I forgot about my father’s memory and neurology clinic visit even though I had promised to go down to Denver with both of my parents to help them navigate the complex world of healthcare four months before. A lot changed in those four months, most notably COVID-19 swept across the world and made its way into the US. The pandemic placed my aging parents at a greater risk if they contracted the virus while traveling from Fraser, Colorado to Denver and my work schedule was beyond capacity as I added Federal and State COVID-19 reporting coordination to an already full project portfolio. How could a take a day and a half off work? How could my parents stay safe?
Telehealth and Rural (Mountain) Living
I decided to move on from my first health care job in neurophysiological monitoring to acute care in 2011. I also wanted to move to the mountains of Colorado. My parents already moved from Colorado Springs to Fraser, just outside of Winter Park, Colorado. Yampa Valley Medical Center brought me on as a quality analyst before they were part of the UCHealth system. After moving to Steamboat, I realized how remote and isolated Steamboat Springs, Colorado was from Denver and the other “Front Range” cities in Colorado. Here are some fun facts about driving from Steamboat for medical care:
- Steamboat Springs to University of Colorado Hospital and the Anschutz Campus
- 169 miles
- 3 Hours and 10 minutes if traffic is good
- One major mountain pass (or two if Eisenhower Tunnel is closed)
- Steamboat to Poudre Valley Hospital
- 159 Miles
- 3 Hours and 21 minutes if traffic is good
- Two major mountain passes or the choice to leave Colorado, go to Wyoming and drive back into Colorado so you only have to deal with one major mountain pass (adding on 30 more miles)
Many specialists come up to mountain communities on a rotational basis. However, this may be once a month and possibly less frequent. Telehealth is the obvious stop-gap for patients in rural and mountain communities that need specialized care. A barrier to telehealth visits as Dr. Lin has mentioned in his blog has mostly been the providers. However, with social distancing and with CMS lifting restrictions on reimbursement for telehealth, providers quickly adopted telehealth to keep revenue streams flowing for their practices.
Telehealth and Telemedicine Expansion and Deregulation
Telehealth and telemedicine rules and regulations relaxed at the start of the COVID-19 pandemic. Now is the time to figure out how else to utilize technology to improve healthcare delivery. Now is the time for innovation and policy reform. So, how can telehealth help patient advocates and family members? Could it be the answer for me and my dad’s visit? Will it work for others in an urban setting or family members that are geographically separated?
Being a Patient Advocate Remotely
Before the pandemic, I had planned on taking a day off of work to drive down to Denver to accompany my father to an appointment at a neurology clinic. This appointment transitioned to a telehealth visit following the outbreak. I considered making the two-hour drive from Steamboat Springs to Fraser to be with him for the appointment. After all, I would generate a net gain of two and a half hours from not having to drive all the way to Denver. In a moment of clairvoyance, however, I decided to find out if I could join remotely. After working with a few key stakeholders at UCHealth, we discovered that if my father gave me access to his My Health Connection account, I could join the same way he would for the remote visit. This access also allowed me to review my father’s medications as the provider discussed them with my mom and dad and access the summary notes from the visit, so I could discuss treatment options with him and my mother at a later time.
The Visit (that’s me at the bottom, by the menu bar)
It was strange to know that I would be on a video call with my parents, but to be on the phone with them as well, ensuring that they could log on. My wife and I have discussed the shift in caring for both sets of aging parents, but this was the first time I needed to support them on multiple fronts. First working with them on technology and second being a health advocate. The visits felt distant, yet at the same time normal. The medical assistant greeted us virtually and started the intake process. Dr. Zachary Macchi jumped onto the call about five minutes in and reviewed history and started the evaluation. About twenty minutes into the call, Dr. Samantha Holden was able to join as well. In the span of twenty minutes a total of six people (including my father) were working together. Had we all gone down to Denver together, this may have been the same outcome. However, Dr. Macchi joined the call first to help Dr. Holden. He stated right away that she would be able to join us, but had other commitments. My guess is that if we were in a traditional setting, we would have waited an extra 20 minutes but telehealth gave the flexibility for coverage. Telehealth has its limitations. My father had difficulty following the motor skills test. We were unsure if it is his motor function or his ability to follow a two dimensional image in the three dimensional world. For this and other reasons, everyone agreed on an in person visit three months following the virtual visit.
Just the first step… what are the next.
This visit made me realize the opportunity for telehealth in the patient advocacy realm. While telehealth offers a convenience for the patient, it certainly helps with obstacles that patient advocates face. I am lucky to live just a few hours drive from my parents. If I lived outside of Colorado, I doubt I would be as involved in their care. However, we now have the tools to improve care coordination between family members. Our first step needs to be promoting the technology to allow for remote patient advocacy. However, we could take it even further. What if we could have an MA set up a camera during an in-clinic visit so the advocate (or family member) could join the visit if they lived too far away to join in person? What are the other ways to utilize telehealth for family members and patient advocates? Will CMS go back to restricting reimbursement for telehealth? Time will tell for these questions, but we need the health care community to (dare I say) advocate for telehealth and the access it can bring for patient advocates.