Since the beginning of the Covid-19 lockdowns, physicians in small and large practices, and in major healthcare systems have been struggling to give patients more access to medical care without face-to-face visits.

For years advocate have urged greater use of electronic health technologies, in which phones, computers, online patient portals and remote monitoring devices can be used for patient-clinician communications. A New York Times story by Paula Span explains that federal agencies responding to the pandemic crisis have temporarily loosened restrictions and regulations on telemedicine, and that sweeping changers in healthcare delivery are likely to continue when the pandemic ebbs.

“This crisis has forced us to change how we deliver healthcare more in 20 days than we had in 20 years,” Dr. Robert McLean, an internist and rheumatologist and past president of the American College of Physicians told The Times.  The major barriers, he said, have been financial. Medicare has traditionally paid less for electronic visits than for in-person visits, and rural patients were often required to travel to an office or clinic rather than participate from home. In March, Medicare and Medicaid  removed those barriers, the story reports, and added coverage for many new tele-health services including emergency room visits, initial and discharge visits at nursing homes,  and remote monitoring for chronic conditions.  The Department of Health and Human Services also agreed to temporarily relax the HIPPA  patient privacy requirements  when providers used Skype and Facetime.

Another New York Times article by personal health columnist Jane E. Brody describes how people who receive health care using devices they already have in their homes can get result in faster diagnoses and treatments while efficiency of care is increased and stress is reduced.  A telehealth appointment, she writes,  can eliminate travel time, lengthy periods in waiting rooms, and risk of infection from other patients. Brody suspects rule changes that encourage use on telehealth will outlast the pandemic, and that many patients and clinicians will come to prefer electronic appointments. A technology-based health visit may become the new normal.

Brody adds that when a doctor has televisits with patients in their own homes, the doctor may be able to assess a patient’s living conditions and determine how they help or hinder health. For instance, she writes, if the patient gets up frequently during the night, is there an obstacle course between bedroom and bathroom that invites falls and injury? Is the bathroom safe for the physically challenged?

Electronic visits won’t completely replace in person visits. Some conditions require a physical examination, and some difficult conversations are bet done in person, unless the clinician and patient know each other very well.

Dan Halpren-Ruder, MD, PhD, CHCQM, is a former emergency room physician whose vision now is to create healthcare value by adding e-health and patient activation began his medical career as an emergency room doctor, then ran an urgent care clinic.  Over the years, he’s been involved in nearly every aspect of healthcare.  He has treated patients, learned the business side of medicine, and explored the role of innovation and new technologies in health care. He is now principal consultant to Healthcare Engagement Strategies in Providence, RI.  Dr. Halpren-Ruder believes patient activation may be the most cost-effective innovation in healthcare today, and he thinks telemedicine will be a major influence as patients become increasingly engaged in managing their own health. Read his primer on telehealth, which appears online in Patient Safety and Quality Healthcare.