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A crisis like this puts pressure on the system and forces it to adapt faster
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There's a lot we don't yet know about COVID-19 right now: does ibuprofen make it worse or not? What happens if you get it and recover? Does it do lasting damage to your lungs? These things are all in the air right now (no pun intended) and we might not get answers to them for a long time.
One thing is clear right now, though: the world will not be the same after this crisis finally ends. Every aspect of society will be at least somewhat altered, from how we consume entertainment, to how we vote, even what we eat. This is a potentially game-changing event.
The biggest impact, of course, will be on our healthcare system. The virus is still in its relatively early stages (though the death toll in the US is 545) but it has already exposed some deep cracks in the American healthcare system, some of which we already knew about, and some of which may have come as a surprise.
On one hand, we've all known for a long time that the number of uninsured or underinsured people in this country was unsustainable; when people can't afford to go to the doctor, they won't seek care, making a pandemic like this one potentially even worse. More surprising was the lack of available supplies, like hospital beds, respirators and, most shockingly, face masks for healthcare professionals. Overall, this has not been a great look for the richest country on the planet.
The question now becomes: what lessons will we take away from this crisis? What will our healthcare system look like when this is all said and done and how far will the coronavirus push us into the future of where medicine was likely already going?
Overwhelming the healthcare system
One of the potential problems that healthcare officials have been citing most frequently in recent weeks is the stress that will be placed on a system that is unprepared for the coming onslaught of cases; that doesn't just include those who are sick, but also those who are scared and worried and want to be tested.
Already there has been an influx of people into the system; for example, a spokesperson for Providence St. Joseph Health, Southern California told VatorNews that calls to its telemedicine solution, called ExpressCare Virtual, increased 400 percent in California in just six days. System-wide, it went from 70 visits per day to over 350 visits per day, a 500 percent increase.
Adrian Aoun, CEO and Founder of Forward, a healthcare startup that operates its own clinics, told me that the number of patients accessing its services was recently 400 percent above the norm, and that in a few days it increased by a factor of 6x.
"A lot of people are worried about the virus. Some of these folks are actually fine and they’re just scared and worried, but some of these folks are very high risk. We’ve been doing testing and obviously we’ve been finding folks that are positive and working to treat them as best we can," Aoun said.
One problem with the healthcare system as it currently stands, he explained, is that while technology has improved the vast majority of industries, "healthcare is really still living in the past in that regard."
"There’s less than 650,000 primary care doctors in the United States for the 325 million folks that we have, so we know that it’s an order of magnitude less than we need. What happens right now is you have an enormous amount of people who are sitting there going, ‘I think I might be COVID positive,’ but they can’t even go see a doctor," he said.
Mohammad Gaber, founder and CEO of healthcare payment platform WellPay, compared what might happen in the U.S. in regards to the coronavirus to what happened in Italy, where too many people tried to access their healthcare system at once, forcing doctors to turn patients away, basically choosing who lived and died.
There is fear among providers in America, Gaber said, that something similar could happen here, and he believes the best solution is for there to be clear and open communication between doctors and their patients.
"There needs to be a fair amount of communication in regards to how patients should react, what they should be doing, and how these providers should be preparing for a potential influx of patients into their clinics. How can they handle that in a way that doesn't put their employees at risk? This is what we’re hearing from the front lines of providers who are rightfully getting a lot of questions from the patients that they see on a normal basis. There isn't enough information out there on how they should be handling that patient scale at this point," he said.
"They need to be prepared for what’s going to be a lot of patients who have a lot of questions and showing a lot of symptoms that are overlapping with the flu that is going around as well. They need to have up to date information, and to know to leverage digital tools to communicate with their patients who are going to be concerned. A lot of these things are going to be very valuable."
Technology to the rescue
Of course, the most obvious way to alleviate the pressure on the medical system, and the providers themselves, is with technology that can lighten some of that load, while also keeping them, and their patients, safe. The bigger question is: what technology will actually help in that regard?
Numerous hospitals and providers have already been looking at expanding telemedicine services, which allow doctors and patients to connect without risk of anyone getting sick; these are services that the Trump administration has been pushing and helping to open up access to.
