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Remote Cardiac Care via Telehealth — Before, During, and After a Pandemic

By Stuart Long

Telehealth is here to stay. While that’s great news for many, it’s a confusing, scary option for others. Older adults are in a position to benefit the most from speaking with their physicians remotely, but there are many more questions that come with the option of telehealth. Is the technology in place to provide reliable access to a quality call via phone or via video? Will health insurance providers and Medicare continue to reimburse as they have during the coronavirus crisis, for telehealth to remain in place?

Telehealth in Real Time
A recent story about a cardiac patient hits close to home for many older adults with existing or new heart issues who are social distancing due to the coronavirus. A female patient who was wearing a remote cardiac monitor was experiencing an elevated heart rate; her physician could see her heart rate and reached out to her via telephone. In order to keep the patient safe from the coronavirus, the physician reviewed her data remotely and made some changes to her medication while she remained at home. Her heart rate stabilized but became elevated again a few days later. With the ability to see the patients’ data immediately, the physician was able to have her admitted directly to the hospital to have a pacemaker implanted to regulate her heart rate.

The importance of having immediate access to patient data and the ability to access those data from anywhere are second to none. Those two things paired with the access that telehealth brings to the health care spectrum is going to elevate patient care to new heights.

Telehealth has been accelerated by the coronavirus, and the genie can’t be put back in the bottle. The opportunity to start with a telehealth visit before traveling to their physician’s office or to participate solely in telehealth is going to be and needs to be an option for all patients going forward.

Connecting in a New Way
The use of telehealth has rapidly and vastly increased across the United States. People from all areas, rural to urban, have access to their physicians remotely. The ability to access the physician via phone, tablets, and computers is a convenient way for caregivers to provide the very best patient care.

Will people want to go back to the doctor’s office? Yes, they certainly will, but having the option for telehealth appointments is going to bring a new benefit to patients. However, a balance will need to be set between how comfortable the older adult population is with the technology needed to chat virtually with their physicians and whether they feel cared for.

Historically, the number of older adults that were willing to participate in or even try telehealth was very low. While most of the country remains in quarantine because of the coronavirus and even while some states are slowly opening up, the need for telehealth is extremely high, especially to keep patients safe. Physicians have the ability to assess their patients remotely and decide on next steps, which may mean a recommendation for a physical trip for an in-person visit or to stay home and continue to be monitored via telehealth.

Making Telehealth Accessible to Everyone
The Centers for Medicare and Medicaid Services (CMS) announced that effective March 6, 2020, a telehealth visit between a physician and a patient would be reimbursed at the same rate as an in-person visit in the physician’s office. Prior to this announcement, Medicare was focused on telehealth for patients in rural areas only.1

With this new information in place, the following two questions arise:

• Is there an option for this to continue for the foreseeable future?

• How comfortable are older adults with the technology required to complete a telehealth appointment?

To answer the first question, it’s necessary to monitor the success of the telehealth initiative by looking back at how it’s worked up to the pandemic and how it is working during the pandemic. The focus will be on how other technologies can catch up to the now-explosive growth of telehealth. Having immediate access to patient data will become essential when clinicians prepare for appointments via telehealth or during urgent telehealth calls. Medical devices and electronic medical record platforms that provide such information in a timely way for the telehealth visit will become a mainstay in private practices, skilled nursing facilities, and hospitals.

Older adults, in general, are becoming more comfortable with using an internet-connected device to speak to their caregivers. That’s accelerated since the stay-at-home order was issued by federal and state authorities during COVID-19. Patients’ confidence in the care they receive may be reduced by not visiting their physician in person; however, seeing their physicians via video can provide comfort and continue to build patient satisfaction.

Many families are encouraging their older family members to embrace technology and are setting them up with the devices and connectivity they need to take advantage of a telehealth visit. In many cases the patients may be able to avoid trips to the emergency department, or a phone call or video call may direct them to visit the hospital immediately.

In order to make telehealth accessible to everyone, connectivity for patients must be implemented in urban, suburban, and rural areas. Finally, physicians must have the information they need, which requires access to patient data in real time—from monitoring devices to testing platforms and laboratory systems.

Bringing telehealth to the forefront quickly and efficiently has not only transformed health care but also brought several other pieces to the puzzle to light. If the CMS guidelines remain in place for the future and older adults become more comfortable with socially distanced clinical care, there may be very positive long-term outcomes.

— Stuart Long is the CEO of InfoBionic, the developers of the MoMe Kardia.

1. Medicare telemedicine health care provider fact sheet. Centers for Medicare & Medicaid Services website. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Published March 17, 2020.