A new day has dawned in the way UAB doctors treat their patients, interacting with them by video or phone with telehealth.

Dr. Eric Wallace has led UAB Telehealth since 2017 and also is an associate professor of nephrology. (Holly Gainer/UAB)

On April 29, the hospital saw 1,400 patients with a video visit  – a 350-fold increase in video visits. The month before, UAB doctors averaged only three telehealth visits per day. UAB eMedicine Director Dr. Eric Wallace said the huge jump shows that during this pandemic, many patients and providers are choosing a telehealth visit over an in-person appointment.

As people continue to engage in social distancing during the COVID-19 pandemic, telehealth has rapidly become crucial to the way UAB doctors provide medical care, allowing patients to receive excellent care outside an office.

Telehealth uses video technology to facilitate a two-way, real-time interactive communication between the patient and physician or between physicians, by computer screen and telephone.

“Because of the COVID-19 and constraints of social distancing in a waiting room, patients are weighing the perceived risk of being cared for in a doctor’s office,” said Wallace, a nephrologist at UAB. “The success story is that 60 percent of visits can be handled through telehealth. In many cases, patients have been willing to bypass needed medical appointments for months, which isn’t good for the patient.”

Patients are receiving care for primary care visits as well as health issues for specialized care, such as neurology, transplant and  genetic diseases, for example.

“We are seeing that patients like video better than the phone,” said Wallace, medical director of UAB eMedicine since 2017. “To me, the most telling thing is that 90 percent of patients say they would do a telehealth visit again.”

Recent changes in regulatory rules for Medicare, Medicaid and commercial insurers have allowed the growth of the service.

“It took the COVID-19 crisis to allow us to unleash the benefits of technology in healthcare delivery,” he said.

UAB rapidly trained more than 2,500 doctors, nurse practitioners, physician assistants and other medical staff using an educational module by HealthStream.

“UAB eMedicine had to train everyone in rapid form to do telehealth in a matter of weeks to make sure that they understood how to do it, and do it right,” Wallace said. “The handwriting was on the wall about a week before March 13, when the president declared the coronavirus pandemic a national emergency. It’s nothing short of a miracle we are able to provide this level of care and transform our healthcare system in a matter of weeks. Our doctors knew we had to do this, and they made the choice to do telehealth for their patients because they cared for and about their patients. Without telehealth, patients who needed care would not have been able to receive it, thus putting them at risk.”

He noted some medical situations do not fit the “footprint” of digital requirements – one-on-one care may be required or a patient may be unable to do video visits – but a majority of doctor visits can be conducted by telehealth.

Telehealth conserves resources

The coronavirus has been devastating to the economy. Those losses are also affecting hospitals and doctors who lose patients who fear coming in for annual checkups, and could force some hospitals to decrease salaries of doctors and nurses at a time when they are desperately needed.

“Telehealth has allowed us to minimize those losses,” Wallace said. “The last thing you want to do is let doctors and nurses go during a national healthcare crisis that is going to require more doctors and nurses, not less.”

Telehealth has allowed UAB Hospital to minimize the use of personal protection equipment (PPE), such as N95 masks.

“The more patients that can be cared for over telehealth, the less PPE we need to use,” Wallace said. “This allows us to conserve PPE for situations where it’s absolutely required. We’re using technology to our advantage.”

Pandemic highlights need of high-speed internet

The pandemic has underscored the requirements for high-speed internet. In Wallace’s mind, the internet is no longer a luxury – it’s a requirement.

The Federal Communications Commission recently unveiled the Connected Care Fund, a new program to help healthcare providers access the broadband resources they need to support telehealth programs. Connected Care aims to improve telehealth access in rural areas.

“We must recognize that not having internet service is creating a health disparity. The disparity is the addition of video to their visit which requires internet and allows for physicians to do a physical exam,” Wallace said. “We must start getting people the internet. Alabama needs to prioritize broadband access for all on a state level and get all the federal funds we can.”

“The internet is now how we do commerce, it’s health care, and it’s education. Without internet in every home we put our state and our country at risk,” Wallace said. “If we’d not had telehealth, the only option would have been to drastically reduce the number of doctor’s visits at a great loss to both patients and healthcare. We must ensure that telehealth remains an option for patients even after the pandemic has subsided.”

In the midst of the pandemic, Wallace said that it’s critical that people not ignore symptoms and postpone needed healthcare.

“The after-effects of thousands of people delaying care will be revealed in time with more strokes, heart-attacks and chronic kidney disease, all preventable had basic care been given to prevent these illnesses up front,” he said. “Telehealth allows us to do that. We cannot delay care to a future date or when COVID-19 is “over,” because we do not know when that will be.”

In the long-term, telehealth may also provide a large cost savings, with a reduced need for buildings and infrastructure.

“The unfortunate reality is that telehealth reimbursement is set to expire June 1 of this year, and has in general only been allowed to continue on a month-by-month basis,” Wallace said. “If reimbursement goes away for telehealth by insurers, so will all of the benefits that patients and providers are benefiting from today. Longer term, permanent telehealth reimbursement is vital to the healthcare in our state both now and in the future.”

“Telehealth is a win-win for everyone,” he said.