How is Telemedicine Helping Mildred?
Mildred, 75, is retired and lives alone as her husband passed away a few years ago. She keeps herself busy with volunteering in her community, keeping up with her grandchildren and children, and maintaining her physical and mental health as she continues to age. She was diagnosed with arthritis 3 years ago and the pain in her joints and hips keeps increasing with time. However, she tries to remain as independent as possible by being active, taking the local transport and driving to wherever she can- to get her groceries, attend the weekly church service, get her hair done at her hair dresser’s, and visit the hospital for her regular health check ups. She prefers driving around as that’s her sense of independence, however the traffic tires her now and the expensive city parking pinches on a retiree’s pension. Technology is not her best buddy but her children are trying to teach her to start using ride hailing apps to allow her greater mobility in life. She’s learning, albeit slowly.
Mildred represents the persona of a good majority of the older adult population. As part of the team at Future Lab on Mobility in Fall ’19, we worked with the Toyota Mobility Foundation in conjunction with the partners for the project- Executive Office of Elder Affairs (EOEA) and Massachusetts Bay Transportation Authority’s (MBTA) paratransit service- The Ride. We used the Design thinking methodology to identify the opportunity space and research our users. We met with many older adults, interviewed them, observed them, and even spoke with some of their caretakers to research and make suggestions that could aid Boston city’s initiative to become more age friendly.
Amongst the older adults, people are at different stages of aging and life moves at different paces for all. There are those who are independent, active and still able to support the community and then as we go up the pyramid the mobility restrictions and dependencies increase. Mildred falls somewhere in the middle. However, even with differing levels of need for support, what remains constant through the three layers, are the points below. While we had a list of insights pertaining to the motivations and needs of this section of the society, some of the key ones relevant to this piece are:
- Need for personal interactions and relationships- The visit to the church and the hairdresser is their sense of a social life.
- Challenges with Technology- Technology is not their best friend and adapting technology for most is not the smoothest experience.
- Growing anxiety and mental health issues- These begin creeping in as life slows down and control on external factors lessen. This is higher for those who may not have a strong personal support circle of friends and family.
When the COVID-19 pandemic hit, the Future Lab team collaborated with Harbor Health Services, a group of community health centers in eastern Massachusetts, and ideated around the increasing mobility challenges of health care access. We understood that one of the worst hit was the older adult population. The most vulnerable group and also the most isolated. Providing care to them suddenly became a challenge. Since hospitals are a high contagion zone, and even remote in-person care for older adults is now avoidable as many health workers test positive, the options for care have become very limited and risky.
Here is where discussions began around accelerating the implementation of telemedicine solutions and providing virtual care. Telemedicine is the practice of medicine using technology to deliver care virtually. A physician in one location uses a telecommunications infrastructure to deliver care to a patient at a distant site. (AAFP).
As per the American Medical Association, the use of telemedicine and remote care services are critical to the safe management of the COVID-19 pandemic, while also ensuring uninterrupted care for 100 million Americans with chronic conditions. There is an increase in demand from hospitals seeking to cope with the pandemic. For years, regulatory concerns around privacy and physician liability, and a general resistance to change in health care, restricted the growth of this field. However, the pandemic has nudged the loosening of restrictions to encourage a greater use of technology, allowing doctors to care for people from a distance, reducing the need for travel to hospitals. Restrictions around medicare reimbursement for telehealth have also been relaxed by the Congress and the U.S. Department of Health and Human Services as the country deals with the pandemic. This increased demand for telemedicine, could also potentially drive more venture-capital investment in the field. (WSJ, Pandemic Could Spur Longer-Term Gains for Telemedicine, Mar 2020)
Telehealth offers many options to make healthcare easier and more accessible such as tracking vital signs with remote monitoring devices, communicating with the care provider through a web portal, and receiving on-the-spot care from a doctor via video chat. Seniors are definitely a key target for these services as they stand to benefit greatly through this new model of care.
- Easier access to care- Eliminates the hassle of travel and unpredictable wait times while allowing real time care.
- Saves time and money- Remote evaluation and treatment helps eliminate costly and time consuming trips to the doctor’s office and the emergency room.
- Lower risk- Helps keep the at-risk older adults out of high contagion zones such as hospitals.
While telehealth and telemedicine have a lot to offer, there still are a few concerns and I pose a few questions regarding those-
- Costs- There are costs associated with accessing the services and understanding the reimbursement terms with current insurance providers, as the loosening restrictions around reimbursements is a fairly new development. There also are hidden costs, such as convenience fees, with the telemedicine service itself. Is there a way to make the process more transparent and user friendly?
- Learning Curve- Technology comes with a learning curve and especially when it’s new. We know that there is friction with respect to change and adapting technology, and it’s stronger for this group. With the pandemic, the older adults have not had sufficient time to accommodate this learning curve and the current lack of in-person support does not help either. Makes me wonder if forcing change at speed with no alternatives would push people to break out of their mental models and adapt faster? Or will it culminate into resentment?
- Addressing mental health concerns- While online counselling or talk therapy models are scaling well, but for individuals that might be dealing with more serious mental health concerns, and need in-person care, telemedicine is perhaps still not there. Also, adjusting to change is bound to cause a certain amount of anxiety. With already growing anxiety in older adults as they age, how do we make this transition less stressful?
Telemedicine might have worked well as a compliment to traditional in-patient visits, but I wonder if we’re ready for it to completely replace the in-person visits yet? Will the pandemic force the system to look at an inclusive design to deliver solutions or will it create greater silos?