Impact

The video visit platform proved so popular that the volume of patients seen online since its launch was comparable to or even exceeded the volume of patients seen in the emergency department. The large majority of patients using this platform were appropriate for outpatient supportive care.

The aim of expanding video visits was to provide an alternative to in-person care, with the secondary benefits of conserving PPE resources and reducing unnecessary exposure to COVID-positive individuals who did not require hospitalization. Theoretically, patients seen via virtual visit may have instead presented to the emergency department if the telemedicine service were not available. In fact, more than 40 percent of adult patients who completed post-visit surveys reported they would have sought in-person care had they not used this virtual service. Although this theory cannot be formally tested now because of decreased ED volumes resulting from Illinois shelter-in-place orders, it is reasonable to hypothesize that the telemedicine platform led to decreased ED visits.

The Future of Emergency Medicine?

Telemedicine granted emergency medicine physicians the ability to perform house calls, albeit virtual ones. This was a unique opportunity to be present in a patient’s home, understand their living situation, and speak to members of their family. Physicians gained a more holistic view of their patients, which allowed them to identify specific challenges that patients face and determine their ability to remain under self-quarantine. In the time of a pandemic, this was one of the few opportunities for patients to interact with their physicians without the barriers imposed by face masks. Perhaps this was a more personal and fulfilling experience for both patients and health care workers than what could be offered by the sterility of a gowned, gloved, and masked physician in an austere ED room.

Emergency physicians on the front lines will face tremendous adversity in the coming months. And although video visits have been suggested as a means of reducing burnout during a pandemic, perhaps this brief segue into telemedicine foreshadows a grander future for the technology even after the pandemic subsides.3 The application of telemedicine in emergency medicine may allow us to identify nonemergent complaints prior to their presentation in the emergency department and increase overall efficiency while simultaneously increasing patient satisfaction.^4–7

Reimbursement

In an effort to ensure continued access to health care during the pandemic, the Centers for Medicare & Medicaid Services has allowed for payment parity for telehealth visits. We believe that our specialty should advocate for continuing this parity post-pandemic. To be a truly effective intervention that complies with EMTALA regulations, telemedicine programs should focus on outlining credentialing, expectations, and privileges for its workers and specifying protocols for triaging patients and transferring patients for in-person care.8 Ultimately, we believe that if executed with care and due diligence to hospital bylaws and governing regulations, telemedicine could serve as an impactful release valve for the exponential growth in ED volumes and waiting rooms that was seen prior to the COVID-19 pandemic.

Emergency physicians should be the driving force behind telemedicine efforts because we are arguably the most qualified specialty to determine when a patient requires emergency services and inpatient care. With this in mind, emergency medicine residency programs should incorporate telemedicine as a core component of training. 

Sometimes it takes a crisis to sow seeds of innovation. Telemedicine has favorably disrupted medicine and paved the way to new approaches to health care delivery systems. Our response to the pandemic has accelerated the proof of concept that telemedicine can be successfully implemented to advance emergency medicine and, ultimately, better serve our patients.