August 15, 2020

Home Visits: Telehealth During and Beyond COVID-19

By Kennedy Salamat

Many Americans are afraid to take a trip to the doctor’s office during the COVID-19 outbreak. An estimated “40 percent [of older adults] put off non-essential treatment, while about a third went without preventative care” at the start of the outbreak in March (1). Moreover, a study found that towards the start of the pandemic, ER visits decreased by 42 percent (2). This poses a real issue, as doctors worry that heart attacks and strokes are going untreated, and non-COVID patients, including vulnerable populations living with chronic conditions, miss vital appointments for fear of contracting COVID-19 (3). When conditions go untreated, more severe complications may arise; in fact, approximately 30 percent of ER visits for chronic conditions may be preventable (4). So, how can individuals get the healthcare they need without being exposed to the virus? 

The rise of telehealth allows individuals to access their physicians via video-chat from the comfort of their own home, without the risks associated with a doctor’s office visit. Wearable technologies allow individuals with chronic conditions to monitor their symptoms, and provide blood pressure, temperature, and other necessary health data to their healthcare providers through apps. For example, continuous glucose monitors (CGM) provide constant blood sugar data to detect hyperglycemia or hypoglycemia in diabetic patients (5). Moreover, pulse oximeters, which are frequently used in hospitals, can constantly monitor oxygen levels in people with respiratory conditions, alerting healthcare providers to alarming spikes (6). Other sensors include accelerometers to monitor dyskinesia -- jerky motion -- in Parkinson's patients, as well as “ingestible monitors” that determine whether a patient has been regularly taking their medication (7, 8). The latter can be particularly useful for patients who are isolated due to COVID-19 and may not have family members around to remind them to take their medications. As wearable sensors such as blood-pressure devices and electrocardiograms detecting heart-arrhythmias further develop, patients will be able to better monitor their conditions at home, providing doctors with the information they need to make diagnoses and provide consultations and follow-ups through telehealth platforms (9). Telehealth has already developed to the point where the CDC recommends that people “talk to [their] doctor online… us[ing] telemedicine, if available” during the pandemic (10).

Beyond monitoring health conditions during the COVID-19 pandemic, the rise of telehealth has significant implications for the future of medicine. One well-established branch of telemedicine is that of telestrokes (9). Acute ischemic strokes are one of the most common causes of disability in the United States and should be treated immediately for the most effective results, as in some cases, “every minute delay in treatment from symptom onset would result in loss of 1.8 days of extra healthy life” (11). Many hospitals do not have a stroke specialist, so telestroke platforms allow neurologists to remotely diagnose the severity of the stroke and determine the necessary treatment (12). This demonstrates how telehealth can be critical in increasing accessibility to healthcare and enabling increased collaboration between healthcare professionals, especially as new technologies are developed during the pandemic to better enable remote diagnosis. Moreover, telehealth platforms such as health-monitoring apps can be critical in advancing research of various diseases.  For example, Oregon Health and Science University created a Mole Mapper app, where users take pictures of their moles, in an attempt to train a computer model to detect early stages of melanoma (7). Other similar health apps use wearables to monitor patients with epilepsy, COPD, asthma, and other health-related conditions and conduct remote research studies (7). The results of these studies could in turn improve telehealth platforms, by improving computer algorithms in order to catch diseases in earlier stages (7). 

Telehealth systems have the capacity to improve our everyday lives, by constantly monitoring chronic conditions, decreasing unnecessary hospitalizations, making it significantly easier, cheaper, and quicker to access a doctor, mitigating the risk of contracting a virus at the doctor’s office, and catching health concerns early through wearable technologies. As more and more healthcare providers and patients turn to telehealth in the age of the pandemic, telemedicine may become a more permanent establishment in our healthcare system, shaping the face of medicine.



Sources:

  1. Jaffe, I. (2020, April 28). Survey: 1 in 6 Older Americans Delayed Or Canceled Medical Care In March. Retrieved from https://www.npr.org/sections/coronavirus-live-updates/2020/04/28/847607008/survey-1-in-6-older-americans-delayed-or-canceled-medical-care-in-march
  2. Hartnett KP, Kite-Powell A, DeVies J, et al. Impact of the COVID-19 Pandemic on Emergency Department Visits — United States, January1, 2019–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:699–704. DOI: http://dx.doi.org/10.15585/mmwr.mm6923e1
  3. Stone, W., & Yu, E. (2020, May 06). COVID-19 Fears May Be Causing People To Ignore Medical Emergencies. Retrieved from https://www.npr.org/2020/05/06/851173949/covid-19-fears-may-be-causing-people-to-ignore-medical-emergencies
  4. Castellucci, M. (2019, February 07). Unnecessary ED visits from chronically ill patients cost $8.3 billion. Retrieved from https://www.modernhealthcare.com/article/20190207/TRANSFORMATION03/190209949/unnecessary-ed-visits-from-chronically-ill-patients-cost-8-3-billion
  5. Hanna, J., Bteich, M., Tawk, Y., Ramadan, A. H., Dia, B., Asadallah, F. A., . . . Eid, A. A. (2020, June 01). Noninvasive, wearable, and tunable electromagnetic multisensing system for continuous glucose monitoring, mimicking vasculature anatomy. Retrieved from https://advances.sciencemag.org/content/6/24/eaba5320
  6. Torp KD, Modi P, Simon LV. Pulse Oximetry. [Updated 2020 May 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470348/
  7. Cannon, C. (2018, April 04). Telehealth, Mobile Applications, and Wearable Devices are Expanding Cancer Care Beyond Walls. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0749208118300159
  8. Parkinson’s Foundation. (n.d.). Dyskinesia. Retrieved from https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Movement-Symptoms/Dyskinesia?gclid=EAIaIQobChMIl6Th48rS6gIVionICh3cuQFwEAAYAyAAEgJGY_D_BwE
  9. Cohen, A.B., Dorsey, E.R., Mathews, S.C. et al. A digital health industry cohort across the health continuum. npj Digit. Med. 3, 68 (2020). https://doi.org/10.1038/s41746-020-0276-9
  10. CDC. (2020, June 08). Doctor Visits and Getting Medicines. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/doctor-visits-medicine.html
  11. French, B. R., Boddepalli, R. S., & Govindarajan, R. (2016). Acute Ischemic Stroke: Current Status and Future Directions. Missouri medicine, 113(6), 480–486.
  12. Akbik, F., Hirsch, J. A., Chandra, R. V., Frei, D., Patel, A. B., Rabinov, J. D., Rost, N., Schwamm, L. H., & Leslie-Mazwi, T. M. (2017). Telestroke-the promise and the challenge. Part one: growth and current practice. Journal of neurointerventional surgery, 9(4), 357–360. https://doi.org/10.1136/neurintsurg-2016-012291