First, let me start off by saying that all that have been impacted and will be impacted by COVID-19 are forever in my thoughts.

As we all know, the way we go about life is changing as a result of COVID-19. What we are experiencing and learning about it daily continues to shape our future. We are protecting our most vulnerable, we are assimilating to a new environment and we are evolving. This evolution of empathy has shown us that the responsibility of ensuring the safety of all Americans falls on all those that live and breathe. It comes with a price, that will ultimately need to be funneled through our economy, with new ecosystems emerging and changes in value placed on many items/services.

Many of our historical periods have shown us, when a human need is not met, a new, innovative way of life occurs. The renaissance period fulfilled our need for the arts and culture, the industrial revolution fulfilled our need for growth, the internet revolution fulfilled our informational and curiosity needs, this new age’s definition will certainly be defined by COVID-19 ……what needs will this Healthy Revolution fulfill and what will it ultimately look like?

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Our position relative to another object is considered “space” for purposes hereon. The term “Social Distancing”, a longtime phrase used by public health officials to stop the spread of highly contagious diseases, helped set our new guideline for the space between you and I to be six feet. Herein lies the first conundrum; our infrastructure is built around togetherness, efficiency of space (maximizing occupancy), personal touch, etc. and it is clear that there will be psychological discomfort for many people if they are within six feet of another person unnecessarily. Our environments must become welcoming and respectful to those that need space (the vulnerable). Specifically, in the healthcare environment, space is limited, and close interactions are common or required.

Highly contagious and symptomatic people will no longer feel welcome in a clean environment. The delivery system will have to be bifurcated to ensure cross contamination is limited and people feel “safe” when they elect to go somewhere. Different options are currently being investigated, such as regional or neighborhood infectious disease centers, specialized entrances to ERs, and structuring primary care offices with sick and well sides, like pediatric offices. 

We are already seeing the move of inpatient only procedures to the outpatient side. This trend will most certainly continue as inpatient beds will need to be for the truly sick rather than the elective procedures that can heal elsewhere. Clean and dirty units will be a requirement, if not mandated through regulation, people will demand it and vote with their feet. Most facilities are already going through re-configurations, this will be a new norm as we create a healthier environment. Subsidization of bed holds has already become topic of conversation.

Cleanliness is next to godliness for a reason. People will demand sanitized, clean spaces to perform their daily duties, shop and entertain. So not only will we need more space to do what we have over the last 30 or so years, we will also need that space to be extra clean. We are seeing a rise in the value of cleaning services and supplies. This will trickle down to every brick and mortar facility that holds people costing more time and money to fulfill this need. Healthcare facilities have been scrutinized for their cleanliness for decades, dirty appearing facilities will not be tolerated going forward. As stated previously, the ability to perform services in cleaner, more efficient outpatient settings will continue to attract post COVID-19 weary people. Keeping these facilities up to the new standard of clean is going to be an added cost that needs to be offset.

Keeping clean takes time and as the old business adage goes, time is money. Healthcare providers will need to reconfigure throughput estimates and KPIs to allow for sanitization. This includes areas like the ER, waiting rooms, pre and post op, registration areas, etc. New responsibilities for clean spaces will take time from employees and workflows will need to be adjusted for the time it takes to perform these new tasks.

The added space and care we need to take to ensure other’s safety will also take more time. The hours in the day are not going to change, our routines will need to change, we will need to be more flexible with our time. This includes while we are at work, during recreational activities, events, etc. The same way terrorism created the TSA, bottle-necking our airports, the new Healthy Revolution impacts will be similar across all facets of life.