"We believe that all in the medical delivery community are encouraging care providers to accelerate use of certain technologies proven effective in advising patients, inclusive of tele-visits, e-visits, and video visits," Dan Robinson, Chief Administrative Officer at Hill Physicians Medical Group, told me. Hill Physicians is a network of independent doctors in Northern California, with more than 4,000 primary care physicians and specialists.
"Plans and medical groups are closely examining their reimbursement protocols for such physician-patient interactions to ensure that no unintended reimbursement barriers interfere with use of this technology. The benefits are obvious: it creates greater access to care for patients, and helps reduce the opportunity for exposure leading to spread of the virus."
Indian Health Services, an agency within HHS that provides health services to over two million American Indians and Alaska Natives, has also been using an increasing number of telehealth services.
"Many of our facilities are using telehealth by replacing office visits for things such as prescription refills for chronic conditions with phone calls for some patients. Many service units are screening individuals for COVID-19 either by phone or prior to the patient entering our health facilities to determine their risk for COVID-19 and to prevent additional infections within our facilities," a spokeperson told me.
"This week, HHS announced unprecedented steps to expand Americans' access to telehealth services during the COVID-19 outbreak. CMS expanded Medicare coverage for telehealth visits and the HHS Office for Civil Rights announced it will waive potential HIPAA penalties for good faith use of telehealth during the emergency. This opens up the possibility of using widely available tools such as Skype and FaceTime to conduct telehealth visits."
Aoun, however, isn't entirely quite convinced that telemedicine is the answer, at least not in its current form of simply talking to a doctor over video chat.
"Everybody talks about telemedicine but the reality is that the vast majority of medical interactions these days are still done in person. And even when they are done through telemedicine, they’re pretty weak because we know that the doctor that’s watching us over video isn't really going to understand what’s going on with our bodies," he said.
What we actually need, Aoun said, is "telemedicine that actually works." And by that he means lots of sensors to allow doctors to be able to monitor their patients remotely, so they can actually see how they are doing even during a virtual visit.
"Our view of the world is really what you need to do is be able to reach people where they are with a very light touch and be able to keep an eye on them. Think sensors in the home, think sensors monitoring your body, think sensors radioing back to systems that are keeping an eye on you, going, ‘You’re doing ok, but you need the doctor to start paying attention and diving in.’ Think of this as some form of automated triage, that’s becoming more and more important than ever," he said.
In a crisis like the coronavirus, something like this, which was once a nice to have, now becomes a need to have, especially as it becomes more and more difficult for people to see their doctor in person.
"Literally your only choice if you want to see a doctor is to either wait in line and hope that you get to the front, or to start using technology. The first thing is we’re not going to be able to scale doctors if we don't give them very good tools."
A vision for the future
So what does the healthcare system actually look like when the coronavirus eventually fades away? According to Forward's Aoun, it's actually not going to be all that different, at least not in the short term. But he believes that this will put us on the longer path towards where he need to go.
"I used to work at Microsoft and Bill Gates told me, ‘People always overestimate the amount of change that will occur in one year, and underestimate the amount of change that will occur in 10.’ Everybody who says the world is going to look entirely different from a healthcare perspective in the next six months is probably a little fanciful. It takes time for real change," he told me.
"That being said, what’s more important isn't the change that we’re going to see in the six months but the movement that we’re seeing right now. We’re changing the trajectory more than we’re changing the absolute."
While every hospital isn't going to be handing out 1,000 sensors to every patient any time soon, eventually he believes they will, and that "It’s very clear that they are all on a path towards doing that now."
When it comes to positive impact of the coronavirus, Gaber was sensitive when assigning any potential good that might come out of this, given the amount of human suffering going on, while also acknowledging that there is some upside.
He called what's happening right a stress test for the system, one that brings out the weaknesses in the system so we can go in a fix them.
"Obviously, with the ultimately sensitivity to the human impact that’s going on right now, one of the things that is part of these crisis, these stress tests, is it shows some of the weaknesses in the existing models in how you disseminate information, how you communicate with patients and how you deliver information to patients so they’re informed. If there’s any positive out of these crisis situations is does accentuate and share the weak spots," he said.
"My hope is that as we emerge from this, and hopefully we do very quickly, that some of those lessons are used and acted upon. How do we do more telehealth? How do you keep those citizens from going into a financial shock? This is going to be a good learning moment for everybody."
(Image source: medisigndisplays.com)
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