Telehealth in the ERA of the COVID-19 Pandemic

by Mary Pasquinelli, DNP, FNP-BC, APRN 

I work as a nurse practitioner in an outpatient oncology setting. As the COVID-19 pandemic hit Chicago, our clinic rapidly turned to telehealth to provide the safest care for our patients.

In March of this year, the COVID-19 pandemic brought stress and uncertainly to our healthcare system. Within the first week of the pandemic before we understood the importance of universal masking for both patients and staff, a cancer patient of mine was diagnosed with COVID-19.  This patient did not appear to present with the typical COVID-19 risk factors.  A low-income Black woman without a travel history, and she rarely went out of her home except to get groceries and to come to the clinic for her chemotherapy. I immediately realized that if this person has COVID-19, then this epidemic has taken root in the most vulnerable communities.

We had to quickly adapt to provide safe and effective care to our patients.  We changed our practices to require  universal masking, COVID-19 testing when needed, social distancing, and providing telehealth to most patients. The learning curve was quick with an “all hands-on deck” mentality. Looking back on these past six months, I am at awe of the resiliency I have witnessed in our patients and our healthcare team.

Telehealth, commonly used to connect rural populations to healthcare, proved to be a valuable tool to connect with our patients and continue to provide high quality health care. The Centers for Medicare & Medicaid dramatically expanded services to allows telehealth visits to be conducted and paid at the same rate as regular, in-person visits during the COVID-19 public health emergency. The Health and Human Services for Civil Rights provided flexibility to provide telehealth using communication apps like FaceTime and Skype.  The government now requires insurance companies to cover patient visits regardless of platform.  Insurance even covers phone-only encounters, important in my practice as many patients in our catchment area do not have mobile phones with data plans or computers in their home.

Despite many patients not having access to technology for video telehealth visits, even telephone only telehealth has the opportunity to overcome barriers that many of our patients face – barriers of transportation, taking off work, paying for parking, concerns of COVID-19, having physical condition which make in-person visits difficult. To understand the telehealth technology barriers and the patient perspective to telehealth, we conducted a survey in two specialty clinics (the pulmonary clinic which went >90% telehealth, and the medical oncology clinic which became of a hybrid clinic with in-person and telehealth visits). Of the population we surveyed, 42% stated they were concerned about exposures to COVID-19 when engaging in the healthcare system, 20% did not have a mobile phone with a data plan although they were able to connect to a telehealth visit using an alternative platform that included phone only visits. Of the patients who received telehealth visits 67% stated that their telehealth visit was just as good or better as a traditional in-person visit, they were able to express themselves effectively during their telehealth visit and their health concerns were adequately addressed. Only 9% said their telehealth visit was not as effective as  an in-person visit. When asked what type of visit they would prefer to have after the COVID19 pandemic, over 60% of patients requested to have the option of either an in-person or a telehealth visit, 14% would like to have telehealth for the majority of their visits, and 23 % opted to go back to in-person visits. Although telehealth reimbursement was recently extended, reimbursement for this option may not last indefinitely.

Telehealth has allowed us to continue to provide care to our patients as the healthcare system transforms due to the COVID-19 pandemic; it also has improved our ability for socially distancing in the clinic by seeing patients that did not have to come in to the clinic via telehealth. Telehealth provides the flexibility to meet a wider range of patient needs. Many of my telehealth patients have expressed gratitude for being able to continue to receive their healthcare during the COVID-19 pandemic, particularly those recovering from COVID-19. During these visits, we also discuss importance of masking, social distancing, and how they can best protect themselves and others from COVID-19. Moving forward through the COVID-19 pandemic, it is important that we continue to advocate for our patients and our healthcare system to provide patient centered care via the option of telehealth.

Dr. Mary Pasquinelli, DNP, FNP-BC, APRN is a nurse practitioner specializing in lung cancer screening, pulmonary nodule management, and lung cancer at the University of Illinois at Chicago (UI Health). She also serves as IMPACT’s Interprofessional Community Advisor.