Why we need a ‘one-to-many’ telehealth model of care

One thing the COVID-19 pandemic has made clear is that telemedicine is a public health necessity. With annual check ups and elective procedures delayed, more patients than ever before are receiving care virtually - often through real-time video calls or phone calls. These remote interactions slow the spread of coronavirus by keeping patients healthy at home and away from medical facilities where germs can spread.

The problem is real-time, or synchronous, telemedicine isn’t sustainable or scalable. We’re already seeing synchronous telemedicine practiced on a small scale put a strain on our health care system during COVID-19. There are many reports of patients waiting hours to see a doctor virtually. Beyond that, it’s difficult for some of the most vulnerable patients in rural areas to video chat with a doctor if they don’t have access to broadband.

For telemedicine to work at scale, it must also have a one-to-many component. In this model, data can be remotely gathered and consistently monitored over time, and then used for timely and targeted communication between patients and providers. This allows care to scale from one-to-one to one-to-many.

Fortunately, a model already exists for how we can use asynchronous, one-to-many remote monitoring at scale for even the hardest-to-reach patients. The health system overseen by the U.S. Department of Veterans Affairs (VA), once infamous for its backlog, is now innovating and embracing telehealth in ways greatly surpassing the private market and doing so successfully. They’re using asynchronous telehealth right now to ensure patients who cannot or should not visit a VA facility in person are still able to get the frequent care they need from a distance.

One such example is their efforts to remotely monitor veterans at risk of diabetic amputations, one of the most debilitating and costly complications of diabetes. Veterans place their feet on the Podimetrics SmartMat for just 20 seconds a day in their home, and the temperature data captured is then automatically sent to our care management team to monitor. When early signs of issues are detected, we notify patients and their providers so that clinical action can be taken quickly, helping to prevent more serious complications like infections and amputations.

Such large-scale preventive care could not be achieved through synchronous, one-to-one telemedicine. There simply are not enough doctors available to check in with every patient for even one minute every single day. However, remote asynchronous systems can gather data over time to help prioritize synchronous telemedicine, ensuring patients receive the care they need when it matters most.

The VA has long been on the forefront of telehealth adoption with a slew of offerings including the VA Video Connect system. And in response to COVID-19 and the potential need for the organization to serve as a backup civilian health care system in times of crisis, its fourth mission, the VA received $14.4 billion as part of the CARES Act for telehealth adoption to reduce hospital bed usage and prepare in case of an influx of civilian patients. This funding is critical at a time when we must keep beds available for the sickest patients, and when a visit to a medical facility could endanger an individual at high risk for contracting viruses.

Our current crisis is certainly one we can learn from in many ways. One key takeaway has been the importance of telehealth, however in order for it to be sustainable we  need a combination of synchronous and asynchronous patient monitoring tools that allow for targeted communication. Going forward, we should expect more health care providers to incorporate this kind of model to offer access at scale and save lives.

Jon Bloom, MD, is co-founder and CEO of Podimetrics, Inc., a care management company with the leading solution to help prevent costly and deadly diabetic amputations.