Virtual Care: Time to Develop Your “Screenside” Manner?

Virtual care, (telehealth/telemedicine), a highly efficient model of care to meet today’s needs in appropriate circumstances, was quickly and widely implemented in the midst of the COVID pandemic when the need for physical distancing became critical- and as billing constraints limiting its earlier adoption were relaxed. Stephen Klasko MD termed the impact of the pandemic on this previously underutilized model healthcare’s “Amazon moment.” For example, at Philadelphia’s Jefferson Health, where Klasko serves as President and CEO, the clinical team there was able to pivot from 50-100 virtual visits (VVs) per day to nearly 3,000. This transition required training over 1500 clinicians in providing virtual care.

A June 2020 survey of 1,000 patients (72% of whom were accessing a VV for the first time) who had recently experienced a VV demonstrated that

• Over 75% reported being very satisfied with their experience
• Close to 3/4 would like VV to be a standard part of how they receive care in the future; 50% would be willing to change care their health care provider to be able to access VVs.

As might be expected, the 3 top drivers of patient satisfaction were convenience, safety, and speed of access. The top 3 drivers of dissatisfaction were quality of care, impersonal experience, and technical issues.

Various healthcare organizations are working to better prepare physicians and advanced practice providers for best practices in providing virtual care. In April, the Cleveland Clinic published their COVID-19 Response Digital Health Playbook, which provides guidance for the clinician in establishing a relationship with a patient, expressing empathy during a VV, collaborating on the treatment plan, and using teach-back to confirm that you have communicated as intended.

Virtual care is particularly well-suited for the follow-up of patients with chronic disease who require frequent surveillance. In June, the Heart Failure Society of America published “Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America” describing the benefits and challenges of VVs, the policy and reimbursement changes that have allowed for wider use of VVs during the pandemic, the models of care for VVs, and a vision for the future of VVs.  The authors note that the COVID-pandemic has generated an important opportunity to learn about delivering HF care in a different modality. They explore whether the use of VVs might improve adherence, transitions of care, prevent emergency department visits, and hospital admissions (and readmissions)for patients with HF. Importantly, they call for the need to collect outcomes data to help guide the future of the incorporation of VVs into the standard of care.