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Expert Viewpoint: Though abrupt, the shift to telehealth should be embraced

When the COVID-19 pandemic arrived in Chicago in the late winter of 2020, the college’s clinic, Mile Square Humboldt Park Health Center, quickly pivoted to telehealth, providing 85% of primary care visits and nearly all mental health visits at a distance. Charles Yingling, DNP ’12, MS ’05, FNP-BC, FAANP, then-associate dean for practice and community partnerships, says the pandemic is forcing a much-needed sea change in healthcare delivery.

“For us at the Humboldt Park clinic—like many across the country—we fumbled a bit as we tried to abruptly shift much of our practice to telehealth due to COVID-19. We marched through four telehealth platforms in short order. The devil was in the details: How do we send patients a telehealth link when we didn’t have their email address? How do we bill for visits? But once we got both our providers and patients comfortable with the fourth and final platform, we began to reap the benefits of telehealth.

“COVID-19 was the impetus to move here very quickly, but for far too long, it’s been a provider-centric model of care. If you have a health need, your only way to address it is to move yourself to the place where the person is providing care. That is not patient-centric.

“Move the data, not the people.

“I learned that phrase from telehealth entrepreneur Judith Hicks, MS ’75. It’s the idea that, as a clinician, my decision-making is based on data that I get from you: things you tell me, elements of your physical exam and test results. If we can move the data, not the people, it makes our patients’ care a lot more accessible, so they don’t have to take a half day off from their job to come see me in my clinic across town.
There are certain things we can’t do remotely, such as physical exams and lab tests. Body language cues can be harder to pick up on in telehealth. But the lion’s share, at least of primary care, can be done via telehealth with the right equipment, the right structures in place, and the right resources in place. I think that’s what COVID-19 has proved to us.

“I envision a blended model of remote and in-person care. At our Humboldt Park clinic, we have a number of patients on long-acting, injectable psychotic drugs. Those patients have to come to the clinic every three to four weeks for an injection as well as a consultation with a psychiatric nurse practitioner. But if that consultation can happen via telehealth at home, they can zip in for the injection at a time that’s convenient for them.

“A lot of people think of telehealth as a video visit, but there are many other aspects of telehealth, including remote patient monitoring, or devices that can remotely gather and send data about a patient. We know access can be a problem for some patients, and we are piloting solutions to that. We have a DNP student working on a project using remote glucose monitors that send data using cell phone SIM cards, rather than relying on Internet access that many of our patients don’t have.

“We can’t go back to the old model, and, in fact, must grow our competence in care at a distance. We, of course, will resume more in-person care when the pandemic is under control, but we can’t walk away from this transformation in healthcare delivery. It’s exciting.”