Telecardiology advances rapidly in COVID-19 era
The COVID-19 pandemic continues to challenge our health care system to deliver essential inpatient and outpatient care to infected patients while continuing to treat patients with non-COVID-19-related illnesses.
All of this is occurring in a challenging environment intended to minimize spread of this virulent virus. The telehealth techniques that have proliferated to address this increased demand for medical care will have lasting and profound effects on the future practice of cardiology.
Telehealth is not a new concept. Cardiologists have long made use of transtelephonic monitoring of pacemakers, and more recently use other biometric devices and cardiac imaging procedures for both live and asynchronous data transmission to our offices and hospitals for interpretation and management recommendations.
With COVID-19, we quickly recognized the convenience and value of person-to-person tele-video communication with our patients outside the hospital and office settings, especially for those patients needing post-acute care or experiencing chronic illnesses such as HF and hypertension.
Potential of telehealth
Properly applied, televideo can improve our efficiency and deliver more and better care than many routine in-person office visits. Televideo is especially effective in providing education and individualized support, increasing patients’ compliance with both medical and lifestyle interventions, which in turn improve patients’ quality of life while avoiding the expense and inconvenience of nonessential office visits, unnecessary urgent care and avoidable hospitalization.
The stress the COVID-19 pandemic has placed on our health care system has exposed deep-rooted inequities in health care delivery in our country. Socioeconomic, racial and geographic disparities extend far beyond COVID-19. The acute, chronic and worsening shortage of physicians has heightened recognition of the power of televideo communication to supplement in-person care and appreciation of the essential role nonphysician members of the health care team play in expanding productivity to bring high quality care to more patients with CVD than otherwise possible.
Cardiac images, electrocardiographic and hemodynamic recordings of other data relevant to CV diagnosis and management are now commonly recorded in digital formats that are well suited to transmission to centralized sites for expert interpretation, often with the assistance of machine learning and artificial intelligence. Telehealth certainly does not eliminate the need for in-person evaluation and treatment but can focus and supplement these visits to make them more valuable and productive.
Telecardiology may permanently replace some or many routine in-office cardiologist visits even after COVID-19 abates. We have learned that much of what is customarily accomplished during in-person visits can be done in the comfort of the patient’s home, and we don’t need to have a horse and buggy to make house calls. Medication compliance and lifestyle modification may especially benefit from in-home consultations. While there is no denying the importance of a direct hands-on physical examination, the value of nonverbal communication, and respect for the cultural and psychologic expectations of both the patients and their physicians, improvements in the technology of telemedicine and monitoring devices and adoption of online communication by society in general are fostering gradual acceptance of telemedicine as real medicine.
Issues to address
Many questions remain to be answered. When is it appropriate for a cardiologist to see an established or new patient by televideo rather than in person? How should televideo visits be coordinated with in-person, in-office and inpatient care? How should we handle televideo visits initiated by a patient who has no previous or ongoing relationships with a health care team? What are the implications for communication with other health care providers? Much of the ultimate utility and acceptance of telehealth will depend on interaction with a patient- and doctor-friendly, problem-focused, nonredundant, open-access electronic medical record coupled with respect for patients as individuals, promptly and definitively responding to their needs in a time of stress.
How will telehealth visits be compensated going forward after COVID-19? Several measures are now before Congress to extend and expand emergency payment for telemedicine visits. How will fees for telehealth visits be compensated in fee-for-service vs. value-based systems of care? Health insurance rules and professional licensure laws need to be updated to recognize the flexibility of the telehealth environment, which does not depend on the relative physical, geographic location of the patient and the doctor. Infrastructure proposals are under consideration to provide wide broadband internet access, essential for effective telemedicine, to socioeconomically disadvantaged neighborhoods and rural locations. How will the traditional health care systems relate to the shift to proliferation of services delivered at retail stores and online operations?
The unprecedented demands COVID-19 has placed on our health care system has exposed fundamental weaknesses in the current delivery system, not just in socioeconomically underserved communities. The hope is that our professional societies, the biomedical and health care industries, hospitals, clinics, insurance companies and governmental agencies will come together to coordinate effective and equitable application of this new telecardiology paradigm for better care of our patients.
For more information:
L. Samuel Wann, MD, MACC, FESC, is a cardiovascular specialist at the University of New Mexico. He is also Section Editor of the Practice Management and Quality Care section of the Cardiology Today Editorial Board. He can be reached at firstname.lastname@example.org.