During 2020 and into 2021, the coronavirus (COVID-19) pandemic has made it increasingly difficult for residents and patients served by long-term post-acute care (LTPAC) organizations to be safely seen by physicians in a timely manner. The challenges have cut two ways: patients and residents have risked their health by traveling outside their facility or home to a doctor’s office, while physicians also have borne risk by traveling to LTPAC facilities— many of which had significant numbers of COVID-19 infections.

As a result of all this, residents haven’t gotten the care they need when they needed it most, medical outcomes have suffered and quality of care has been impacted.

Thankfully, there is a solution—one that’s existed for years, yet hasn’t been fully embraced within the LTPAC realm until now: telehealth.

Adoption of telehealth – i.e., the delivery of health-related services and information via electronic information and telecommunications technology – by LTPAC organizations has been unnecessarily slow in years past, due partly to lack of education and training. That said, the current pandemic is compelling facilities to revisit telehealth and find ways to integrate it throughout their care continuum. The good news: Telehealth is proving itself time and time again as a viable and effective means of providing the care that residents need while keeping them, physicians and your staff safe.

 There are four basic types of telehealth used in healthcare settings, including LTPAC organizations:

1. Synchronous (aka, real-time interactive systems), which refers to the interactive delivery of health information in real time. Synchronous telehealth often utilizes technologies such as videoconferencing to connect residents with physicians and other health practitioners. Synchronous telehealth also can occur through what’s called a facilitated virtual visit (FVV) where diagnostic equipment is located near the resident, and the physician and/or practitioner is remote. A medical assistant utilizes the equipment to collect vitals and other diagnostic information (e.g., weight, blood sugar, heart rate, blood oxygen levels), then transmits the data to the remote provider. 
2. Asynchronous (aka, store-and-forward), which is the electronic transfer of resident health information (e.g., medical history, images, reports) to be used by a healthcare provider. With asynchronous telehealth, the health information that is transmitted is reviewed later by a healthcare provider.
3. Remote patient monitoring (RPM), whereby health data is collected in one location and electronically transmitted to a healthcare professional in another location for monitoring and review. Providers can track residents’ progress over time and receive real-time alerts if data indicates warning signs or declining states.
4. Mobile health (mHealth), which, as defined by the World Health Organization, is “…use of mobile and wireless technologies to support the achievement of health objectives.” Simply put, mHealth uses smart devices (e.g., tablets, mobile phones) and software applications to support activities such as monitoring blood sugar levels and weight and in the end, enhance service delivery.

RELATED RESOURCE: Telehealth for LTPAC Organizations: Best Practices for Enhancing Clinical Outcomes

So, how can each telehealth type be most effectively used by LTPAC providers?

Synchronous Telehealth
Synchronous telehealth most often is used to conduct general exams and assessments, and diagnose immediate concerns. It is convenient for all parties involved, and its virtual nature helps protect immunocompromised residents from health risks associated with exposure in outside environments. Synchronous telehealth also is useful in building and nurturing relationships between residents and physicians; they’re not in the same physical location, but there still is one-on-one interaction that provides comfort to residents and provides physicians with signs and insights that help inform decision-making. Additionally, it often occurs more quickly than traditional in-person physician visits.

Asynchronous Telehealth
Asynchronous telehealth, meanwhile, helps providers take a step back and analyze all resident information collected in order to identify changes and trends over time—all without having to make split decisions in real time as with synchronous telehealth. Overall, it enables providers to apply evidence-based care practices to make the best diagnosis and treatment decisions.

RPM
RPM is well-suited to keeping tabs on residents with chronic conditions in their homes or facilities, which frees them from the burden of making daily or frequent trips to physician offices. With regard to RPM, resident data generated through tools like Rosie Connect (which manage vital signs) can be wirelessly transmitted into a facility’s EHR system and accessed remotely by physicians to make better informed decisions on care. There are also devices that help ensure clear P-wave captures on ECGs.

mHealth
mHealth like RPM, can help to identify health trends in residents upstream, which, in turn, helps physicians make optimal recommendations for treatment. It is used extensively to obtain information that can be used to diagnose illnesses and track diseases—particularly in remote areas where doctors and nurses may not be physically present when treatment is needed. Additionally, many healthcare organizations use it to facilitate training and education.

Obviously, if a resident and physician are in the same physical location, and assuming risk of infection is low, an in-person visit or consultation is likely the preferred option. But more and more, LTPACs are utilizing telehealth to enhance outcomes while keeping all parties –residents and caregivers – safe.

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