Bernie Forcier is 62 and has diabetes. The Biddeford man has been able to keep it under control for the past 30 years, but it’s a constant balancing act that includes regular blood work and a visit with his diabetes specialist every three months.
COVID-19 has forced some changes to his routine. He still has to get blood work (always masked), but visits with his provider are no longer in person. Forcier is extra cautious because his diabetes puts him at high risk if he gets infected, so he’s fine with having an online visit with the specialist instead.
“I was already familiar with Zoom,” he said “I’ve used it three or four times since the start of COVID. It’s face to face, which is the next best thing to being in person.”
Telehealth has been around for a long time, but services have exploded since COVID hit. For example, pre-COVID, the telehealth programs at MaineHealth, Maine’s largest hospital network, had between 1,500 and 2,000 video visits a month. By May, the health system was seeing more than 30,000 patients each month, and now it’s seeing about 40,000 a month.
The only way it could handle the surge and ramp up quickly was to start using Zoom. MaineHealth did not use Zoom prior to COVID, but found it easy to set up and, more importantly, that it offered a special security model for health care. Visits cannot be recorded, for instance, and there are layers of encryption.
One of the biggest hurdles was that Medicare wouldn’t reimburse for in-home video visits. Because of the pandemic, however, the restrictions were temporarily lifted, which has made a huge difference, said Jasmine Bishop, MaineHealth’s director of telehealth.
“It allowed us to move our medical care from the clinic setting to the patient home setting,” she said.
Within a week of the World Health Organization declaring COVID-19 a pandemic in March, MaineHealth had launched telehealth at its more than 50 primary care practices. Within two weeks, telehealth was available at specialty practices. Today, Bishop said, 200 practices and 1,200 providers participate.
Because of the increased demand, MaineHealth has expanded its telehealth teams, and is also expanding services that help support the video visits. The focus is on high-risk populations and getting devices such as blood pressure monitors, pulse oximeters, digital scales and thermometers into patients’ homes so they check their own vitals and report to their providers.
Even when the pandemic abates, Forcier doesn’t plan on returning to fully in-person care.
“If it’s a consultation only, I think video is the way to go. If I can do it just about anybody can,” he said. “I use my computer but can imagine using my phone at some point. The convenience of it and the zero risk of being next to somebody is huge.”
But what if you don’t have a great internet connection, which is the case in much of Maine?
That’s something Jim Rogers was working on well before the pandemic hit. His Bangor-based firm, HealthConnect Networks, manages a network that provides internet access to more than 1,000 hospitals and clinics, primarily in Maine, New Hampshire and Vermont, allowing them to offer telehealth services and providing them with other capabilities such as electronic health records and digital storage of X-ray and other images.
The amount of data the network transmits daily has spiked during the pandemic, Rogers said.
Creating a powerful and secure network for hospitals and clinics is vital, but patients need reliable internet access as well to make telehealth work. That’s why Rogers has created another company called Mission Broadband.
“I would say that Maine is pretty bad as far as adequate internet to the majority of the population,” he said. “Their internet is nonexistent, isn’t good, they can’t get it, or they can’t afford it.”
In 2018, Rogers saw that many towns were struggling to solve the problem in their communities by building their own private networks. Under his model, instead of going it alone, towns could collaborate with private companies that provide internet service and together, apply for state and federal funding.
It’s a new company, so it’s a work in progress.
But the question remains: If telehealth continues to expand and more people can access it, will providers and patients still be interested in the future? That depends on how easy it is for both parties, said Bishop of MaineHealth.
“There are definitely portions of almost every practice that couldn’t be done over telehealth, but conversely, I would say every practice and every single specialty has something they can do over telehealth,” she said.
The biggest challenge that remains, she said, is not knowing if Medicare reimbursements will continue for in-home video visits, though there is some support in Congress for lifting those restrictions permanently.
Yet another challenge is making sure providers are well versed in seeing their patients online instead of in person. To that end, MaineHealth launched a simulation center training program in which actors take on the role of patients so providers can test their telehealth skills.
“It’s not just hardware and software,” Bishop said. “It’s teaching providers something they didn’t learn in medical school — how to have what we now call a good webside manner, how to understand what makes an appropriate visit that makes both sides feel comfortable.”