In the healthcare field, the change in time, space and need for cleanliness will impact:

1.      Business cycle – New beginnings are often disguised as painful endings – direct to patient care – subscription care – Decentralized and distributed workforce models will emerge, Pandemic swat teams, Subscription and delivery business models will be pushed and M&A will certainly pick up

2.      Our willingness to electively go to hospitals and purchase foreign products without safety guarantees – New assurances and methods to attract patients will be commonplace

3.      The reach of the caregivers between states – providers are beginning to practice across state lines, reciprocity of scope of practice is being worked out and reviewed

4.      The reimbursement schemata will have to change as it takes longer, it is more expensive to keep clean and more guarantees are needed

5.      Patient anxiety level/ Tolerance of non-compliance will increase our need for home services

6.      Real Estate needs – Some of the changes planned are more walls to enclose open areas, more space between individual workstations, privacy panels around individual workstations, employees will be stationed at workstations facing out

7.      Remote work – More positions will be moved to the home and wage scales will be restructured

These changes need to be addressed today and technology is most definitely part of the answer. Machine learning is helping to identify root causes for medical issues, design safe and efficient workplaces, organize information timely and disseminate it to the appropriate individuals, correct human error, etc. The need for more “thinking help” while we transition to this new environment will ensure our workforce can continue with their current duties unencumbered by the massive volume of data that needs to be evaluated periodically to ensure the ship is moving in the right direction. 

The most significant tool we have today to help resolve our new needs is most definitely telehealth. Much of the diagnostic and preventative care we receive today in a bricks and mortar facility will be performed via telehealth. The environment is ripe for this to take place. People are getting used to video discussions and they are trusting the technology after being thrown into it over the last few months. The proper use of telehealth will lower the cost of care and allow financially strapped organizations to evolve into a new telehealth ecosystem. This ecosystem is a much higher touch environment, while maintaining safe distance. The use is not just for out of area care, it can be used in a more local environment to accommodate our new needs more efficiently.

Telehealth is via: 1) Interactive Medicine – which allows patients and physicians to communicate in real-time while maintaining HIPAA compliance 2) Store and Forward – which permits providers to share patient information with a practitioner in another location or 3) Remote Patient Monitoring – which allows remote caregivers to monitor patients that reside at home by using mobile medical devices to collect data (e.g. blood sugar or blood pressure).

Store and forward

Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc.) and then transmitting this data to a doctor or provider at a convenient time for assessment offline does not require the presence of both parties at the same time. Dermatology, radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record preferably in electronic form should be a component of this transfer. The ‘store-and-forward’ process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.

Remote monitoring

Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective. Examples include home-based nocturnal dialysis and improved joint management.

Real-time interactive

Electronic consultations are possible through interactive telemedicine services which provide real-time interactions between patient and provider. Videoconferencing has been used in a wide range of clinical disciplines and settings for various purposes including management, diagnosis, counseling and monitoring of patients.

This technology can be used in almost any specialty today, Emergency care, TeleNutrition, Telenursing, Telepharmacy, Teledentistry, Teleaudiology, Teleneurology, Telerehabilitation, Teletrauma care, Telecardiology, Telepsychiatry, Teleradiology, Telepathology, Teledermatology, Teleophthalmology or even Telesurgery – Remote surgery (also known as Telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of Telepresence. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections, haptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.

In addition, there are nonclinical uses. Distance education including continuing medical education, grand rounds, and patient education. Administrative uses including meetings among networks, supervision, and presentations research, healthcare system integration asset identification, listing, and patient to asset matching and movement, to remote admission. 

People now understand that telehealth can eliminate the possible transmission of infectious disease or parasites between patients and medical staff. It can be simple or complex for a provider to implement telemedicine into their practice. For solo practitioner and clinic, most just require a basic HIPAA compliant video conference software to start delivering telemedicine consultation.

For providers looking to have a more complete virtual clinic solution, they need to consider their existing workflow and incorporate the telemedicine software solution into their practice. Usually software needs to have a waiting room, EHR and payment function.

Organizations will have to change operationally and have knowledge of the regulations, legalities, and technological aspects of implementing telemedicine and the other changes needed to keep up in this Healthy Revolution.

Email [email protected] for a more in-depth discussion and tips on implementing new technologies and workflows. Stay safe, smart and strong.

A Healthy Revolution

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