As telemedicine transitioned from optional to essential in the spring of 2020, the Yale School of Medicine became an early leader in the field. Telemedicine was already an appealing option due to transportation costs and delays; illness or injury; and the risk of new infections. A number of Yale clinicians have offered remote visits for several years. Even so, telemedicine was not the default system of care until the pandemic struck. Yale Medicine (YM) and the Yale New Haven Health System (YNHHS) coordinated a rapid response, and the number of video visits increased dramatically. Where there might have been 34 on any given day pre-COVID-19, that number has since risen to 1,500, according to Pamela Hoffman, MD, medical director of Telehealth Services for YM and YNHHS.
Although ultrasounds and surgeries cannot be performed remotely, the range of appointments that can is extensive. So much medical care is cognitive, and telemedicine can provide access to a variety of specialists who can ask questions and observe physical manifestations. Patients can also check their own vital signs if they own the correct devices. “Certain specialties are particularly suited to telehealth, especially those whose consultations are strongly based on diagnostic tests and less so on the physical examination,” said Aldo Peixoto, MD, professor of medicine (nephrology) and clinical chief of the section of nephrology.
Departments defined by physical procedures can also use virtual appointments. “I anticipate that we will continue to use telemedicine in our preoperative screening process post-COVID,” said Jill Zafar, MD, director of presurgical evaluation at Yale New Haven Hospital. In the Department of Surgery at YSM, some 25% of clinic visits are being conducted remotely; ENT surgeons have implemented a novel destination program to conduct cochlear implant testing via telehealth.
Telehealth and research
“To participate in telemedicine at Yale, patients download the MyChart app and log in to connect with a provider for a scheduled appointment. The platform is completely compliant with HIPAA,” said Hoffman. If necessary, a telephone consult is a second option.
Elsewhere at YSM, the medical student curriculum was also upended by COVID-19. When training moved online and clinical rotations were suspended, students were eager to engage in other ways. Several new electives popped up, including two on telehealth. They may be incorporated into the YSM curriculum over the long term.
Progress, challenges, and the future of telemedicine
Yale sees a future in telemedicine after the pandemic. The platform used to perform ambulatory video visits was recently upgraded to accommodate more devices; share a screen; invite family members; and use integrated interpreter services. An inaugural telehealth symposium has been planned for the fall of 2021 and Facebook sessions focus on telehealth and the patient experience. YM Operations is also rolling out a virtual support team to provide the digital equivalent of services offered during in-person visits.
Health equity is a significant challenge that has yet to be fully resolved. “The pandemic has revealed the great potential of telehealth, but also the great risk of the digital divide—for patients who can’t connect at all; can only connect by audio; can only connect within narrow time windows; have limited English proficiency; and so many other barriers,” said Marcella Nunez-Smith, MD, MHS ’06, founding director of the Equity Research and Innovation Center (ERIC) and deputy director for Health Equity Research and Workforce Development of YCCI. “We can seize this policy moment and respond to the reality that connectivity is a critical health determinant and align incentives so all patients benefit from telehealth innovations,” she said. Karen Wang, MD, MHS ’12, is leading ERIC’s research efforts in this area. The center has a team of researchers from across YSM working on several projects related to telehealth and digital equity.
Before COVID-19, telemedicine in the United States accounted for an estimated $3 billion in health care spending per year, according to a recent report by McKinsey & Company. Going forward, that number could rise to $250 billion now that so many institutions have made the leap. Telehealth programs across YM and YNHHS have experienced spectacular growth over the past six months, with almost 325,000 video visits conducted to date. Yale physicians, patients, trial participants, medical students, and IT leadership have accepted the new normal with commitment, comfort, and optimism. If telemedicine is the future, Yale is poised to lead the way.
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Telemedicine refers to medical appointments made via video or phone. Telehealth describes the broader use of virtual technologies in health care.