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Perspective | Magazine

COVID-19 brought health care into the 21st century. Here’s what we need from telehealth next

The crisis has also ushered in a new era of virtual health that is long overdue, but we need to make sure it’s equitable for everyone.

An illustration of a patient talking with a doctor via smartphone.
Adobe Stock

Much attention has been paid to the health care system’s failures over the course of the COVID-19 pandemic: lack of testing and personal protective equipment for front-line workers, hospitals at capacity, byzantine websites for vaccine sign-ups. But the crisis has also ushered in a new era of virtual health that is long overdue. If we take advantage of the gains we’ve made, COVID-19 won’t just be a once-in-a-century pandemic — it will also be the spark for a once-in-a-century reinvention of American health care.

Nearly overnight, clinics like mine went from providing zero percent to 80 percent virtual care as our patients sheltered in place. Nationally, 46 percent of US consumers used telehealth in the first months of 2020, up from just 11 percent in 2019. And these virtual visits weren’t just for urgent complaints or COVID-19 screening: Patients received primary care, mental health care, and even specialty care such as physical therapy.

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Some of these trends will likely reverse as people return to doctors’ offices, but we’re witnessing a set of cultural shifts that will persist beyond the pandemic. Now, 76 percent of patients are interested in the use of telehealth in the future and 64 percent of doctors are more comfortable using digital health to connect with patients, according to a pair of May 2020 surveys by McKinsey & Company. More critically, 60 percent of roughly 1,600 health care providers surveyed last year report that telemedicine has improved their patients’ health.

As a physician, I welcome these shifts: The current, in-office patient experience is woeful. Asking patients with acute respiratory illnesses such as COVID-19 or the flu to sit in a crowded waiting room where they can expose themselves and others to infection makes little clinical sense. The move to care outside of the clinical setting can also work well for chronic diseases (where health outcomes are driven by daily behaviors such as exercise) and mental health (where stigma often deters patients from seeking care in a physical location).

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Rather than backsliding to the old ways of practicing medicine, this transformation in patient and physician attitudes toward digital health offers us an opportunity to make care more accessible, equitable, and affordable for everyone. But this won’t happen on its own.

There is already widespread evidence that the digitalization of care has left out underserved populations, such as minority and rural communities, those living in poverty, and the elderly. Prior to the pandemic, telehealth services were largely designed for urgent care and transactional visits, such as upper respiratory infections and rashes (rather than comprehensive or relationship-based care). They also showed limited results in improving health outcomes, and may have even increased costs.

Seizing this opportunity to improve telehealth for the future will require a holistic approach. In January, Governor Charlie Baker signed into law a telehealth bill that permanently mandates payment parity for digital mental health services, as well as parity for virtual primary care and chronic illness management through 2023. While this is a step in the right direction, additional measures are urgently needed.

First, we must invest in inclusivity. Virtual care can reduce health disparities by increasing accessibility for underserved people who face significant barriers to in-person care. But without deliberate efforts aimed at those communities, we risk exacerbating inequities due to the digital divide (which the education crisis has also brought into sharp relief). To help, New York’s largest health care provider, Northwell Health, started dispatching health care workers to elderly patients’ homes to set them up for their first virtual visits. In 21st century medicine, digital access will increasingly equal health access.

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We also must create standards and measure outcomes for virtual care. The difference is clear between a video appointment with a primary care physician familiar with the patient’s medical record and a five-minute audio-only visit with an ad hoc provider. We can’t risk recognizing both under the umbrella of “virtual care,” nor can we afford to pay for them equally. Rather than micromanage doctors to document each component of care, we should prioritize payment methods that measure patient-reported outcomes and experiences, like levels of trust.

Additionally, if we’re going to pay for virtual care like in-person care, we need to ensure that it is at least of equal quality. There’s a worrying increase in private companies offering virtual care that don’t adhere to the same standards as brick-and-mortar clinics. Many lack rigorous quality control and comprehensive electronic record keeping, and could pose privacy and security risks.

To fully realize the potential of digital health, more services and tests should be available at home. The cost of not doing so can be huge: The Food and Drug Administration originally prohibited at-home COVID testing, a desperately-needed tool that may have slowed the spread of the disease during a critical time. Just like patients can take pregnancy tests at home without a doctor’s order, they should be able to test themselves for other conditions like high blood pressure, diabetes, and colon cancer. We should also be able to deploy nurses and health care professionals into the home when needed.

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Perhaps most importantly, we should take this opportunity to reimagine how care really works for patients. We can’t take a broken experience and simply make it virtual. There’s no app for fixing health care. Fundamentally reinventing the entire system will require new partnerships — like that of AstraZeneca and Mass. General to digitally enable care for asthma and heart failure — and outspoken advocacy from patients, doctors, and policy makers.

A force outside of the health care system — a novel virus — was what finally brought medicine into the 21st century. Now it’s up to us to create a better future, not just for the next pandemic, but for all patients, all the time.


Dr. Shantanu Nundy is a primary care physician and chief medical officer of Accolade, which helps people navigate the health care system. His new book, “Care After COVID: What the Pandemic Revealed Is Broken in Healthcare and How to Reinvent It,” is available Tuesday. Send comments to magazine@globe.com.