Evolution of Virtual Care

Those of us who are of a certain age may remember early NASA flights in which animals were sent up into space orbit to test their response to zero gravity. Later, this technology was used to monitor astronauts in flight and then adapted to extreme events and the need for expertise in remote locations. All of this occurred in the 1960s. So, the idea that telehealth was new during the pandemic is false. In the early 2000’s the technology was being applied to the highly specialized care of stroke patients with programs focusing on earlier detection, intervention and improved outcomes by doing so. Dr. Lee Schwaab was one of the earlier pioneers utilizing this technology. That model has spread beyond the USA and across the globe. The theme here is around access, timely care, improving outcomes, and leveling the playing field in equity of care. This has not changed over the last two decades.

Fast forward to just before the global event that would rock the world and eICU ® had evolved utilizing predictive analytics to lend virtual support to critical care teams at the bed side. The goal was and continues to be more preemptive and less reactive intervention to prevent complications for the patients and to ease the cognitive burden of the bedside team. More hospitals were developing programs that used this and similar technology and found improved outcomes and staff satisfaction by using such programs. Those fortunate enough to recognize the connection between this program and tele stroke were at the forefront of the evolving field of telehealth in acute care and were best poised to cope with the increased demand when COVID hit.

The pandemic also highlighted the degree of disparity in care and access, both to technology and providers for many globally. Funding was created in the US to rapidly improve broadband access through grants, and by adding insurance reimbursement at equivalent rates as in person visits. Investment in Broadband infrastructure has helped to combat the disparity, although cost is still a factor in most communities in the US. In Europe and elsewhere, some countries understand the need for public access to broadband as a public service, and here there is at least a minimum product that is free to the public in various forms. Security varies amongst public access broadband, and this is a concern as it applies to the restrictions to protect patient privacy. This will continue to be a challenge well into the future. Specialties began to embrace telehealth as a modality in higher numbers post-pandemic, to make efficient use of in-person scheduling and expand access to underserved people and communities. The healthcare community was on an online seminar at least weekly on a global and national forum exchanging ideas and sharing innovative approaches, and lessons learned that then enveloped other types of virtual care to make it a bit more connected, such as chatbots, and remote patient monitoring (RPM). Asynchronous sharing of medical information/imaging through methods employed for other reasons in the past became common to specialty consultation. Everyone who had a related product was joining the cause and realizing not just the opportunity during COVID but of a longer lasting shift.

Just prior to all this the other alarming trend had been the decreasing number of nurses and physicians entering the field. This added to the burden during a global pandemic and contributed to a continued existential crisis for healthcare workers and declining enrollment in related training/educational programs. Telehealth and technology rescued some who were on the brink of leaving fields for which they had a passion but were suffering compassion fatigue.

It is important to know where we stand today to understand what our future could and should provide in the realm of Virtual Care.   In the US, the Health Resources and Services Administration (HRSA) has projected a shortfall of 63,720 nurses by 2030. According to a McKinsey report, similarly, Physicians show a potential shortage of 86,000 by 2036.

Today some 5 years since the Pandemic there are specific programs and products on the market directed to specific chronic disease management, weight loss, Behavioral Health Care, Second Opinions/ Specialty care, remote patient monitoring along with asynchronous and synchronous chatbots and more. Some health systems believe they have fully integrated delivery systems across the continuum that integrate all of this. But the vast majority are using bits and pieces to solve a singular problem, The programs may have become silos that prevent us from looking at our patients holistically. The shiny new toys used in these programs still have appeal even if it does not fit into the overall strategy. Once purchased the people holding the purse strings want to know about ROI which has been difficult to parse out. We call care a hybrid if there is an option for telehealth vs. in-person appointments with our providers. But it is still segmented sometimes due to technology, sometimes despite it. The goal should be integration.

Thus, today, the vast amount of time we spend as we roll out a program is not about the technology as much as whether the desired workflow and what is needed to “make the technology” work are compatible. We still find challenges with ease of use and the blending of data to be more anticipatory and less reactionary in our response to health. We do use predictive analytics and some degree of AI, but on models that may not have been trained on the populations we are treating. Rarely are they the same and rarely do they fully integrate into preexisting systems. Without a fully integrated approach, it is hard to know the true value. What is it we are trying to measure? What are the variables that impact “outcome”? These are the struggles we deal with daily, but it does not deter us. We know technology can improve access, accuracy, timeliness and provider and patient experience but rare is the tool not flawed in at least one of those aspects.

We are also pushing the realm of remote robotic surgery. While forms of this have been around for over a decade, there is now more attention to honing this craft. This could enable specific expertise to be obtained anywhere there is reliable internet. Technology will fail at times, so there can never be erasure of the human component; in this case, a cache of standby hands-on providers will need to be accessible at each location. While we continue to automate aspects of healthcare, we do not have to lose humanity in medicine but rather relieve unnecessary burden.

Yet we live in a time of rapid change. One example of a population particularly needing rapid evolution of digitally integrated care is those over 65. The "Silver Tsunami” of older adults (those 65 and older) who do and will need full thickness care support in nontraditional settings is approaching numbers not seen before. According to Susan Miller in her workforce article “The silver tsunami is here. Is the government ready?” Pew Research sites a trend that since 2011, 10,000 Americans are reaching 65 every day and will continue through 2030. This along with the downward trend in the number of providers means this is an area to focus on. The elderly should have the right to age in place in most cases. But the tools we give them must be easy to use, integrate into EMRS, connect to food stores, pharmacies, their families, their providers, and intuitive and preemptive smart devices that make this movement of information seamless and painless without losing the humanity and touch. Large challenges are all being explored.  I believe the future of health care will be more connected, integrated, and effective and patient focused globally. Good health (care) leads to improved productivity, less time away from work, less reliance on highly costly hospital care, and better QOL. The smart home of the future will include a large smart TV with a monitor and assistance built in with ambient listening and the ability to communicate and operate devices on behalf of the resident(s). It will use and build upon existing technology that predicts risk of fall and declining health via sensors already being used in specific niche products to anticipate and intervene when there is a deviation in vital signs.

From a provider aspect, technology should ease the burden by decreasing mundane processes and absorbing them fully. Think LLM (Large Language Models) and transcription. As we continue to face a shortage of providers, technology, being able to filter out the noise and allowing them to concentrate on patients' needs ought to make things easier. Bringing back the joy of medicine is one purpose of technology. It should allow time for human interchange by relieving humans of mundane processes, improving speed and access to highly specialized care and measuring every bit of it in terms of outcomes, as we course correct. Keeping our eye on the ball has never been more essential. Politics aside, it should and could be a global mission, for if we improve the health of all it makes sense that we have a more productive and less burdened society.

References:

Deloitte Insights:A report from Deloitte Center of Helath Solutions. The Future of Virtual Health. Electronically Accessed 2/22/2025.
Lloyd Price, May 17, 2023. Future of Telemedicine and Virtual Care: Key Trends and Predictions. Electronically Accessed 2/22/2025
AACN Nursing Shortage Fact Sheet accessed 2/24/2025
https://www.mckinsey.com/industries/healthcare/our-insights/the-physician-shortage-isnt-going-anywhere(The physician shortage isn’t going anywhere. McKinsey and Company Healthcare Practice. By Laura Medford-Davis and Rupal Malani with Chelsea Snipes and Pieter Du Plessis. 09/2024).  Electronically Accessed 2/22/2025  
Susan Miller: Government Executive/ Workforce: June 10, 2024: The silver tsunami is here. Is  government ready? “  Accessed 2/24/2025 https://www.govexec.com/workforce/2024/06/silver-tsunami-here-government-ready/397237/

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