doctor, but I was hesitant to make an appointment. The vaccine was not yet available, and COVID case numbers were on the upswing in Roanoke. So I called the Carilion office where my physician is based to discuss it, and they offered me a telemedicine appointment.
Telemedicine or telehealth is the delivery of health services and information via technology, like an app on a smartphone or through a website. It allows for long-distance contact between a provider and a patient and in its most basic form, it can be an over-the-phone chat with a doctor in lieu of an in-person visit. A video chat where a doctor can view a concern is a more advanced option.
When it was time for my appointment, I logged into Carilion’s MyChart website, and my doctor and I met over the video chat feature. It was smooth and painless, and I quickly got on with my day when we said goodbye. As I later learned, I was one of thousands of patients in the Roanoke Valley who engaged in a telemedicine visit since March 2020, and even when the pandemic is a distant memory, we may credit the crisis with accelerating a move towards telemedicine as an integral part of a robust medical practice.
Telemedicine becomes vital in pandemic
Telemedicine was a fledgling service in the Roanoke Valley before COVID-19, but exploded overnight when the pandemic forced the suspension of in-person appointments for all but the sickest patients.
“Prior to the pandemic, we [Carilion] were averaging about 100 visits per month,” explained Stephen Morgan, MD, who as the chief medical information officer for Carilion oversees its telemedicine operation. “At the height of things, providers were conducting about 800 telemedicine visits per day.”
Before March 2020, you could have fit the three Carilion patients accessing telemedicine per day in a rowboat—but by late spring, you’d need a cruise ship to fit the 800 patients who were utilizing Carilion’s telemedicine system every day. The sudden burst of activity was not without growing pains or challenges, a sentiment echoed by Carilion’s healthcare neighbor, LewisGale Hospital and its provider group, LewisGale Physicians.
“In rural areas particularly, we were troubleshooting network issues and bandwidth issues,” said Matthew Bowles, PA-C, the director of advanced practice providers for LewisGale Physicians, who has worked in cardiology for the physician group for more than a decade. Bowles said that when the stay-at-home orders from the governor were announced, LewisGale moved quickly to implement a telemedicine solution.
“Within 72 hours of stay-at-home orders, we had developed a plan and had a task force in place,” noted Bowles. “We launched into the field in southwest Virginia and had 220 providers trained to start on telemedicine within three days. LewisGale recognized that it was going to be the only initial vehicle to provide healthcare to our patients, because everyone was scared to come to the doctor’s office.”
Similar to Carilion’s MyHealth tool, Lewis Gale utilizes a program called Healow, which serves as a patient portal for information such as lab test results, appointment scheduling and reminders, and the ability to email a provider directly, so video visits are the natural evolution of that already existing communication between doctor and patient. Patients can download an app on their phones for both Carilion’s and LewisGale’s systems.
Pre-pandemic telemedicine
Bowles said that before COVID-19, 11% of medical providers across the nation were conducting telemedicine visits, and that during the pandemic, that number shot up to 76%. Insurance carriers and the Centers for Medicare and Medicaid Services (CMS) “loosened up a lot of regulations so that telemedicine could be utilized in an emergency setting, like a pandemic,” said Bowles. The guarantee that the visits would be covered by insurance gave health systems and providers the green light they needed to move forward.
At Carilion, a small department focused on telemedicine already existed prior to the COVID-19 crisis. In 2016, said Morgan, the health system received a USDA grant to offer telemedicine services for behavioral health, such as psychiatry and psychology, primarily in the rural areas outside of Roanoke. Carilion was working on expanding telemedicine to other specialties and had hired a director of digital health, because Morgan noted that they knew it would be part of the health system’s future. Then the future arrived overnight.
At LewisGale before the pandemic, Bowles said, “Some of us had used telemedicine sporadically. We had some specialties and some primary care practices that used it for limited things.”
Telemedicine’s future
Behavioral health care translated well to video visits, because mental health issues often don’t require hands-on examination. Some follow-up appointments were also good candidates for telemedicine, but when doctors, physician assistants and nurses were forced to adapt to video visits, they learned a lot could be accomplished over the phone or through video chat.
Tara Stone, NP, is a family medicine nurse practitioner for LewisGale Physicians, and she estimates that she conducted approximately 16 telemedicine visits a day during the pandemic’s strongest grip. At first, they had a longer list of conditions they wouldn’t see virtually, but that list became shorter as she and her colleagues became more comfortable practicing medicine through the computer screen.
“Patients would take a picture of a rash, or a tick bite, say, and send it to me or show me on the computer during the visit,” said Stone, who now conducts a handful of telemedicine visits a day, mixed in with in-person patient appointments. She enjoys the variety, she said, and feels like the service is very beneficial for patients.
Some types of visits don’t translate well to telemedicine, such as physicals or wellness exams, or a complicated issue requiring multiple tests. However, a telemedicine appointment can be a screening tool, so that if bloodwork or an imaging exam needs to be done, it can be ordered in advance and the patient can take care of those things before seeing the provider in person.
There are medical devices and products in development that will augment telemedicine, said Morgan. Some of them sound like science fiction dreams, but Morgan assured they are close to being a reality.
“Eventually we’ll be able to provide devices to high-risk patients to listen to their heart and lungs while they are at home and measure oxygen levels, and we’ll be able to do things like a basic dermatology exam with a small mobile camera. It’s exciting,” said Morgan, whose group at Carilion has gotten a second USDA grant to explore remote technologies.
“As long as insurance carriers continue to provide coverage, my practice will stick with it,” said Stone. “I think people are more likely to make a telemedicine appointment...it’s more convenient, less time consuming, and if you live far away or lack transportation it’s a good solution.”
The story above is from our July/August 2021 issue. For more stories, subscribe today or view our FREE digital edition. Thank you for supporting local journalism!