From the SELA President: Navigating the Perfectly Imperfect World of Telehealth

All issues of LipidSpin are special, but this one is particularly so since it was co-developed by the Southeast and Northeast Chapters of the National Lipid Association. It was a real pleasure working with Dr. Karen Aspry, Northeast Chapter President, on this important and timely issue.

Although telehealth has been around for decades, it was thrust upon everyone when the pandemic began last spring, as it became our primary means of providing care to our patients, while also keeping them safe. Health systems and clinics scrambled to rapidly implement telehealth programs of various types. Now, most of us are accustomed to conducting visits by telephone and video. Fortunately, some patients are returning to the clinic and I must say it’s really nice seeing their faces and getting to talk in person. But once this pandemic is over, are we going to go back to the way things were? I don’t think so.

It has been easy to avoid embracing telehealth up until now. Previously cited barriers to implementing telehealth have included everything from concerns about its cost to regulatory issues surrounding reimbursement. Disruption, however, leads to innovation and shifts our thinking from how things are - to how they could be - to how they will be. The pandemic has certainly been a major disruptor to healthcare, and we must see this as an opportunity to improve how we deliver healthcare in the United States. Western states that are predominantly rural have relied on telehealth for decades to deliver care to individuals who may live hours from healthcare facilities and clinics. Now, instead of thinking of telehealth as just a tool for rural communities, we have the opportunity to repurpose telehealth as a means to increase access for all patients.

In my own practice in Richmond, Virginia, our inner-city population includes a large portion of underserved patients who often must take time off from work, find childcare, purchase a bus ticket or pay for parking, among other things, just to come in for a 15 to 30-minute visit. Moving to telehealth has been immensely helpful to these patients as it removes these barriers and permits more flexibility when we schedule appointments. It’s also been surprising to me how many more medication-related problems I’ve discovered by being able to go over a patient’s medications while they’re in their homes looking at the medication bottles. Discussing healthy lifestyle behaviors has also been more effective as patients can give me a more accurate picture of what is in their refrigerators and pantries. Lastly, patients can measure their blood pressure in real-time at home where they’re more at ease.

Despite the positives, telehealth is far from perfect. There are still appointment “no shows” and sometimes patients are driving their cars (or taking a shower) when you call them. The technology doesn’t always work like it’s supposed to. The optimal model for how to best implement telehealth also remains unclear. Patients must still physically come in for laboratory tests, although the “traveling phlebotomist” may be a thing of the future. Reimbursement for telehealth services also remains an important issue, although the Centers for Medicare and Medicaid Services have been open-minded about regulation addressing this issue. Clearly, these issues require attention, but I think we’re capable of figuring them out.

I’m very grateful to the authors who contributed their time, effort, and expertise to produce some terrific content. It is a real honor to serve as the President of SELA, and while many challenges lie ahead, I’m confident we will come out of this better able to provide our patients the care they need, when they need it.