Navigating Healthcare Through the Practical Lens of Telehealth

Telehealth refers to the strategy of providing virtual healthcare. This includes any technologies and services that physicians use to conduct appointments remotely. Another feature of telehealth is the use of communications between hospitals and clinics to bring collaborative expertise into emergency procedures.

As early as the 1970s, telehealth was used to assist remote, underserved Native communities in the Southwest. In the 1980’s, telehealth made its way to the final frontier by providing care to the astronauts aboard Space Station Freedom. Since those formative days, telehealth hasn’t exactly exploded in popularity—that is, until the emergence of COVID-19 (1).

We often hear people reference a “new normal” when they talk about the latest innovations and guidelines for keeping our communities safe during the coronavirus pandemic.

Many questions remain about the respiratory disease that has infected millions worldwide. What we do know is that many people with chronic illnesses are also in the category of “high risk,” meaning that they are more susceptible to contracting and developing a serious case of COVID-19.

To compound this problem, people with chronic illnesses are likely to require frequent medical appointments to help manage their diseases.

People with chronic conditions are often faced with the impossible choice of risking contact with the virus by continuing their treatment plan, or putting off vital care in order to mitigate that risk. This is where telehealth has the potential to transform patient experiences—and not just for the chronically ill.

If healthcare providers can serve patients from afar, it means that less people will come into contact with the virus by way of clinic and hospital visits. 

There is also potential for telehealth to help tackle some of the racial and socioeconomic disparities that exist in healthcare today.
Disparities that lead to delayed or denied access to care include—but are not limited to—access to transportation, translation services, travel expenses associated with specialist visits, and insurance.

According to a Journal of Community Health article titled “Traveling Towards Disease: Transportation Barriers to Health Care Access”, research indicates that “such delays in care may lead to a lack of appropriate medical treatment, chronic disease exacerbations or unmet healthcare needs, which can accumulate and worsen health outcomes.”

In light of these challenges, chronic conditions can become worse and overall health can suffer. Both circumstances increase susceptibility to severe COVID-19 complications.

Dr. Benny Kerzner, a pediatric gastroenterologist at Children’s National Medical Center, is successfully utilizing telehealth to treat young people with celiac disease.

He refers to telehealth as a silver lining in healthcare during the pandemic. As a high-risk individual, his work in telehealth has allowed him to continue patient care routines uninterrupted.

Dr. Kerzner notes that telehealth has eliminated many of the factors that turn his patients into no-shows. In fact, his no-show rate has dropped from 20% to about 1%-2%. According to Dr. Kerzner, the factoring out of potential transportation barriers, as well as eliminating the burden of long and expensive travel, are among the factors that have influenced this trend.

These outcomes are consistent with what researchers have observed.

Studies indicate that transportation barriers can have tremendous consequences for treatment outcomes in chronically ill patients, and that these barriers are disproportionately experienced across certain populations, including ethnic minority groups (2, 3).

Dr. Kerzner’s cases suggest that telehealth may prove to be a viable approach to eliminating certain transportation issues that limit access to care, including inadequate transportation, unforeseen issues with public transportation, and time and expense of travel.

The keystone of Dr. Kerzner’ telehealth work is the Multidisciplinary Celiac Disease Clinic at Children’s National Medical Center in Washington, D.C. The Clinic provides an integrative approach to celiac disease treatment, where each patient is seen by a gastroenterologist, nutritionist, education staff, psychologist, neurologist, and neuropsychologist.

Telehealth has allowed Dr. Kerzner and his team to streamline this model of care. The entire team can convene in a virtual meeting room before and after an appointment to discuss the patient’s case and coordinate follow-up care. Telehealth also allows the team to efficiently mobilize other types of patient support, such as translation services.

The ease of virtual care means that translators can be more readily available, which can ensure less delays in care. Translators are also more likely to improve delivery of healthcare services, thus improving overall health outcomes.

Like many, Dr. Kerzner believes that there is tremendous need to address disparities in access to healthcare. Translation services help illustrate the size of that need, as studies estimate that about 14% of the US population—and as many as 36% of the population of some US states—do not speak English as a primary language (4).

In spite of its enormous benefits, Dr. Kurzner points out that telehealth is not without limitations.

One of the most limiting factors in telehealth success is access to technology and broadband services. Without a concrete way for providers to identify and address that need, households who lack access to these necessities could very well be excluded from telehealth programs.

One possible approach to expanding telehealth services might be to identify nearby clinics that could facilitate specialist telehealth exams using their own equipment.

Issues involving access are complex and multi-layered. Dr. Kerzner believes that solving such issues will ultimately require advancements within legislation, as well as within the health insurance companies.

Still, he remains hopeful that telehealth can and will close some of the gaps that limit access to sustained, quality care. 

When asked what he sees for the future of telehealth, Dr. Kerzner replies that he believes telehealth is the future of healthcare.

With an enthusiastic smile, he says, “We’re just at the beginning. I’d love to come back in 50 years’ time and check this out, because I think it’s going to be amazing.”

Check out our entire interview with Dr. Benny Kerzner to learn more about telehealth, its applications, and possible limitations.