Virtual house calls flourish in the age of coronavirus

COVID-19 has pushed health care into cyberspace — and some rural practitioners might stay there.


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Back before the time of coronavirus, Elizabeth Powers, a family doctor in the tiny town of Enterprise, Oregon, carefully examined patients in her office in an effort to arrive at a diagnosis and treatment. She still pays attention to the physical details — the color of her patients’ skin, their breathing, any signs of swelling — only now she does it via computer screen. “I’ll adjust their medication and talk about lab tests or follow-ups,” she said, treating them just as she did when they came to the clinic. “It’s very customizable, based on the patient’s needs.”

Millions of workers in various fields have been pushed into cyberspace by the pandemic. Powers is one of them. For her, however, the transition was relatively smooth because Winding Waters Community Health, where she works, has been integrating virtual visits into its practice for years to better serve its rural clientele.

Sébastien Thibault/High Country News

When the pandemic is over and social distancing is no longer necessary, Powers will see patients in her office once again. But now she — and many other health professionals across the country — will be better prepared to use virtual visits when necessary. This “telemedicine revolution,” as some medical providers call it, is especially vital in the rural West, where hospitals and doctors are few and far between.

According to a 2019 Life in Rural America survey by NPR, Harvard University and the Robert Wood Johnson Foundation, about one in four people living in rural areas say they’re unable to access healthcare, often because the nearest clinic or hospital is too far away. And the problem is getting worse as small-town hospitals and clinics shut down, baby-boomer doctors retire and newly graduated medical students gravitate toward larger cities in search of better opportunities. Meanwhile, the refusal of many states to expand Medicaid coverage has greatly increased the odds of rural hospital closures, according to research out of the University of North Carolina.

Winding Waters is one of the only clinics in Oregon’s Wallowa County. Some patients have to drive up to two hours to reach it, which is why the center has spent years working to incorporate  telemedicine into its practice. They were one of the first members to implement telehealth with OCHIN, a Portland-based nonprofit that assists underserved health centers with technological support. Now, with the pandemic in full swing, the effort is paying off. In early March, just before COVID-19 hit, 5% or fewer of the clinic’s patients had telemedicine appointments. As of early April, that number had jumped to 45%. “It has definitely made the transition to social distancing easier,” Nicolas Powers, CEO of Winding Waters and Elizabeth Powers’ husband, said.

“It took a pandemic to really force a lot of the changes that needed to happen in an expedited manner.”

This jump reflects a greater trend across the nation. According to OCHIN, the number of video visits in its 500-odd health centers has skyrocketed since the coronavirus was declared a pandemic. This April, there were 10,418 video calls, a 291% increase from March. The crisis has also prompted the Federal Communications Commission to create the COVID-19 Telehealth Program, which will provide $200 million for telecommunication services. “It took a pandemic to really force a lot of the changes that needed to happen in an expedited manner,” said Jennifer Stoll, OCHIN’s executive vice president of government relations and public affairs.

Yet barriers remain — including limited access to high-speed internet in many rural communities. One in five rural adults in last year’s survey said that this was a problem, impacting their family’s ability to use telemedicine. “It’s a very complicated thing in the rural West because of our low populations, which makes it difficult for a business to care about investing (in rural broadband),” said Debra Hansen, Washington State University’s extension director for Stevens County. She has been working on expanding internet access for over 20 years. It doesn’t help that the FCC database on broadband availability erroneously says that Stevens County is already 100% covered. “That’s absolutely not true,” said Hansen.

The current rise in telecommunication will help pinpoint weaknesses in the broadband system, and ideally drive officials to fix these problems. Online health-care appointments will never replace face-to-face visits with a provider, nor are they intended to. Some medical issues need hands-on care, and maintaining the intimacy of the provider-patient relationship is crucial, Powers said. But for many isolated patients, telemedicine offers an easy and secure way to get help from the comfort of home. For rural providers, there’s a silver lining there. “We have to keep moving forward,” Stoll said. “We can’t go back to how we were pre-COVID.”  

Helen Santoro is an editorial fellow at High Country News. Email her at [email protected] or submit a letter to the editor.

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