Health care becomes more of a hybrid, digital world

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Even if you sit in a gown on an exam table and see your doctor in-person, the visit likely will have some elements of digital technology. 

Maybe you made the appointment online. Before you went to the office, you logged onto a text-based app that asked how you were feeling — and not just if you had COVID symptoms. Perhaps you left the appointment with recommendations for apps that can help you manage your condition or a device to monitor your symptoms. 

Robots that read the emotions of a patient, virtual reality and augmented reality are some of the ways that digital technology will integrate with in-person care in the post-pandemic world of health care. 

“I think it’s an exciting time,” said Michael Hasselberg, who holds a doctorate in health practice research and is senior director of digital health for UR Medicine. “The opportunities to create more personalized access and high quality care at much lower cost are more wide open now than they were before.” 

The terminology to describe visits that take place when doctor and patient are in separate places has broadened as options have expanded, Hasselberg said.   

Telemedicine and telehealth — which involve patients getting their care or communicating with their provider on the phone or through a video conference — often are used as synonyms.  

But the use of text-based and other apps, virtual reality, remote monitoring and artificial intelligence make the phrase “digital health” more accurate and comprehensive.  

While some forms of this care delivery have been around for several years, digital medicine took off during the pandemic. 

Initially, the growth was driven by the need to keep providers and patients safe in the early stages of the pandemic. 

For context, UR Medicine in 2018 had 1,931 telemedicine visits out of about 1.8 million office visits.  

In the week of March 8, 2020, there were 60 telemedicine visits out of 37,924 office visits — or 0.2%, which actually was a lower percentage than the previous week. The first COVID case in Rochester was announced March 11, 2020. Telemedicine visits rocketed in the next four weeks. By the week of April 5, telemedicine was 76.2% of all office visits. 

The trajectory was similar at Rochester Regional Health. In 2019, the system had five video visits with patients. In 2020, the number was 205,366. As of mid-December 2021, the system had 177,971 video visits. 

Dr. Hemant Kalia is an interventional pain and cancer rehabilitation specialist with Rochester Regional Health and treasurer of the Monroe County Medical Society. He said continued success will be based on three things: patient satisfaction, reimbursement by government and private insurers, and what the federal government says about the need for video and other technology used for remote patient visits to comply with the Health Insurance Portability and Accountability Act. 

For UR Medicine at least, patient satisfaction with remote visits isn’t an issue. Hasselberg said survey data show approval rates at 90% or higher on questions relating to willingness to continue with telemedicine.  

Kalia said that during the pandemic, reimbursement was the same for different types of remote visits, and was at parity with in-person visits. Also, providers could use unsecured video platforms such as Facetime, Skype and Zoom.  

Assuming those regulations stay beyond 2022, Kalia predicted that overall, between 20% and 30% of visits will be provided solely through digital medicine and the rest will be in person. But even those will have elements of technology. The ratio may vary based on the type of care. Behavioral health lends itself more to remote visits than physical therapy. Depending on the procedure, some surgeons could check in with patients using technology rather than having every post-op visit be in-person.  

“It will be a mixed model,” Kalia said. “For certain subspecialties and certain specialties, you definitely need in-person visits for some evaluations. Obviously, some follow-up can be done over telemedicine, in some cases much more effectively and efficiently than in person.” 

As a psychiatrist, Dr. Rory Houghtalen has found that for the most part, his patients are pleased with remote visits.  

“The vast majority, with the emphasis on vast and majority, of patients are in no rush to return to the office,” he said. “They feel this is just as good, in some instances better.” 

Exceptions may be among patients who struggle with technology or lack internet access. There also are instances where he needs to do a neurological exam or explore potential side effects of medications.  

As a patient, Houghtalen has enjoyed the convenience of video visits with his primary care doctor when he needs a periodic follow-up.  “I can keep doing what I’m doing. As soon as he appears, I switch over. … I didn’t have to drive to Henrietta from Penfield, wait in the office. I’d have to spend two hours for a 10-minute visit. Why would I want to do that? Why would my patients want to do that?” 

Dr. Bridgette Wiefling, chief physician enterprise officer and executive vice president at Rochester Regional Health, said it’s up to providers and patients as to how they want to schedule visits. She said she bases her use of digital medicine on patient preference and their health needs.  

“If they have a lot of chronic disease, I may want to see them every time in the office. If they’re pretty well controlled but I still think I need to keep tabs on them pretty good, I may do every other in the office and the other as a tele visit. If they’re pretty healthy, I may do the in-person physical and six-month follow as a video visit.” 

She said RRH plans to add a hand-held exam kit that transmits data over BlueTooth and can capture heart and lung sounds, perform an ear exam or check a sore throat.  

“It will be a game-changer for families to make a telehealth visit even more powerful,” she said. 

Garry Spink is a Ph.D. psychologist with Rochester Regional Health. He said he reviews and sometimes recommends apps that he thinks may encourage a patient to help them manage their symptoms. 

“For me, having a patient in a trusting relationship understand what we’re doing and why we’re doing it, that tends to help.” 

Spink said apps and other digital medicine devices are tools, and not all of them will work or be appropriate for every person. And, as with any tool, the user may need a lesson in how to use it.  

“Sometimes you need the guidance of a professional to figure that out,” Spink said.  

In the hybrid world of health care, that person will be able to get hands-on instruction or get someone to walk them through the process — whichever is best for the individual and the situation. 

Patti Singer writes about health and wellness. Contact her at [email protected]