Covid-19 is a hurricane, changing the landscape of medicine forever

It may seem quiet on the streets of NYC but there is a hurricane currently raging in healthcare.

And just like with a hurricane, the world as we know it is going to look different once #covid19 has passed. Many landmarks are going to stay the same, but many will be changed. And some will be entirely gone, left only with a memory of “this is how it used to be”.

Since we’re still battling the storm, I don’t know for sure which landmarks fall into which category, but I can tell you what has already shifted considerably in how healthcare is being delivered:

1. Video visits as a way to deliver care are now mainstream in clinical care- I’ve talked to many health systems who say that they have seen visits jump from under a hundred a day to many thousands per day. This is a momentous shift in the number of people who have tried this type of care delivery, both on the patient and the clinician side. I can’t imagine that this volume of care will just got away after the virus is gone. 
2. Regulations restricting many aspects of digital care, such as where the patient is at the time of care, have been waived. Most have been waived at this point only for the duration of the emergency, but once they are shown to be safe and helpful in one environment, it will be difficult to remove those waivers completely.
3. Reimbursement for different modalities of care has been broadened. For many conditions it doesn’t make sense for someone to come in and talk to a physician or nurse every time you want to communicate with them. In our normal lives many people communicate many important concepts through texting and emails. Patients view their relationships with their physicians no differently and would love the option to text or email (or the healthcare equivalent of that). Now CMS has set the precedent that clinicians can get paid for that time as well.
4. Patients are engaging with health systems digitally through chat or even chatbots, if health systems offer those supports. Groups like Providence based out of Washington were some of the first to create chatbots to engage with, educate, and guide patients to the right level of care. They have seen these tools used hundreds of thousands of times by people who want help from a trusted source. We now have that robust data that can guide us in what we offer to our communities.

These are just a few of the changes that have already happened, all across the country. Many, many more will fall into place over the next weeks. We in the medical community are using all of hearts, brains, skills, and ingenuity to bring as much care to as many people as we can, as safely as we can. And we’re doing it together, connected to each other across the country and the world by pictures, vignettes, protocols, and tips sheets, all digitally housed in the piece of the world that we carry in our pockets nearly everywhere we go.

The world is going to look different on the other side. Some changes will be very hard. And some should have happened a long time ago, and only could have been shifted from their inertia by a huge force. But I know that we will work through the hard times and help each other adopt and even embrace the changes that actually make care better.

#Thanks to everyone fighting this fight. #Thanks to everyone weathering this storm. We will continue to work together, to stand together, to mourn, fall down, and stand up again together. 

To quote a meme that’s making the digital rounds right now:

The Devil whispered in my ear, "You're not strong enough to withstand the storm."

And I whispered, “6 feet back, 🤬.”