HRI, affiliate Dr. Liaw discusses the basics, benefits, and challenges of virtual doctor visits during COVID-19 public health crisis.

In the midst of the rapidly evolving COVID-19 public health crisis, we might be seeing the future of health care delivery in action with the expansion of telehealth, or virtual doctor visits. To help contain the spread of the disease, and in preparation for a potential onslaught of patients to hospitals around the country, new laws and guidelines have been fast tracked to increase the availability of telehealth services. In other words, people can communicate with a doctor without ever visiting a health care facility, thus limiting the risk of exposure and spread of the coronavirus.


Dr. Winston Liaw, chairman of the UH College of Medicine Department of Health Systems and Population Health Sciences, led the first study on the relationship between telehealth use and access to primary care. The published research, conducted before the current crisis, found that 90% of telehealth users chose a video visit for convenience and saved several hours of time. Now, circumstances are different and the increased access to telehealth could help save lives.


Dr. Liaw discusses the basics, benefits and challenges of telehealth in the following Q&A.


1. There will be many people using telehealth services for the very first time in the coming weeks. How do patients get started and what advice can you offer to make their virtual doctor visit successful?  

Many practices, health systems, and insurers are offering telehealth options. I would contact your health care team to see if virtual visits are a possibility. In addition, there are online companies that offer video visits with clinicians 24/7. 


To prepare, I recommend making sure you are clear about the goals for the visit. Do you need a refill for a medication, a recommendation for how to approach a new symptom, or information regarding COVID-19? Clarifying these goals will increase the likelihood that you will get the services and information you need and will inform which virtual option to pursue. 


To get the most out of the visit, approach the encounter like you would an in-person visit. Make sure that you are in a quiet, private space so that you can communicate information accurately. Since you may be sharing sensitive information, you will want to be in a space that makes you feel comfortable. Before the session, check your internet connection, and if possible, make sure that the software works on your device. Depending on the issue that you have, you may want to collect relevant information, including your medications, weight, sugar readings, blood pressure measurements, and temperature. If you have insurance, you may want to check with your insurer to determine whether or not the visit will be covered. 


2. You have done extensive research on the value of telehealth. What benefits can patients expect when compared to an in-person doctor visit?

The main benefit is access. There are numerous barriers that interfere with getting care. For example, individuals may be unable to afford transportation, get off work when the clinic is open, afford childcare, or easily navigate the facility due to mobility issues. Video visits reduce or eliminate many of these barriers. In our study of users and nonusers of video visits, we found that users saved two hours by using the video visit. Nearly half of the users of video visits reported that they could not get an appointment to see their doctor that day.  


3. The availability of telehealth services has been increasing in recent years, but not to the scale expected during the coronavirus pandemic. Is the health care system ready to handle the influx of patients seeking virtual care?

Anecdotally, I’m seeing signs that the health care system is rapidly embracing virtual care. The Lone Star Circle of Care clinic at the University of Houston is converting many of its in-person visits to telephonic or video visits. This is particularly important for individuals with multiple chronic conditions who are at high risk for complications from COVID-19. My previous clinic in Virginia (Fairfax Family Practice Centers) has been doing video visits since 2015. Historically, they averaged six video visits each month. Over the past month, my colleague there, Alex Krist, informed me that they conducted over 4,000 video visits, and this week, all of their visits are virtual. The technology has been available for years, but until now, we lacked the demand, incentives, and policies.  


4. What challenges do you think health care providers will face as federal and state agencies are revising guidelines and reducing barriers to telehealth access?

Clinicians will need to adapt to this mode of delivery. Because the type of information that can be obtained is limited, the questions asked are different for video visits. Relationships and trust are critical in health care, so clinicians will need to develop and cultivate a bedside manner that translates to the medium. Even though studies have found that the quality of care delivered is similar for both modalities, clinicians will need to determine how they will make accurate diagnoses without being able to physically touch patients. They will need to identify those conditions that they feel comfortable diagnosing and managing through video visits. Finally, they will need to decide whether they can treat individuals they have never met in person. 


Similar to other industries, hospitals and clinics are suffering financially. While these visits are reimbursed, the amount can be lower than in-person visits. This has already led to staffing reductions and hospitals and clinics that are on the verge of closing at a time when these entities are needed to respond to the COVID-19 pandemic.  


5. Depending on how successful, or not, telehealth works during this pandemic, do you see this as an opportunity to redefine health care? 

Yes. While telehealth has been expanding due to an explosion of online companies, it has primarily been used to manage acute issues, like injuries, colds, and allergies. Video visits have always made more sense for managing chronic diseases like depression or diabetes where the relationships are longitudinal and the physical exams are less critical, but this would require practices to adopt the technology. With the introduction of electronic health records over the past decade, these practices have been reluctant to invest in additional software, and their tolerance for more change has been low. In a national survey of family physicians, my colleagues found that the main barriers to telehealth adoption were lack of training, inadequate reimbursement by insurers, cost of the equipment, and liability concerns. The current pandemic has forced the system to adapt, and health care leaders now have their eyes on the future. Rather than focus on just this week’s needs, practices are developing telehealth systems that will continue to help patients in the next month and year.  

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