A Telehealth Surge: Virtual visits change usage trends even as in-person services have reopened

Dr. J. Gavin Helton: Broadband issues impact rural patients.

Telehealth technology has improved dramatically since the early 2000s, when virtual connections to patients were few, and companies and hospitals were only just beginning to accept the idea. Following the COVID-19 pandemic, the relaxation of federal regulations and the ubiquity of stay-at-home orders, telehealth became a major way in which the industry juggled fewer in-person visits and the continuing needs of patients.

“COVID made it to where people needed it, because they were not able to get out,” said Citizens Memorial Hospital Chief Operating Officer Mike Calhoun.

Telehealth technology can be used to describe a doctor video conferencing with a patient, a hospital texting a patient as a follow-up to an in-person appointment to check on symptoms or a device that passively monitors blood pressure or sleep. Telehealth is effectively any method by which medical professionals can continue to administer or monitor care from a distance.

For St. Louis-based Mercy, telehealth services started in the mid-2000s, said Dr. J. Gavin Helton, president of clinical integration of Mercy Virtual. Helton said the system – which operates out of St. Louis and provides virtual care for patients across Mercy’s coverage areas, including Springfield – was well positioned to pivot and meet people’s new needs when the pandemic hit.

“We started using telemedicine in 2006 to care for critically ill patients at ICUs across the ministry,” he said. “We built those inpatient services as well as complementary ambulatory service in 2006.”

He said in-home telehealth care for Mercy began in 2015, describing the system as integrated with the traditional bedside and ultimately team-based approach, with the aim of higher quality, lower cost care.

The 2020 pandemic
The adoption of telehealth by patients of CMH and its rural footprint came later. But it came quickly.

“We had four virtual visits in May of 2019,” said Calhoun. “May of 2020, which would have been after we really ramped up our efforts because of COVID, we had 1,775.”

Since mid-March 2020, around the start of the pandemic, CMH has had 21,500 patients use its telehealth program.

Mercy reports a similar increase in the number of patients using its health services.

 In the Springfield market, the number of video calls went from one in the week of March 16 to 268 calls the next week. By May, Mercy was managing 2,108 telehealth calls.

Helton said the pandemic changed the landscape for telehealth features.

“Provider adoption from the traditional clinic and patient adoption both accelerated immensely as a result of the pandemic,” he said. “Things otherwise in the past that you might otherwise make an appointment for … became, ‘Let’s schedule a video visit, let’s utilize telemedicine.’”

Officials at Mercy and CMH say telehealth usage has dropped significantly since the lockdowns and pandemic pressures early on, but it still is much higher than it was before 2020.

“It’s tapered off a little bit,” Calhoun said, noting that in May 2021 CMH recorded almost 1,000 telehealth appointments.

As patients return to in-person visits, the demand for long-distance health care is dropping. But the realization that telehealth was available made a significant change to how people saw making an appointment.

“It probably will have a lasting impact on how we provide mental and behavioral health,” Calhoun said, “as that’s something people are seeking now that they know that’s available.”

Rural communities
Telehealth’s expansion as a medical tool also changed the way rural patients access medicine.

People in rural communities can face challenges accessing medicine as easily as urban residents. Distance can play a major role in whether a patient gets access to all the treatment they need.

Internet connection difficulties are the main problem that health care providers face when trying to reach patients in rural areas.

“It’s not so much on our side,” said Calhoun. “But we do get into some connectivity issues from the patient’s side. It’s still an issue in the rural setting.”

That connectivity issue has been recognized by local and federal governments. According to Missouri Department of Economic Development research, high-speed internet is lacking in pockets of southwest Missouri: central Dade County, central and southeastern McDonald County, far southwestern Barry County and eastern Taney County. The state of Missouri and the federal government have launched programs providing grant money to companies willing to supply broadband to those underserved communities.

Helton expressed his concern with connecting to rural patients.

“We have patients all over the state,” he said. “I think we are going to see that telemedicine helped so many people, but we could have helped more if we didn’t have the connectivity issues that we have in some of the rural areas in the states that we serve.”

Helton said the government efforts to expand rural broadband fit into consumers’ expectations that telehealth is part of providers’ menu of services.

A medical tool
Telehealth is limited, however, in the extent of what it can provide.

Karen Thomas, president of Springfield-based Cardeum LLC, has 20 years of experience in the telehealth industry. She was part of developing and securing funds for the first Medicaid-covered telemonitoring program within Missouri’s Disease Management Department.

“Telehealth is a tool, and it is a tool to provide care,” said Thomas. “It doesn’t replace the physician.

“It just provides the care remotely.”

However, Thomas said that it will not always be as limited as it is now.

“Years ago, video was more cumbersome and expensive, and there wasn’t 4G, 5G or Wi-Fi,” she said. “And now we can see into these people’s homes. And we can help them more than we have been able to do in the past.”

Companies and organizations are currently cropping up around the telehealth technology, offering analytic information and dynamic solutions that would be prohibitively tedious without the advances in the field.

Independence Blue Cross in Philadelphia has rolled out a telehealth program combined with predictive analytics to keep patients with risk of congestive heart failure safely at home. And Corstrata, a Georgia health care business specializing in wound and ostomy care, uses telehealth to help provide a costly medical service at lower prices.

Helton points to a program Mercy created for what he sees in the future of telemedicine.

In 2020, in response to the pandemic, Mercy took high-risk patients, those with immune system compromises, and enrolled them in a program with daily smartphone interactions. Patients were sent text messages to check on them and ask if they had escalations of symptoms or if they expressed the desire to go to the hospital. If the patients said yes, a health care professional would give them a video call to check in. This allowed Mercy to triage patients and prioritize in-person interaction for those who needed it most.

“I think it is a good example of what I hope health care is going to be in the future,” Helton said.