It’s a new world—in so many ways.
The last few weeks—even as I have watched my Zipnosis team dig deep into COVID-19 work with incredible dedication—I can’t help but think of post-Coronavirus healthcare. I have been following accounts of doctors in this pandemic who are profoundly changing the way patients are being cared for and, despite all of the trauma and disruption, I am hopeful that we might emerge in 2021 with vastly more efficient and higher quality healthcare in America.
At the beginning of the pandemic outbreak one practice, profiled in the New England Journal of Medicine, rapidly worked to prevent patients from coming into their clinic. Instead, they used telemedicine options to help patients safely get care at home:
“We are actively redesigning the way we deliver care to do what is best for our patients during this time of crisis. Some aspects of that redesign will likely persist after the crisis has passed.
I first heard this notion from a physician who was just starting the ordeal of deciding which patients did not really need to come in for their next appointments. After she was at it for a little while, her observation was, “Isn’t this the way it always ought to be?” In other words, shouldn’t we be trying to figure out how to take care of patients without making them come into the office if we could?“
Meanwhile, when discussing the significant changes as COVID-19 began to spread in the west, a clinic administrator in Oregon said:
“We have turned our organization on its head. Rather than welcoming in-clinic patients, OMG (Oregon Medical Group) is now trying to keep them away from its facilities and to treat them over the phone instead… A doctor’s typical workday used to involve a grueling schedule of up to 25 face-to-face meetings with patients. But that’s changed dramatically… In just two days, primary care providers have cut back to seven or fewer in-office visits a day per provider. Those are limited to seriously ill patients, said Karen Weiner, CEO of the Eugene-based 10-clinic, 750-employee system. Phone consultations – which used to be rare – have increased to 15 to 20 a day per provider, she said.”
The profound changes have also hit our own Zipnosis model. We have flipped from our historic and appropriate use patterns, referring sick patients to be seen in person, into our new COVID-19 model. We now let these patients be evaluated in our platform by local providers who can determine next best steps in this rapidly evolving situation. We are allowing chronically ill and potentially symptomatic COVID-19 patients to be diagnosed, treated, and referred by their trusted providers in their own health systems.
It will also be hard for us at Zipnosis to go back to our prior way of working with only the mildest conditions in healthy patients. As the former VA Secretary David Shulkin, MD, said when describing the VA’s new reliance on telemedicine:
“There won’t be any good reason to reverse it: ‘It won’t be possible to put that genie back in the bottle.'”
… and he wasn’t even referring to asynchronous telemedicine!
This pandemic is devastating, overwhelming, and tragic—but it is also an opportunity to reimagine healthcare in America. With social distancing across the country, hospitals are experimenting with telemedicine at a large scale for the first time. New workflows, innovative staffing models, national scaling of lab tests, reliance on guidelines… efficiency and quality will be key to every part of the new model.
The power of asynchronous care in treating high patient volumes has been proven throughout this pandemic. We have seen our own health system partners move to offering asynchronous care first, and only stepping up to synchronous when absolutely necessary, in the face of huge increases in patient visit volumes. Going forward asynchronous care will continue to be an imperative part of a health system’s virtual care mix. Without it, we cannot scale to provide the high quality health care our country needs.
With the possibility of intermittent social distancing over the next year, changing healthcare in America for the better is our challenge and our task.