Virtual Care Under COVID-19 and the Barriers to Effective Telemedicine

“Even if no other good for health care emerges from the coronavirus crisis, one development — the incorporation of telemedicine into routine medical care — promises to be transformative. Using technology that already exists and devices that most people have in their homes, medical practice over the internet can result in faster diagnoses and treatments, increase the efficiency of care and reduce patient stress.” – Jane E. Brody, New York Times, May 11th, 2020

While COVID-19 has accelerated a number of technological trends that were already emerging—like Zoom meetings from home and virtual grocery delivery services—perhaps no industry is more due for a digital makeover than healthcare. Under the current situation, every waiting room is a potential biohazard and long lines only exacerbate the risk of exposure. With many doctors forced to connect with their patients via online video chat, the potential for quick and responsive care without having to leave the home is finally upon us. But for cancer patients in need of treatment options, the efficacy of digital care depends on the availability of their data, and their data is often out of their control.

Telemedicine won’t completely eliminate clinical visits for cancer patients on active treatments, but it can cut down on unnecessary trips to the hospital.  A recent article in Targeted Oncology explains that doctors “have to take careful steps for deciding which patient cases can be managed through telemedicine and which require in-person visits,” adding that the patients more ideal for virtual care are those who have finished treatment and only require surveillance. For cancer patients currently on a treatment plan, those responding to the treatment are also suited. But for those in need of a treatment plan or direction for care, getting that help requires they have their medical records. 

Dr. H. Jack West, associate clinical professor at the City of Hope Comprehensive Cancer Center, stated in a recent interview that oncology is “well-suited for telemedicine or at least for second opinions,” and that decisions are “based on the value of a pathology finding or imaging, talking with the patient about their symptoms, and then coming up with a comprehensive plan together.” In short, the value that telemedicine brings to oncology is the ability to sit with a patient and put together a strategy, so long as the patient’s data is available. An article in Cancer Network recently cited the need for more patient involvement when it comes to telemedicine, adding that “without the nurses, nutritionists, and others generally involved physically together to strategize care for patients, more communication on the side of the care team has been necessary.”

However, for those patients unable to organize and share their health records freely, telemedicine doesn’t offer the same potential for care. A recent blog at the World Economic Forum looked at potential barriers to effective telemedicine and put data sharing near the top, noting that our “healthcare industry is very rigid” and that “in times of deadly pandemics, this rigidity can endanger the very people it seeks to protect.” The piece also pointed out Asia’s success in combating COVID-19 due to a relaxation in data-sharing laws that allowed doctors and patients more agility. Using telemedicine to combat cancer will require that same flexibility, allowing patients to quickly and easily obtain their health records in order to share with doctors digitally.

Getting a copy of one’s health records from a provider can be hard enough, but getting a digital copy can be even more difficult. A recent STAT article opines that COVID-19 will be the ultimate stress test for electronic health records, noting that EHRs are designed to “track and bill procedures, rather than provide optimal patient care” and are not built for quick analysis. “It can take a clinician a long time to get a clear picture of the patient in front of him or her,” because some patient information is listed under the problems tab, “some under medications, some under imaging, and so on.” As a result, it’s difficult to reassemble a patient’s data from the EHR into a clear narrative of their health—an essential need for telemedicine to be effective. 

At Ciitizen, helping patients collect their health data, convert it into a digital format, and organize it within their Ciitizen profile is exactly what we do. Having long understood the barriers to faster treatment, the current COVID-19 dilemma has only highlighted what we already know. Recognizing the obstacles to telemedicine for cancer patients is important; overcoming them is crucial. Without the ability to quickly and easily share our health data, virtual care for cancer patients is no better than a casual conversation over Facetime or Zoom. Oncologists and clinicians will need a clear and detailed patient summary in order to provide the comprehensive planning described by Dr. H Jack West above and take telemedicine into the modern age.

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