by Sarah Firisen
I just spent two months living on the Caribbean island of Grenada. It’s a wonderful place with a somewhat antiquated healthcare system. To visit Grenada, I had to have a negative PCR test within 72 hours of flying. I was planning to go to a clinic and wait in line, which I’d done for a previous PCR test. I’d waited in line in the freezing cold for almost 3 hours. But a couple of weeks before my flight in January, Jet Blue let me know that Grenada was accepting PCR tests through a company called Vault who would mail me an at-home test. I signed up, they sent me the test, and three days before my flight, I logged onto a Zoom call with Vault from the comfort of my own living room. My test kit had a barcode and I had to show that to the technician on the Zoom. She then watched me spit into the vial with the barcode and instructed me how to package up the kit appropriately to send it back. I walked it over to UPS 30 minutes later, and within 48 hours, I received my results by email.
A couple of weeks ago, towards the end of my stay in Grenada, I started to get some awful shooting pains in my right leg. A few days later, I woke up to a horrible rash that was blistering. I went on WebMD and put in my symptoms. Looking at the possible diagnoses it suggested, I was reasonably sure that I had shingles. I was able to look at photos of a typical shingles rash that looked a lot like what was all over my thigh. I took a photo of my rash, went online to my health insurer, UnitedHealthcare, and requested a telehealth video call. Five minutes later, a doctor came online. I uploaded the photo of my rash, told her my symptoms, and said that I thought I had shingles. She immediately validated my WebMD diagnosis and prescribed a course of Valtrex, which I could get filled at a Grenadian pharmacy.
One of the additional upsides of getting the diagnosis virtually, apart from the fact I was able to get it even though I was in another country, was that I was able to get it quickly. It’s important to get on Valtrex as soon as possible after the rash appears. Pre-COVID, I worry that I might not have been able to get a doctor’s appointment in a timely enough manner. And of course, it was because of the internet and WebMD that I was able to identify what I had very quickly and realize that time was of the essence in getting treatment.
There’s no doubt that healthcare is amongst the many things changed, probably forever, by COVID-19. Patients, physicians, and insurers have embraced telehealth as a safe and effective way to treat many issues that we would have previously trekked to a Dr’s office to deal with. During the pandemic, most insurers, including Medicare, paid providers at their full rates rather than the fractions they used to pay. My insurer UnitedHealthcare had a $0 co-pay for my telehealth appointments. Some of that is going to change post-pandemic, “Medicare’s coverage of a broad range of services is slated to end when the coronavirus no longer poses a public health emergency. Private insurers, which followed the federal government’s lead, could revert to paying doctors for virtual visits at a fraction of the cost for traditional visits, if anything at all. Some of the nation’s biggest insurers, like UnitedHealthcare and Anthem, say they haven’t decided beyond September or October on whether to extend the policies they adopted that allowed for coverage in lieu of doctors’ visits during the coronavirus crisis.”
In order for telehealth to continue to be widely used post-pandemic, there does need to be a financial model that works for everyone, particularly the doctors, “Unless they are required to by the states or federal government, a lot of carriers will try to reimburse less for telehealth than an in-person visit.” Just as with remote working and Zoom meetings, COVID has driven mass adoption and acceptance of telehealth and has shown that it’s a perfectly acceptable and efficacious way to deliver a lot of medical care. Of course, this does assume that patients have smartphones or computers and internet access, not always a given in the US, let alone in poorer countries. As it has with education and so many other aspects of our lives, COVID has highlighted and further exacerbated the inequalities in our society.
The use of personal and at-home monitoring devices is, and will increasingly be, a way to expand the utility of telehealth and the range of health conditions it’s appropriate for, “Online visits can be enhanced by Internet-connected devices that collect patient data at home and then send it to a doctor. These include fitness trackers, blood-pressure cuffs, pulse oximeters, and gadgets like Kinsa’s smart thermometer and TytoCare’s self-examination kit, which link up with a phone and make it possible to perform at least part of an annual wellness check on yourself.”
A few years ago, I ran an emerging technologies innovation workshop. One of the activities involved participants envisioning possible technologies that might be applicable to their industry sector. One group was very proud of themselves when they announced their innovation: the diagnostic toilet. We were holding the workshop in a hotel that had high-tech Japanese toilets that washed, dried, and even automatically raised the seat. They envisioned the next generation of these toilets where a person’s waste was automatically diagnosed for a variety of health issues. It was a great idea. Such a great idea in fact that it was already a thing: the smart toilet, “this toilet is fitted with technology that can detect a range of disease markers in stool and urine, including those of some cancers, such as colorectal or urologic cancers.” This kind of at-home diagnostic capability, combined with wearable fitness and wellness trackers could help expand telehealth beyond its current range of recommended conditions.
Post-pandemic, we probably won’t see a world where as many people are remote workers as there has been this past year. Some people will go back to offices. Eventually, some business travel and in-person travel will resume. But the wide-scale adoption and acceptance of the technologies that have made it possible for us to continue to work, learn and socialize while in lockdown are going to ensure that things will almost certainly not go back to the way there were pre- March 2020. And the same is true for virtual healthcare. Just as with remote working, when we were all forced to use telehealth or have no healthcare, we quickly adapted and found that it was pretty convenient. We’re still going to want to go to doctors’ offices for visits, there are things that are just better in-person, whether it’s a work meeting or a health check-up. But there’s been a paradigm shift in how we’re willing and able to use technology to access healthcare. It’ll be interesting to see how this matures post-COVID.