The Digital Doctor Is In

Virtual appointments with doctors are on the rise amid social distancing measures / Photo courtesy of Edward Jenner for Pexels

Anne Sansevero saw it coming. As the first cases of COVID-19 began surfacing in America, Sansevero, who has been a geriatric nurse practitioner for more than 30 years and runs a private practice serving seniors, foresaw that her elderly clients—one of the most vulnerable populations to the contagious virus—would particularly be at risk.

“I knew we were in trouble,” she said.

Normally, care managers like Sansevero regularly check in with their senior clients, many of whom live alone or suffer from mental or physical disabilities, often dropping by their homes for a visit every week or month, depending. But as local governments began to enact social distancing measures to prevent the spread of the coronavirus, health care specialists have been forced to re-strategize, and many of them have increasingly turned toward telemedicine to consult with patients.

A form of remote care, telemedicine encompasses anything from consulting with a healthcare specialist through the phone, to having video interactions through Skype or Zoom, sometimes assisted by devices like scales, blood pressure cuffs, or information from a smartphone or Apple Watch. Recently, more sophisticated technologies have enhanced these efforts, employing artificial intelligence and machine learning algorithms to help doctors monitor their patients.

The use of telemedicine has surged during the COVID-19 outbreak as health departments across the country began urging those with symptoms to stay at home and call their doctors, rather than go to a hospital and risk spreading—or contracting—the virus. The CDC launched a self-checker chatbot to assess symptoms (which, more often than not, advises you to stay home), while Mount Sinai and NYU Langone Health bolstered their various online, video and call care services in an attempt to alleviate the strain on an already burdened healthcare system in New York City.

Patients, it seems, are heeding directives and using these virtual consultations. A recent Axios survey of 1,021 adults found that around a third of respondents have turned to telemedicine: 22 percent said they consulted a healthcare provider via phone call, and 13 percent said they’d done so through video chat. NYU Langone Health also saw a spike in its urgent care telemedicine platform from 50 virtual visits a day before March to an average of 900 a day during the week of March 23.

Remote care options are especially crucial for those who are more vulnerable to the highly contagious virus: the senior population and those with existing serious underlying health conditions.

Health insurers are also recognizing this need. Previously, telehealth benefits were restricted to those seniors who lived in rural areas and who already had a provider. On March 17, the Centers for Medicare & Medicaid Services broadened the scope of its benefits, which will now cover telemedicine for routine follow-up visits. Some private insurers like United Healthcare and Aetna also waived copays on telehealth services.

“Medicare beneficiaries across the nation, no matter where they live, will now be able to receive a wide range of services via telehealth without ever having to leave home,” said CMS administrator Seema Verma.

Although telehealth companies are not a new phenomenon, many have seen a spike in use amid the global pandemic, and are also employing their technology to target problems unique to COVID-19, from straightforward symptoms monitoring to less obvious issues like emotional wellbeing.

MyndYou, an AI-based startup founded four years ago in Tel Aviv, for example, aims to provide remote care for senior adults on a larger scale. Their cornerstone solution is a voicebot dubbed MyEleanor, which calls seniors regularly to assess risk to the virus, asking screening questions like “Do you have a sore throat?” and more general questions like “How was your week?” An AI algorithm, co-founder and CEO Ruth Poliakine Baruchi explained, then analyzes the responses and voice data—like pitch and tone of voice—that she says correlates with brain activity.

Polakine Baruchi said that the calls act as an additional touchpoint and work in tandem with check-ins from a human case manager. She believes there’s a “real need” for this, especially with isolated seniors living alone during the pandemic. “Everyone needs to speak with someone,” she said.

Sansevero, who also founded HealthSense, a private practice of care managers serving seniors, recently began using MyndYou to monitor some clients. She recalled a recent incident when MyEleanor detected an anomaly during a call with a female client who is often vulnerable to anxiety. Her caregiver couldn’t determine what was wrong, but, later that night, heard the client talking nonstop—to her dead husband. Sansevero thinks that this was likely a stroke or a similar neurological event, which the technology was able to detect and portend from an anomaly in the client’s voice.

There are limitations to remote care, such as that the senior adult must be physically and mentally able to respond. So it rules out those who, for example, have advanced dementia. In addition, those without Internet access or don’t know how to use the technology aren’t able to access telehealth services.

The social aspect of human interactions—which is especially important to isolated seniors—is also missing, of course, though Sansevero is trying to offset this with virtual happy hours and board game nights over Skype.

“It’s helping,” Sansevero said of remote care technologies, acknowledging that it’s difficult, if not impossible, to fully replicate the complexities of in-person healthcare. “It’s not the same, but it is better than nothing. There are two of our senses involved: there’s sight and hearing. We can’t touch, we can’t smell. And we do have our spidey senses”—the nursing instincts that come with experience as a care manager—“which can be virtual.”