Implementing telehealth during a pandemic: key takeaways for cardiac care.

Telehealth use in April 2020 was 78 times higher than it was in February 2020, according to insights from global management consulting firm McKinsey & Company (McKinsey).¹ “During the tragedy of the pandemic, telehealth offered a bridge to care, and now offers a chance to reinvent virtual and hybrid virtual/in-person care models, with a goal of improved healthcare access, outcomes, and affordability,” said the firm.²

JUMP TO A TOPIC:

• How Spectrum Health implemented telehealth.
• Top 3 learnings about telehealth for cardiac care.

This idea was echoed by Dr. Andre Gauri, MD, FHRS, Spectrum Health of Grand Rapids, MI, AFib Clinic, in the May 2020 webinar “Using telehealth to create a new path forward.”³ He said, “Change is hard, and everyone knows that, but it's no longer optional. Unless we change our healthcare system, we will not make it with all the changes that have happened as a result of COVID. Unless we adapt, we're done.”

As of July 2021, McKinsey estimated telehealth use at 38 times higher than pre-pandemic levels.⁴ In January 2022, American Medical Association vice president of Digital Health Innovations Meg Baron said in an article, “Telehealth is here to stay.”⁵ She explained, “It's not whether telehealth will be offered, but how best to offer telehealth services as we move toward what we're terming digitally enabled care—which is not just hybrid care, but more so fully integrated in-person and virtual care based on clinical appropriateness.”⁶

The evolution of telehealth that Baron spoke about could be underway with healthcare newcomer Amazon Care. The company was founded in September 2019, prior to the COVID-19 pandemic, it offers healthcare services through a hybrid model.⁷ Care begins with a video appointment that may be followed-up with an in-home visit from a nurse.⁸ The organization recently announced the nationwide expansion of its virtual service and plans to make its in-person care offering available in more cities.⁹ The company works with clinicians from Care Medical to support primary care and urgent care services—hypertension is listed among the chronic conditions the clinicians can treat.^10,11

How Spectrum Health implemented telehealth.

Today, with variants continuing to compel societal and organizational change, Dr. Gauri’s foresight appears to remain applicable, along with Spectrum Health’s ability to provide cardiac patients with care remotely.

According to a case study,¹² Spectrum Health comprises an advanced practice and RN-run clinic for the early evaluation and treatment of new or recurrent atrial fibrillation (AF). Utilizing evidence and guideline-based protocols, Spectrum has established a multidisciplinary approach that leads patients from various referral pathways to the AFib specialists in a timely manner.

Spectrum’s referral pathways enabled the organization to pivot and implement telehealth quickly, at the onset of the pandemic. Use of a patch monitor, distributed through a home enrollment program helped enable the transition. Spectrum Health continues to implement a flexible, hybrid approach to care comprised of in-office and virtual appointments.

In 2021, Dr. Gauri told Cardiology Magazine, “At our peak, we were seeing probably 70% to 80% of our patients via telehealth. We’ve learned that many patients would rather see a provider in person if given the choice. The doctor-patient relationship is extremely important yet somewhat diminished via telehealth. Obviously, not being seen at all is worse than being seen over a computer, but I definitely think there’s a fine balance. At the end of the day, there are many people who just want to leave the house and see their doctor in person. I think we will find a balance where maybe 20% to 25% of patients will be seen via telehealth, and the rest would still be seen in person—time will ultimately tell.”

Top 3 learnings about telehealth for cardiac care.

• Multidisciplinary collaboration and the use of protocols contributed to Spectrum Health’s ability to optimize patient access, especially through the AFib clinic.¹³

• Spectrum responded quickly to embrace telehealth and partner with a home enrollment ambulatory cardiac monitoring program to allow for continued identification of arrhythmias requiring clinical intervention.¹⁴

• Spectrum successfully modified its operation for access to all procedures and surgeries with a focus on same-day discharges.¹⁵

To hear more about Spectrum’s pathways, protocols, and telehealth strategy, listen to the webinar here.

Andre Gauri, MD, FHRS

Cardiologist and Electrophysiologist at Spectrum Health

Andre Gauri is a board certified cardiologist and electrophysiologist and is a fellow of the Heart Rhythm Society. Dr. Gauri earned his medical degree from Stritch School of Medicine, Loyola University in Maywood, Illinois, and completed his internal medicine residency at Stanford University School of Medicine in California. He completed his cardiology fellowship at University of Chicago in Illinois, and completed his electrophysiology cardiology fellowship at Loyola University Medical Center in Maywood, Illinois. Dr. Gauri’s clinical interests include catheter ablation of atrial fibrillation and other complex arrhythmias, and implantation of pacemakers, cardiac defibrillators, and resynchronization devices.

Dr. Gauri has been with Spectrum Health since 2005 and became the chief of Electrophysiology and medical director of the AFib Program in 2015. He helped grow the EP program from a two-physician group in 2005 to an eight-physician group in 2020.