Amid a roiling ocean of distress, telemedicine emerges as a vital port in a storm. By Nick Brandi
By Nick Brandi, Michelle Gillan Larkin, Amy R. Partridge & Gina Valentino

No industry experienced the pandemic the way the healthcare industry did. For that workforce, it wasn’t a shutdown but rather a ramp-up, with frontline staff, support staff, and administrators pushing themselves to limits previously unimagined. We spoke with many of Westchester’s key healthcare providers, who shared their thoughts on what the future of medical care would look like in the county. What emerged was an enlightening consensus that for all the uncertainty and virtually incalculable loss, it’s possible that it took COVID-19 to bring healthcare where it needed to be all along.

“Six months from now, if you come in with a rapid heartbeat, a severe injury, or something else, people will be wearing masks,” says Dr. Rafael Torres, director of emergency medicine at White Plains Hospital (WPH), which, with more than 65,000 visits a year (under normal circumstances), is the home of Westchester’s busiest emergency department. “We will be wearing N95 respirators; we will be wearing eye shields; we will be using cover-up gowns. These are all things that [hospitals] should have been doing before. There’s even evidence out there that physicians should not be wearing ties when seeing patients. I think until we have a vaccine, we are going to have to test all patients who are admitted into the hospital, which is what we are doing now.”

But that’s in the hospital. According to Torres, the real system game-changer in present and future healthcare comes in what’s not done in the hospital. “Going forward, a trajectory that really needs to continue is the expansion of home monitoring and home care,” he says, “an expansion into what in many ways is the safest place to receive care — your home.”

Torres is referring to what’s commonly known as telehealth or telemedicine, likely healthcare’s most rapidly expanding field. With the diagnostic and telecommunications technology currently being deployed in telemedicine, a patient may not only receive remote care from skilled clinicians while in the comfort and safety of their own home but also real-time lifesaving virtual treatment while at another medical facility, in an ambulance, on a medevac chopper, or even at the site of an accident. To lend perspective to telehealth’s meteoric rise, prior to the pandemic’s outbreak, WPH conducted “tele-visits” only on a limited basis; since the end of March, however, more than 16,000 have been performed.

“Just to give you an idea of how rapidly the field [of telemedicine] is advancing, in April alone, the Montefiore Health System had 114,000 telemedicine visits; in February, we had zero,” says Jeffrey Short, vice-president and chief of staff of the Montefiore Health System, which includes both White Plains Hospital and New Rochelle Hospital. Short added that while the exponential increase obviously arose from exigencies imposed by COVID-19, public receptiveness to the burgeoning field appears to be shifting diametrically, practically overnight.

“In a 2019 national survey, only 11 percent of patients had undergone telehealth visits. Now, 76 percent say they are interested in using telehealth,” says Short.

The Westchester Medical Center Health Network (WMCHealth) is no stranger to telehealth. The 10-member network, which covers much of the Hudson Valley, introduced the program approximately five years ago and has seen rapid adoption during that time.

“Six months from now, if you come in with a rapid heartbeat, a severe injury, or something else, people will be wearing masks.” —Dr. Rafael Torres, Director of Emergency Medicine, White Plains Hospital

“In the past five years, the use of telehealth at WMCHealth has increased 300 percent — and that’s before the outbreak of COVID-19,” says Dr. Corey Scurlock, director of WMCHealth’s E-Health program. “Where it changed the most, I think, is in the older generation. They now see telehealth as a real, viable means to deliver their healthcare. One of the biggest hurdles in the past was the fact that for most telehealth applications — excluding telestroke and telepsychiatry — you could not bill insurance companies or CMS [Centers for Medicare and Medicaid Services] for it. Now, the government has pulled the curtain back on billing, and the prime insurers have followed, so the ability for an organization to implement and sustain a telehealth program has really improved. In return, I think the payers and the government are going to see a huge return on their investments, in reduced transportation fees, reduced hospital admission rates, and reduced length of hospital stays, among other things.

“Think about this,” Scurlock continues, “with telemedicine, from the time a stroke patient is wheeled into the ER until the telestroke doctor has seen them is 12 minutes — plenty of time to administer a lifesaving drug called tPA. Contrast that with a neurologist who’s called in at 2 a.m. and must then drive to the hospital, get ready, and examine the CT scan. That takes a lot longer than 12 minutes, unless the neurologist just happens to live at the hospital. We’ve already created telehealth pathways and hardware in the ambulances to connect pediatric ICU specialists, neonatal ICU specialists, and trauma specialists with patients on route to the hospital, and it will only expand from there.”