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MGH

Published On May 20, 2021

POLICY

An Epochal Change in Care Delivery

During the lockdowns, virtual care took a giant step forward. Can it surmount the obstacles ahead?

It is now possible to imagine a world recovered from COVID-19. In that future, how will medicine have changed? These 10 essays explore the technical, social and political ripples of the pandemic.

During the Great Plague of the 17th century, nobles and the wealthy retreated to their villas in the hills while plague doctors roamed the streets and made house calls dressed in beaked masks to protect themselves, using a stick to “touch” the sick and dying. Today’s plague of COVID-19 has had an equally profound effect on how we deliver medical care. 

Social distancing forced many hospitals and clinics to close their doors, and only the sickest patients were treated in emergency departments and inpatient wards. The silver lining was that we had the technology to visit patients’ homes virtually, in full view and unmasked, to ensure that they received the care they needed without interruption. We traded the beak and stick for the internet and Zoom, and opened a new chapter in medical history practically overnight. 

Mass General Brigham, the hospital system of which Massachusetts General is a part, went from having 100 to 200 providers who made 10,000 virtual visits per year in 2019 to 10,000 providers making 1.38 million virtual visits from March through September 2020. Grandmothers who couldn’t use a smartphone mastered videoconferencing for medical care—and then for just about everything else. My 86-year-old mother started doing Pilates on Zoom for her cardiovascular wellness, and my 90-year-old father now gets all of his medical care online. 

At least 25% of the ambulatory care we provide at MGB is now virtual, and we are revolutionizing what it means to be hospitalized. Patients with COVID-19 are discharged early or not admitted in the first place and monitored safely at home via virtual care. Patients confined to hospital rooms can visit with family and friends via tablet computers brought to the bedside. When nurses, medical interpreters, disease specialists or others are needed, they can appear instantly at the touch of a button, as time and space no longer constrain how and where we practice medicine.

Perhaps most important of all, unlike our ancestors with the bubonic plague, patients with COVID-19 can see the faces of their caregivers. Without masks, gowns or gloves, we can speak with patients face-to-face over video 

to understand their illnesses, help them make choices or just get to know one another. Before the pandemic, we worried that technology in medicine would increasingly come between providers and patients. Instead, it has opened the door to intimacy and connection. 

With so many people cut off from seeing each other and making human connections, mental health has suffered greatly. Yet virtual care has made behavioral health specialists more available than ever before, while reducing the stigma of seeking care. It has also made it possible to offer services in communities that lack local providers. 

While the massive adoption of virtual care during COVID-19 has shown us what is possible, many barriers still exist. With waivers of geographic, licensure and reimbursement restrictions expiring soon, it’s likely there will be a retrenchment that shrinks the footprint of virtual care. We must all advocate together for much-needed legal and regulatory reforms to move forward with modern medicine rather than fall backward to old-fashioned methods.

Of course, not all medical care can be provided virtually, and decisions about when an in-person visit is needed must be driven by what is medically appropriate. Yet COVID-19 has finally shifted the axis of gravity toward a truly patient-centered reality. Value in health care will be transformed when we can monitor our patients remotely while they live their lives, helping us understand their patterns of behavior, identify when those patterns become aberrant and intervene before the next event, rather than after. That is the promise of virtual care. In this way, COVID-19 has changed medicine forever.

Lee Schwamm // Director of the Center for TeleHealth at MGH and vice president for virtual care at MGB Digital Health