Surgical Consultations in the Age of Telehealth

When COVID-19 hit our country with full force, our company (like most medical technology companies) immediately asked, “How can we help?” Although our 3D digital models don’t yet have a use case in COVID patients, we soon realized that our models can play a significant role in a byproduct of the pandemic and its impact on cancer patients. Namely, in the seismic shift toward telehealth.

Ceevra’s AI-driven 3D digital models — created in the cloud from standard CT scans and MRIs — are primarily used in soft tissue cancer cases for preoperative planning (what type of operation to perform, and how best to perform it) and to provide a better picture of the anatomy during the operation. Surgeons also use our 3D models to help educate and counsel their oncology patients during consultations. There’s a stark difference between showing a patient a 2D black-and-white CT scan that’s sometimes difficult to interpret even for trained physicians and showing them a multi-color, interactive 3D model that any person can easily understand. Even before the pandemic, we routinely heard affirming feedback such as, “My patients love them” or “My patient was blown away.” With telehealth visits, the value of our 3D models for patient counseling becomes magnified.

Surgical Consultations Then

Prior to March 2020, telehealth consultations for surgical oncology patients were rare. One reason was economic — the reimbursement codes for remote surgical consultations were unattractive or non-existent. Another reason was pragmatic — a telehealth option simply didn’t exist for most surgeons. Under HIPAA, healthcare providers needed to vet, deploy, and fund fully compliant telehealth solutions; relatively few healthcare providers had made this non-trivial investment.

A third reason was clinical — a concern that telehealth surgical consultations could not be as effective as in-person consultations. Over video, the intimacy of meeting in person is lost, impacting the interpersonal bond that’s so critical in the doctor-patient relationship. Internet bandwidth remains variable, impacting the quality of both communication and comprehension. Adding to this, most surgeons still rely on CT scans and MRIs during patient counseling. The difficulty of explaining standard imaging to patients is well understood and becomes even more challenging with telehealth.

Surgical Consultations Now

In March, everything changed overnight. Reasonable reimbursement codes for telehealth consultations that are on par with in-person consultations quickly emerged. Healthcare providers rapidly and broadly adopted telehealth solutions. Telehealth became so vital — not just for COVID cases but for all cases — that the FCC established a $200 million program dedicated exclusively to funding purchases of telehealth-related technology and services by healthcare providers. In April 2020, virtually all surgical consultations in this country were performed over phone or using telehealth.

The abrupt, wholesale move to telehealth is not without its challenges. In these early days of telehealth, patients appear more apt to forget video appointments than in-person appointments, resulting in more delays for the surgeons. Internet bandwidth on the patient side is oftentimes poor, adding time and frustration to the consult. Reviewing CTs and MRIs over video calls has proven particularly challenging: Imaging is often accessed from a hospital-issued computer that’s connected to the imaging database, whereas the video call is often hosted from the surgeon’s personal computer. This dual-computer setup prevents screensharing of the imaging during the call. As a workaround, some surgeons report valiantly hoisting the hospital computer up to the video camera on the personal computer. Many surgeons, though, candidly report not showing the CT or MRI during telehealth consults — foregoing a key part of the patient consultation entirely.

Despite these challenges, the overall view of telehealth surgical consultations is positive, and surgeons broadly believe that telehealth is here to stay. Hospitals have made the investments, and both patients and surgeons have experienced the benefits. If we embrace telehealth as part of our new medical norm, as we should, we must next look to address some of its challenges. While we don’t purport to have an answer to patient tardiness or poor bandwidth, our 3D models do provide an ideal solution for the more substantive challenges of telehealth, namely, educating the patient and forging the surgeon-patient bond.

Bridging the Gap

During a telehealth consultation, surgeons can easily screenshare our 3D model with the patient — rotating the model, zooming in and out, and showing and hiding structures to educate on specific topics such as tumor depth and vasculature. There’s simply no better way to explain to a patient over a video call, “Here’s where your cancer is, here’s what we need to think about, and here’s what I’m planning to do to help you.

Patients also have the option to view the 3D models from their own phones or tablets — before, during, and after the consultation. This equips them with understandable information that they can consider at any time from the comfort of their homes, and share with their family if they so choose.

Our 3D models also help strengthen the interpersonal bond between surgeon and patient. Clearly, nothing will ever match the intimacy of an in-person meeting. But when patients see their own 3D digital model — a true representation of what’s going on inside their body — and hear their surgeon describe it in a way they truly understand, they experience a tangible example of their surgeon’s commitment to caring for them in an innovative, personalized manner. Patients recognize this, and it’s meaningful.

We’ll continue to invest our time and resources in improving the telehealth experience for doctors and patients. We recently appointed Richard Boxer, MD, FACS, to our Clinical Advisory Board. Dr. Boxer is a two-time finalist for U.S. Surgeon General, a Presidential appointee to the board of the National Cancer Institute, and a pioneer in the telehealth industry having served as the founding Chief Medical Officer of Teladoc. We’re excited to be collaborating with a telehealth expert of his stature.

As we enter this new age of telehealth, we see tremendous opportunity to improve the patient experience on many fronts — including elevating their understanding as well as their confidence in both surgeon and treatment plan. And though we’re not on the frontline of the battle against COVID, we are there for the cancer patients who are indirectly impacted by it, helping how we can.

CEO of Ceevra

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store