COVID-19 Pandemic Transforms Use of Telemedicine Resources, Potentially for the Foreseeable Future

The rapid increase in telemedicine visits that have been a result of the coronavirus disease 2019 (COVID-19) pandemic may ultimately transform how physicians treat patients going forward, according to a new study.¹

Recently published in theJournal of the American Informatics Association, the study describes the rapid expansion of video-enabled visits between March 2 and April 14, 2020. During this time, the researchers found that virtual urgent care visits at NYU Langone Health increased by 683%, and nonurgent virtual care visits increased by 4345% based on daily averages.¹

The researchers conducting the study were from NYU Grossman School of Medicine, NYU Tandon School of Engineering, and NYU School of Global Public Health.¹

New York has been one of the epicenters of the COVID-19 outbreak in the United States, yet NYU Langone was also highly prepared to expand their telemedicine services at the time of the outbreak due to the presence of technological tools that had already been integrated across the health system.²

“The pandemic created an urgent need to divert patients from inpatient care and prevent the flooding of our emergency rooms beyond capacity,” said Devin Mann, MD, associate professor in the Departments of Population Health and Medicine, senior director for Informatics Innovation and Medical Center Information Technology at NYU Langone Health, and the study's lead author, in a press release. “Through telemedicine, we pushed the frontlines to locations far from our hospitals and doctor's offices. And because NYU Langone invested early in this technology, we quickly leveraged digital health to help hundreds of thousands of patients.”²

Previously, telemedicine's growth was slow, and in 2019, only 8% of Americans used telemedicine services, according to the researchers. Although there had been growth in regard to telemedicine’s use in rural settings, there were few reasons for many patients to replace in-person visits prior to COVID-19.¹

Currently, US insurers have needed to rapidly expand coverage to include all telemedicine visit types, including those from home. Furthermore, states have needed to relax state-to-state licensing requirements so that telemedicine care could be covered by insurance across state lines.¹

Additionally, the Office for Civil Rights (OCR) at the Department of Health and Human Services, which is responsible for enforcing some of the regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), has allowed the use of consumer audio and video communication for telemedicine visits even if the technologies and their use do not comply with HIPAA requirements. OCR has also stated that it will not impose penalties for noncompliance in relation to the use of telemedicine equipment by providers.³

Through the use of NYU Langone's electronic health record system Epic, the researchers compiled data from COVID-19 related telemedicine visits using diagnostic codes that they matched with keywords that described symptoms of COVID-19.¹

The researchers found that during the 6-week study period:¹

• There were 144,940 video visits involving 115,789 patients and 2656 providers.
• In video visits, 56.2% of all urgent care, and 17.6% of all nonurgent visits were COVID-19 related.
• Forty emergency medicine providers, managing less than 100 telemedicine visits on a typical day, increased to 289 “surge” telemedicine providers from multiple specialties.
• On March 19, NYU Langone Health expanded video visits to all of its ambulatory care settings, which reached more than 7000 visits in 10 days and represented more than 70% of the total ambulatory care provided during this time.
• Telemedicine usage was highest among patients aged 20 to 44 years, particularly for urgent care visits. Yet, patients of all ages were also successfully able to use NYU Langone's telemedicine platform.
• Patients' satisfaction ratings with telemedicine visits stayed positive, despite the rapid expansion of the program to thousands of new providers in a short period of time.

During this expansion period, the number of providers and patients who used telemedicine for the first time increased significantly. This increase will facilitate a transformation of technologies and work practices across different specialties, according to Oded Nov, PhD, professor and chair of the Department of Technology Management and Innovation at the NYU Tandon School of Engineering, and the study's senior author, in a press release.¹

“An important question going forward is how much this will continue beyond the COVID-19 pandemic. While we expect patients and providers who got a crash course in telemedicine to continue using it long term, regulators and insurers' decisions will have a major impact,” Nov said.²

In order to support the further expansion of telemedicine services at NYU Langone Health and NYU Grossman School of Medicine, each was recently awarded grants from the FCC’s COVID-19 Telehealth Program.²

“Our ability to scale and expand telehealth quickly has allowed us to battle overcrowding and human spread of the disease,” said Paul Testa, MD, assistant professor, the Ronald O. Perelman Department of Emergency Medicine and Chief Medical Information Officer at NYU Langone Health, and a study co-author, in a press release. “It also pushes our ability to care for patients beyond any physical boundary, which you can only do digitally.”²

REFERENCES

1. Oded Nov, Paul A Testa, Rumi Chunara, Ji Chen, Devin M Mann. COVID-19 transforms health care through telemedicine: evidence from the field.Journal of the American Medical Informatics Association. 2020. doi: 10.1093/jamia/ocaa072.
2. Telemedicine transforms response to COVID-19 pandemic in disease epicenter [news release].ScienceDaily. April 30, 2020. sciencedaily.com/releases/2020/04/200430150220.htm. Accessed May 6, 2020.
3. Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency. Office for Civil Rights. March 30, 2020. hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html. Accessed May 6, 2020.