How Virtual Care Has Expanded in 2020 to Improve Access to and Effectiveness of Orthopedic Specialty Care via Telehealth—a Spotlight on eConsult Usage

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By Dr. Hasan M. Syed, MD, FAAOS

The ongoing COVID-19 pandemic has impacted healthcare access and changed the way care is being delivered throughout the country. In particular, the day-to-day practice of my specialty, orthopedic surgery, has been greatly affected. Orthopedic surgery clinics have reformulated surgical indications and, initially, broadly postponed elective cases. Inpatient management has become more difficult, requiring patient isolation and highly restrictive visiting hours, while outpatient visits have been curtailed to minimize contact between patients and hospital personnel. 

These factors have brought significant impacts on quality of care, particularly for post-operative patients, while also severely limiting the availability of care for patients seeking non-urgent or elective procedures.

In response to the challenges faced in the medical field, telehealth use has seen unprecedented expansion, with telehealth companies offering viable solutions to access issues brought on by the COVID-19 pandemic. As hospitals restructure to meet pandemic demands, virtual care solutions have emerged as a means of preventing the spread of infection from COVID-19 patients to others in need of care. 

For the past year and a half, I’ve partnered with an asynchronous telehealth platform that provides eConsults, a form of telehealthcare that connects primary care doctors to specialists via a HIPAA-compliant messaging platform. Using this platform, primary care doctors receive timely and documented specialist guidance on patient care from a remote setting. As a telehealth resource, eConsults fit effectively with the increase in telehealth implementation and utilization seeking to decrease nonessential face-to-face contact. 

I’ve supported an increase in eConsult usage since the COVID-19 pandemic began, as I’ve seen that by employing these virtual care solutions, care providers are better able to triage patients while providing them with greater access to necessary care. 

The impact of COVID-19 on orthopedic surgery practices

Orthopedic surgery has certainly undergone changes over time, but the COVID-19 pandemic in particular has caused a radical shift in our daily practice as orthopedic surgeons. As I mentioned, elective surgeries were quickly deferred to preserve resources such as PPE and hospital beds for the increasing numbers of patients affected by the novel coronavirus.

However, even with this substantial portion of surgeries being deferred, our practices never shut down completely. Many conditions, in particular severe trauma, infections, and musculoskeletal tumors, require immediate surgical attention, and orthopedic surgery clinics need ways to work with these patients safely to prevent further spread of COVID-19. 

Because orthopedic requires such close contact with the patient in an enclosed space, as well as frequent contact via post-operative care, the day-to-day operations of orthopedic clinics needed to evolve with these shifting risks and obligations.

Telehealth supports improved access to care amid lack of typical availability through effective triage and access to virtual specialty care guidance

As we’ve already seen in orthopedic surgery, face-to-face visits can and should be limited during the ongoing pandemic situation. Only urgent cases and specific post-operative care situations that cannot be fulfilled remotely or by the patient themselves should be carried out in person, as much as is possible. However, there are still many cases that require specialist input, and in these cases telehealthcare and telemedicine can help to ensure continuous care. 

Within orthopedic care, I’ve found that many appointment types can be managed virtually, given effective triage, including pre- and postoperative imaging reviews, preoperative labs, and postoperative checkups.

Further, effective triage, such as that supported by telehealth technologies, is crucial for the success of healthcare to improve access and ensure that patients are receiving necessary care–particularly now as access to care is even more limited than usual.

eConsults are providing essential telehealth support for improved orthopedic care in the primary care setting

eConsults have proven to be highly effective in helping orthopedic surgery settings adapt to the demands of the pandemic. In large part, this has been due to the effectiveness of eConsults in helping primary care teams execute a higher level of orthopedic care within the primary care setting while identifying higher-acuity patients to refer for in-person orthopedic appointments or surgeries.

When primary care providers (PCPs) are supported by a team of specialists providing rapid, documented insights, they’re able to treat a greater number of lower-acuity patients within the primary setting. A panel of orthopedic surgeons, like myself, supports PCPs by offering second opinions on X-rays, confirming follow-up treatments, and validating referrals, among many other potential insights. Meanwhile, eConsults also empower PCPs to triage higher-acuity orthopedic cases for an in-person consultation. 

Keeping lower-acuity cases in primary care for treatment and triaging higher-acuity cases for referral helps to minimize potential exposure to the novel coronavirus by making sure fewer patients are being sent to multiple medical clinics. In fact, I’ve seen some cases where the patient never visits a medical clinic at all—the rise of virtual primary care visits, paired with virtual specialty care, can even eliminate some doctor visits altogether.

Telehealth is a solution providing safer, more accessible post-operative care

Post-operative care is an integral component of effective treatment for orthopedic surgery. Effective post-operative care supports positive outcomes, makes a significant impact on patient experience, and decreases avoidable healthcare system burden of increased follow-up care. 

Given this, it’s imperative that the quality of post-operative care is impacted as little as possible while continuing to minimize in-person appointments amid our current healthcare climate. 

Following orthopedic procedures, it is very common for patients to have follow-up questions regarding their recovery and treatment plan. Historically, it’s been difficult to provide timely answers to these questions, as many patients face barriers to receiving care. 

Through telehealth, we’re able to answer these common questions quickly and conveniently for patients. From my perspective, there are two main benefits of this:

First, through the appropriate continuation of postoperative care, we can help patients avoid doing something that may be harmful to their recovery and outcome. And second, convenient and timely access to care reduces the patient’s anxiety. Clear and complete post-operative instructions support patients in feeling comfortable and cared for by their healthcare team. 

A common occurrence following orthopedic surgery is post-surgical inflammation within the healing process. This is understandably a common concern for patients. With telehealth resources, we can quickly provide a patient with a consultation. If anything the patient is experiencing is something of concern, we can quickly direct them to seek attention in a timely fashion.

eConsults, specifically, are a valuable tool to manage patient care within the primary care setting. This both reduces travel and exposure burden for patients and reduces the backlog of orthopedic appointments.

  • Post-operative imaging – patients who have had MRI, CT or X-rays who need feedback or more information about treatment plans
  • Patients who have had fractures that need follow up scans
  • Patients who are being seen for the first-time regarding issues for soft tissues around the joint, that can be addressed through a good clinical history as well as review of standard images.

Maintaining the positive momentum of telehealth technologies 

As the pandemic has forced significant changes throughout medicine, increased use of telehealthcare technologies has emerged as an important adaptation for medical clinics of all kinds. As I’ve seen within my own specialty, eConsults represent one critical component of a complete telehealth strategy, one that also includes video conferencing and other virtual care strategies. Leveraging eConsult technologies saves the patient time and provides prompt care to address issues that would routinely have taken several days or weeks to address. 

For healthcare organizations, this effective virtual triage reduces in-person visits while providing answers to patient related issues. It also lessens in-person exposure in outpatient clinic settings, which helps to reduce the risk of COVID exposure while positively impacting both patient and healthcare operations.

The patient is at the heart of telehealth’s momentum. For the convenience, comfort, and joy of getting answers to questions in a timely fashion, nothing can beat telehealth. This improved, streamlined access to care isn’t going to change, even after the pandemic has ended.

Looking ahead, I would hope to see sustained utilization of telehealth solutions that have proven invaluable to maintaining healthcare operations during this time of immense stress. Continued innovation and utilization of healthtech and other tools that improve operations, efficiency, access, and patient experience will be a sustained method of healthcare improvement, both now and long after the pandemic has passed.

Dr. Hasan M. Syed, MD, FAAOS is a Member of AristaMD’s contracted eConsult specialist panel.

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