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The Covid-19 crisis is far from over. However, the experience so far is revealing ways that the overall healthcare system could be improved to benefit patients, providers and communities. These include:
The patient flow adjustments that have been required by the pandemic can be permanently adopted, in order to minimize — if not in some cases eliminate — the time that patients are required to spend in waiting rooms. Not only does this reduce the likelihood of community spread of the coronavirus and other illness-causing bacteria, but it makes the experience for patients more agreeable. A survey found that for 63 percent of patients the most stressful thing about going to their MD was waiting to get looked at.
In addition, hospitals can (and many already have) move hand sanitization stations closer to points of care, which can improve staff hygiene — and ultimately enhance patient protection. Hospitals can also add lids to toilet seats — research suggests that flushing may release coronavirus-containing plumes — and focus on ways to renovate and build wards that feature private rooms and separate entrances.
The pandemic has thrust telemedicine into the mainstream, which is generating valuable insights on how to — and just as importantly how not to — incorporate this option into an active medical practice. Notably, these insights are not just about best practices for serving various patient populations (e.g. seniors, patients with chronic conditions, pre and post-elective surgery patients, etc.), but also about addressing three key barriers that have traditionally prevented the widespread adoption of telemedicine: reimbursement issues, HIPAA restrictions, and concerns about losing the human connection that is so vital in patient-centric health care delivery.
With respect to reimbursement issues, Medicare and state telemedicine restrictions have been eased during the pandemic, and many experts are calling for these to be made permanent. With respect to HIPAA restrictions, the Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) has made it easier, at least temporarily, for providers to offer telemedicine services (and communicate in general with patients) through remote communications technologies. And with respect to fears about losing the human connection, many physicians who were opposed to telemedicine for this reason before the pandemic have, in fact, discovered that remote technologies are actually bringing them closer to patients. In a first-person article for STAT, Dr. Rujuta Saksena, M.D., a hematology and oncology specialist in Summit, New Jersey offered the following observations:
Over the past few weeks, I have had conversations with several colleagues about this new wrinkle in our professional lives. Here are some of the things we enjoy about telemedicine in the time of Covid-19:
There is also growing interest — admittedly born more out of pragmatic necessity than by a desire to innovate — in using AI to facilitate telemedicine, including tele-assessment, tele-diagnosis, tele-interactions, and tele-monitoring.
From courageous nurses donning head-to-toe PPE and administering nasal swab tests in makeshift parking lot triage stations, to behind-the-scenes IT staff working around the clock to ensure that remote staff have secure access to the tools and technologies they need, hospitals have generated a tremendous amount of actionable intelligence on how to prepare for the next public health disaster; whether that comes in the form of a second wave of COVID-19, a COVID-19 mutation, or an altogether different pandemic. And let us not forget (as much as we would like to) the ever-present threat to hospital functionality and capacity posed by natural disasters like hurricanes and snowstorms.
The pandemic has helped hospitals better understand how to design and deploy remote working in three key areas. The first, and most important, is about keeping staff safe. The second is about engaging remote staff and enhancing productivity at both the individual and team level. A promising method to achieve this is the Circle Up program developed by the Center for Medical Simulation, which uses a supportive system of work-based briefing, peer check-ins, and debriefings to boost clarity, coordination, and resilience across the entire workforce (including but not limited to remote workers). And the third is about identifying functions like report generation that can be done off-site in a way that both increases productivity and mitigates risk (i.e. functions would not be adversely affected by lockdowns or local disasters such as those mentioned in the previous section).
A 2018 report by Mercer warned that in order to properly take care of the country’s aging population, hospitals and other providers in the U.S. would need to hire 2.3 million health care workers by the year 2025, with a particular focus on adding home health aides, medical and lab technologists and technicians, nursing assistants, and nurse practitioners. And by 2032, the AAMC estimates that the U.S. may be short up to 122,000 doctors.
The bad news is that, predictably, the pandemic has severely exacerbated this skills shortage, and forced many health care workers to endure near-impossible conditions. The good news, however, is that it has forced legislators, policymakers and executives to think of new ways of filling the massive staffing gap, including:
Winston Churchill is credited with the warning: “never let a good crisis go to waste.” And Albert Einstein is reported to have said: “in the middle of difficulty lies opportunity.” Both of these sage remarks apply to our present time. The coronavirus pandemic crisis will continue for years, and the road ahead will be grim at best, excruciating at worst, and difficult at all times. Despite this, we can be responsibly and realistically hopeful that some positive things will come out of this experience, and ultimately make the healthcare system better for those who depend on it, and those who drive it.
