Let’s be honest, once we are used to a convenience, we don’t want to go back to doing something in a way that requires more effort. When it comes to healthcare, telemedicine is just that – a convenient and effective solution that is here to stay and will impact how healthcare is provided going forward.
In the entire year of 2019, there were 1,400 total telehealth visits whereas, in just three days during the COVID-19 pandemic the week of March 9, 2020, there were 1,400 telehealth visits (Advisory Board, 2020). Cheaper, more convenient, readily accessible and supporting social distancing guidelines, telemedicine has grown to be a first stop for primary and specialty care services among many Gen X and younger healthcare consumers. Also, most seniors have become accustomed to the use of wearables for chronic care management, with only 16% of seniors stating that technology is a barrier to use of telemedicine (Advisory Board, 2020).
Telemedicine, Telecommuting, Telekinesis?
The COVID-19 pandemic has required healthcare providers to become more creative and efficient. Telemedicine is allowing for triaging of patients without exposing critically needed staff, while also allowing care teams to practice at the top of their license to care for the higher-acuity patient population. Previously described as a “disruptor,” telemedicine has become more of a savior of sorts as physicians are joining the rest of us newly initiated isolationist telecommuters in the world of distance interaction. Telemedicine can assist with real-time consultation between providers, monitor patient health remotely and perform a virtual clinic visit. While telemedicine has not given physicians telekinetic abilities and it isn’t a magic trick that will meet all needs or fix all ailments, it certainly has become a critical tool in our belt.
Will This Last?
We’ve heard the saying that people won’t change unless they are forced to do so. These unprecedented times have forced our hand, perhaps more quickly than some would prefer. Nonetheless, healthcare systems have swiftly rallied to implement new technology that can benefit us all going forward. People get used to things faster than we realize. By the time we can reengage with one another in-person, I believe we will also have learned that we have grown to expect and desire the convenience that telemedicine gives us. Many of our clients have platforms that can be used via smartphone, tablet or computer. For example, SSM Health provides an affordable diagnosis and treatment service through their Virtual Visit platform; Froedtert & Medical College of Wisconsin offers a Virtual Clinic with 24/7 support; and ProHealth Care has Virtual Urgent Care Visits for $20. Why take hours out of your day when you could merely schedule a quick online chat to get your prescription refilled, speak with your mental health provider or have a routine checkup for your chronic disease? Why spend a $50 copay and money on transit when you could spend $20 in the convenience of your own home?
What Do We Need to Do to Make It Work?
From a regulatory standpoint, we don’t know what might change in the future, but on March 27th, 2020, the Coronavirus Aid, Relief and Economic Security Act (CARES) Act was passed. In regards to Telemedicine, the CARES Act “reauthorizes the Health and Resource Service Administration’s Telehealth Resource Center grant programs at $29 million a year through 2025, boosts support for expanded broadband services, encourages the use of remote patient monitoring for home health services in Medicare, and funds new telehealth initiatives for the Indian Health Services and Department of Veterans Affairs.” Under this Act, high deductible health plans (HDHPs) and health savings plans (HSAs) can cover visits before members have met deductibles. Also, new patients have access to use telemedicine without requirement of an existing provider relationship. This greatly increases accessibility to healthcare for many, who previously chose to put off seeking treatment due to cost or who couldn’t easily get onto a physician’s schedule for an in-office visit.
The Centers of Medicare & Medicaid Services (CMS) has relaxed the rules for telemedicine and expanded reimbursement in response to the COVID-19 pandemic. CMS has created a General Telemedicine Toolkit to help guide the implementation of telemedicine. Going forward, financial and legal implications, including HIPPA privacy, need to be considered.
As an architect, I look to understand the physical requirements needed to support telemedicine for our clients. Space requirements are not as complicated as those for surge space. On the clinician side, telemedicine can occur in any space that has privacy and an interactive audio/video telecommunications system that permits real-time communication. The 2018 Guidelines for Design and Construction includes requirements and recommendations for designing for telemedicine services. The size of space, acoustics, lighting, privacy and interior surfaces, space identification and storage for equipment are addressed.
Our clients look for our expertise to provide flexible space and to futureproof for the exponential changes happening in the healthcare industry. A telemedicine space can serve other functions, such as in-person consultation, exam room or conference room. These rooms are also considered “soft space,” or space that is less expensive to initially build and can be more easily relocated for expansion and growth of higher cost correlated space, such as an Imaging department.
A patient might also experience telemedicine while visiting a clinic in-person. For example, an exam room could be supplied with additional monitors, camera and microphone and may need to be large enough to allow for gait evaluation. Lighting should control glare and allow for direct frontal lighting to support the creation of images with even lighting and accurately reproduced skin color rendition.
This is a very turbulent but also exciting time for the healthcare system. Change is upon us, and I believe we will achieve higher efficiencies and see new innovations we could not have imagined just a few months ago. The need for brick-and-mortar facilities will never disappear, but the incorporation of telemedicine can help with right-sizing future building projects and optimizing an organization’s ROI. Together, I believe we can bring more accessible and better healthcare to those we serve.
Jenni Eschner, AIA, EDAC, LEED AP
Senior Project Architect