Telehealth experienced explosive, unprecedented growth early in the pandemic. More than two years in, much of that uptick has slowed, hampered by reimbursement uncertainty and unknown returns on investment.
Still, some health systems have found an enduring use case for virtual care: oncology.
Although telehealth appointments aren’t a replacement for in-person therapies, oncologists say scheduling regular remote check-ins and constantly monitoring symptoms have helped them stay on top of their patients’ health, especially amid COVID-19-related delays in cancer treatments. Despite limits on efficacy data, organizations point to expanded access and reduced emergency department visits as early signs of success.
Some providers characterize remote monitoring technology and digital platforms as essential care delivery tools, even as physicians in other sectors return to in-person visits.
“What’s unique in oncology is that you see the persistent utilization of video visits, despite a trend toward normalcy for most of the healthcare system,” said Dr. Sumit Shah, medical oncologist and director of digital healthcare integration at Stanford Health Care.
“This is largely because oncology is well-suited for virtual care in the sense that most of our decision-making can be made based on objective criteria that are still available through video visits,” he said.
Before 2020, Stanford Health Care in Palo Alto, California, mostly offered remote second opinions for clinicians, with virtual video visits as a potential option for patients traveling long distances, Shah said.
But during the pandemic, the health system found that video appointments allowed its most vulnerable cancer patients to receive necessary care without possible exposure to COVID-19. Virtual oncology visit rates soared, peaking at 80%.
Traditionally, cancer care has been mostly episodic, where patients may only see their oncologist three to four times a year to receive exams and discuss treatment plans, Shah said. By setting up video visits on an as-needed basis, physicians are able to have a better sense of a patient’s trajectory. They can arrange in-person or virtual medical assessments in response to patient requests; adjust prescriptions; or coordinate urgent care visits to offer patients fluids, anti-nausea drugs or pain medications.
Stanford oncologists have embraced telehealth, especially for advanced urologic, lung and gastrointestinal cancers, Shah said. Half of all oncology visits are now virtual, compared with other specialties at the hospital, where rates of remote visits have decreased to 10% or 15%.
When determining which technology to use for virtual care, Shah said it was important for Stanford Medicine to choose a platform that had full integration into its electronic health record. The health system opted to use Vidyo, which embeds directly into its Epic EHR.
So far, oncologists at Stanford have been able to widen the system’s geographic footprint and optimize the use of clinic rooms and other resources, Shah said.
“We are currently implementing an enterprise solution for remote patient monitoring to enable patients to use mobile health devices to gather patient-generated health data and transmit that information to their care teams,” Shah said. “We’re also in the process of launching on-demand services that would allow patients to access a provider through their phone to address an urgent matter.”