Five cardiologists and service line leaders discuss telehealth and how it has affected care delivery in cardiology.
Editor's note: Responses have been edited for clarity and length and are presented alphabetically.
Question: How has the uptick in telehealth adoption affected care delivery in cardiology? Will these trends last beyond the pandemic?
Eric Adler, MD, cardiologist and director of cardiac transplant and mechanical circulatory support at UC San Diego Health
The uptick in telehealth adoption has resulted in a meaningful impact for the care of all patients. Specifically, COVID-19 has galvanized the adoption of telehealth by cardiologists, and as such, lowered the threshold for visits with patients who live at a distance or have trouble with transportation to our clinics. This also allows us to broaden our reach to patients who may want to access specialized care but live in another state or country. Surprisingly, it has also led to new insights into our patients living situations and the health status of others in the home.
However, there are untoward ramifications of the rapid transition to telehealth as well. The inability to perform a comprehensive physical exam impacts our diagnostic and prognostic abilities. Patients are often providing their own vital signs, which they are not trained to obtain and are of uncertain accuracy. Labs and imaging studies are as not as easily obtained. Maybe the most significant drawback is the potential erosion of the doctor-patient relationship and the trust required for shared decision-making.
It is clear that telehealth is here to stay. I am hopeful that the positive consequences of telehealth will persist and will improve with the development and implementation of technology, such as tools for remote physical examination. I think the consequences could be a net positive for consumers — for example, prompt access to specialists for those that live in rural areas with limited access.
Mark Ayers, MD, cardiologist at Riley Children's Health in Indianapolis
The COVID pandemic has created a need for innovation in the way cardiology care is delivered. Pediatric cardiology has been similarly affected. One of the unique challenges we face is that many of our youngest patients require frequent monitoring to track progression of their congenital heart disease. Virtual visits have been very valuable in allowing us to check in with families to see how their children are doing and sometimes allowing us even closer follow-up than previously.
Beyond virtual clinic visits, there has also been innovation in using tablets to monitor vital signs in some of our most fragile children. At Riley Children's Health, we are fortunate that even before the pandemic, we began a unique monitoring system with iPads that allows parents of our most complex patients to enter vital signs, patient weight and other metrics from home. Those metrics can then be viewed remotely by physicians and nurses to screen for subtle signs of disease progression. This has proven invaluable during the pandemic.
Many of the telehealth changes we have implemented will likely stick around even after the pandemic. In pediatric cardiology, many of our families live hours away from the closest medical center capable of caring for their children. I expect telehealth and virtual visits will continue for many of these families to make it easier for pediatric cardiologists to deliver the expert care families have come to expect, but in a way that is much more convenient.
Angie Kelley, RN, executive director of cardiovascular ambulatory operations at Piedmont Heart Institute in Atlanta
Telemedicine gave us an avenue to continue patient care during the acute phase of COVID, while continuing to put processes in place to keep patients and staff safe in the clinics.
We will continue to utilize telemedicine in certain instances for cardiology, but the majority of our visits have returned to in-person. Providers felt they would miss a diagnosis without face-to-face interaction, the ability to listen to hearts, measure edema, perform EKGs, etc.
We have found that the majority of patients would rather come in for an office visit versus video.
William Lewis, MD, chief of cardiology at MetroHealth Medical Center in Cleveland
The pandemic has allowed us to jump-start our use of telehealth due to the greater acceptance by physicians, nurse practitioners and patients. This gives us the opportunity to provide care in situations where an in-person visit is not the best or not possible. We work hard at reducing 'no-shows.' In reality, a 'no-show' is often about the inability to get a ride, a minor illness, or it may be too cold outside. We need to meet patients where they are.
The world has changed its communication capability and style, and medicine has been stuck in the inflexible clinic schedule. Patients, especially young patients, don't want to come to the medical center when it isn't necessary. We have used telehealth to enhance our communication with patients, to increase the patient contacts. We have instituted a one-week call after an admission to ensure that patients have their medications and are not experiencing any problems. We are positive that this will reduce readmissions. We are embracing this change. There is no going back. Telehealth is here to stay.
Subha Raman, MD, vice president of Indiana University Health Cardiovascular Services in Indianapolis
The uptick in telehealth adoption has in many respects made it easier to deliver timely cardiology care. An in-person visit may still be beneficial, and dialogue between patients and their providers can help make this determination. I hope that beyond the pandemic, we keep telehealth as an important option for those with mobility and transportation issues who otherwise might not get the cardiology evaluation they need.