Telemedicine as Part of the Patient Journey
Ophthalmologist Giselle Ricur, M.D., is a zealous advocate of telemedicine, preaching its gospel not only to her colleagues at the University of Miami Bascom Palmer Eye Institute (BPEI) but also traveling the world to promote its many uses. Her enthusiasm is evident in the excited tone of her voice and her deep knowledge of digital health.
She explains that telemedicine is the nexus between medicine and technology, the use of newfangled hardware and software, such as digital communication platforms, to deliver care to patients remotely, whether they’re the next neighborhood over or well across the globe. It’s about access to specialized treatment, efficient use of time and knowledge, and offering training and guidance to medical surrogates in far-flung places.
To the skeptics, Dr. Ricur describes the ever-evolving field of telehealth as a journey. “You as a patient are on a journey, and I as a physician am on a journey,” she says. “Each of those journeys have multiple touchpoints for care. Some care can be delivered virtually, some must be in person, but the opportunity is there to do both.”
Rapid Virtual Eye Care
As the executive director of virtual care at Bascom Palmer, Dr. Ricur wants to change the delivery of medical care and widen patients’ options.
“Maybe a patient can have a virtual first visit, and the concern is resolved then and there,” she says. “But maybe that’s not enough and the patient has to come in to have blood drawn or for an ultrasound. Or maybe you start with an in-person visit and do follow ups virtually. The point is that there are opportunities to look at what the patient needs and how the physician can meet those needs.”
In 2021, Bascom Palmer launched its Rapid Virtual Eye Care (RVEC) program, which enables patients to self-schedule within 48 hours. This allows them to consult quickly with clinical providers regarding their eye concerns. More than 16,000 patients have been seen through RVEC, out of the total 30,000 patients who have availed themselves of virtual visits.
Telehealth entered the public consciousness during the COVID-19 pandemic. Though not new, its use had been limited before 2020. With the need for self-isolation, however, patients — and doctors — found virtual visits an essential alternative.
Pre-pandemic, telehealth use hovered under 1%. It accounted for 80% of health care delivery during some weeks of lockdown before settling into roughly 10% to 15% of care across the U.S. now.
“In 2020,” Dr. Ricur explains, “the whole country had to suddenly shift [the way health care was delivered.] We were able to do more in 30 days than we had done in 30 years.”
Adapting to a new way to deliver health care
People quickly learned to use specialized platforms, and government agencies and private insurance companies changed their regulations to accommodate the increased use of the new health delivery method. The U.S. Department of Health and Human Services expedited the adoption of telehealth by changing some of its regulations and reimbursement rates. A few of those regulations and changes were permanent — mostly for mental health care — but others were temporary and are due to expire at the end of this year. The temporary adjustments include restrictions for originating care sites and providers.
This concerns Dr. Ricur and telehealth advocates. If government and insurance payers pull back, patients’ options will be limited. Some will find it more difficult to receive the care they need. The most affected, she adds, tend to be the most vulnerable: those in rural areas as well as those who don’t have access to specialists or transportation.
A coalition of health organizations, including the American Medical Association, the American Telemedicine Association and the American Association of Medical Colleges, is working to help government and insurance policymakers find the best way to continue offering telemedicine as an option.
“We’ve accomplished so much and now we risk going back to the Stone Age,” Dr. Ricur says. “Why can’t we use the lessons we learned [during COVID] and move forward so it becomes part of our routine model of care?”
The history of telemedicine
Telemedicine, she points out, has a long and illustrious history, dating back to ancient times when civilizations leveraged the technology at hand to deliver remote care. She cites how Egyptian and Greek civilizations used proxies that carried papyrus with medical instructions to inform treatment. Europeans utilized bonfires around a village to warn travelers of the plague. Eventually, as forms of communication became more sophisticated, telegrams and telephones and radios served as a means “to better assist the care of a patient,” Dr. Ricur says.
Modern telehealth traces its roots to the space race of the 1950s and ‘60s, when NASA used communication technology to monitor and care for astronauts thousands of miles away. Even now, the U.S. agency is using a new device with the recently launched Polaris Dawn crew. It will collect heart rate, respiration rate, temperature, and blood pressure in real-time. In addition, the experimental telemedicine device can provide ultrasound imaging and other video camera capabilities.
Awareness of telemedicine benefits
Part of Dr. Ricur’s mission is to raise awareness of the benefits of telehealth. But in some cases she must first expand the way providers and patients view it. Many think of telemedicine as virtual visits to the doctor, but it is so much more than that. Think of it as an e-health system. In other words, telehealth helps patients manage their health care on mobile devices, whether it’s researching symptoms or visiting a health portal for test results. Telehealth can also help with physical or occupational therapy and deliver real-time information through smartphone or wearable health apps.
Patients like it because of the convenience. Sylvester Comprehensive Cancer Center’s Virtual Clinic, for example, delivers quality care while also saving cancer patients time and money. It can be particularly helpful to patients from other Florida counties who receive initial treatment at Sylvester clinics. Their oncology team can continue monitoring their progress even if they don’t live near a cancer center. Researchers have determined that telehealth visits save patients an average of 2.9 hours of roundtrip driving time and 1.2 hours of in-clinic time per visit. It also prevents them from missing work.
From the health care provider’s perspective, telemedicine offers increased access to professional education and training. In addition, medical simulations—whether in the classroom, operating room, or metaverse—provide point-of-contact providers with the advanced knowledge of a specialist when one is not readily available onsite. Advances in nanotechnology, artificial intelligence, 3D printing, and robotics are already revolutionizing medical care.
There are also many advantages to the health system as a whole. Providers can expand their outreach. Logistics for mass screenings and public health education improve. And costs and waiting times decrease
Dr. Ricur recounts how a patient experiencing eye floaters — small shapes that “float” in a person’s field of vision — can have a virtual consult with an ophthalmologist within a couple of days rather than waiting for weeks for an office visit. The virtual visit addresses immediate concerns while also establishing a form of triage to bump up the more serious cases to the front of the in-office line.
“How we incorporate [the technology] helps and supports better medical decisions,” she says.
Telemedicine’s limitations
However, Dr. Ricur does provide certain caveats. Telemedicine is not a panacea. It is not useful in all situations and disciplines.
“There are times you have to put your hand on the body,” she says. “Telemedicine is not meant to replace but to augment delivery of care. We should think of it as an umbilical cord to the health care system.”
Implementing its use also provides challenges. Patients need to have internet access and some comfort in navigating technology.
“The digital divide is not about age but about access to broadband,” Dr. Ricur explains. “During the pandemic we originally thought that senior citizens wouldn’t use it, but once they learned to go online, they used [the platforms] to access their doctors and to keep in touch with loved ones.”
But if a patient doesn’t have access to a device or the Internet, telehealth is simply not an option.
Dr. Ricur is hopeful about the use and expansion of telemedicine. She believes that a hybrid model of in-person and virtual care is the best way forward and foresees providers setting up individualized system features — and safeguards — that are best suited for their patients and practice.
“At the end of the day, I’m just trying to see my patients,” she says. “I’m just trying to use my know-how to deliver care in the best way possible.”
Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow her on Twitter: @AnaVeciana.
Tags: Bascom Palmer Eye Institute, Dr. Giselle Ricur, rapid virtual eye care, technology in medicine, telehealth, telemedicine, virtual eye care clinic, virtual visits
