SIOUX FALLS, S.D. — The COVID-19 pandemic upended many things, but perhaps nothing as much as health care. Almost overnight, many hospitals and clinics limited who could and should come in for care, seeking to limit the spread of the virus and prepare for a potential onslaught of virus cases.

In the place of in-person health care, telehealth boomed. Things like virtual doctor visits had existed pre-pandemic. But they were still a small but growing part of health care. Suddenly, telehealth was essential, as people who otherwise would have stopped into a clinic to seek help found the only way they could consult with their health care providers was through their smartphones and other devices.

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The telehealth explosion during the pandemic upended its role in health care. Telehealth isn’t just a niche player anymore, but a crucial and growing part of the way people get health care. It’s become clear: Telehealth will shape the future of health care, not just for people in rural areas, but for everyone.

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"I think telehealth is going to start being, if you will, the digital front door for health systems, including Sanford (Health),” said Dr. Jeremy Cauwels, chief physician for Sanford Health, which serves patients with clinics and major medical centers in North Dakota, South Dakota and Minnesota.

“I think it is the way that many, many people are going to experience their first bit of care from Sanford Health, and for those people, we want to make sure we deliver on all of the care needs and care wishes that we can without necessarily bringing them in until they need to be.”

The scope of the change

It’s hard to overestimate how quickly health care changed in the early days of the COVID-19 pandemic, in March 2020, for both health systems already doing telehealth and those that weren’t.

Prior to the pandemic Sanford Health, based in Sioux Falls, South Dakota, was averaging about 1,000 telehealth visits a month. Suddenly it was doing up to 3,000 visits a day, Cauwels said.

Essentia Health, which serves patients in North Dakota, Minnesota and Wisconsin, had been planning to launch a virtual visit pilot project in April, said Dr. Sarah Manney, a pediatrician and chief medical information officer for the Duluth, Minnesota-based health system.

“We were along for the ride with every other health care organization in the country when COVID hit,” Manney said. “We were able to turn it on a dime and within a couple of days, really scale up our platform to be able to provide virtual video care for patients across Essentia.”

Dr. Sarah Manney, pediatrician and chief medical informatics officer for Essentia Health, demonstrates a virtual visit.
Dr. Sarah Manney, pediatrician and chief medical informatics officer for Essentia Health, demonstrates a virtual visit. Courtesy Billy Wagness/Essentia Health

At the M Health Fairview health system, which serves patients across Minnesota, nearly 80-90% of their inpatient visits became virtual visits over just three days in March 2020, said Dr. Jakub Tolar, dean of the University of Minnesota Medical School and co-leader of the M Health Fairview.

“So this is something we have been talking about for as long as I can remember, and then we just did it because we had to,” he said. “The beautiful power of constraint has shown itself again, where the necessity to serve our patient has turned into a change that will be here to stay.”

Virtual visits with health care providers weren’t the only massive change for health systems -- and patients. As a matter of necessity, as hospitals filled with COVID-19 patients during late 2020 surges of the virus, health systems kept virus patients at home with remote monitoring devices, keeping an eye on them and bringing them into the hospital only as needed.

“One of the things that worked really well for us during COVID, and we will take out of there, is the ability to monitor people at home, to send them home with the tools they need to be safe there, and be able to work through it in a way that doesn’t require them to stay in the hospital or doesn’t require them to be in a monitored bed-type situation,” said Sanford's Cauwels. “It turns out to have worked really effectively for our patients, so I think it’s something we’re going to keep with us, regardless of how the pandemic is going to go.”

The shape of telehealth’s future

The future of telehealth is almost like describing the future of the internet. It’s transformational in ways that might be hard to see right now.

But whether it's specialists beaming into remote sites to consult on patients, mental health patients visiting via an app with therapists, or using artificial intelligence to spot illness in a chest X-ray taken far away, it’s already changing health care to make it more accessible, simpler and connected to patients’ everyday life.

“I think we’ve really opened a window for sort of a third path into health care,” Cauwels said. "It’s not just about clinics and hospitals anymore. Now it can be about digital connections.”

Essentia Health, like Sanford Health and many other health systems, also realized the functionality of remote monitoring during the pandemic. It’s rolling out a “Hospital at Home” pilot program, using remote patient monitoring for other types of patients as part of an integrated approach to patient care.

“Those devices were deployed initially for (COVID-19), but now we’re pivoting to chronic care management, heart failure, diabetes care and various chronic care conditions that we can provide for at home,” said Manney. “That will look similar to our remote patient monitoring but will provide hospital-level care directly in the home.”

A $300 million T. Denny Sanford gift to Sanford Health, announced Friday, March 19, will fund a range of programs meant to better rural health care, including the establishment of a "virtual hospital "to provide affordable care in rural and underserved areas of the Midwest. Architectural rendering / Sanford Health
A $300 million T. Denny Sanford gift to Sanford Health, announced Friday, March 19, will fund a range of programs meant to better rural health care, including the establishment of a "virtual hospital "to provide affordable care in rural and underserved areas of the Midwest. Architectural rendering / Sanford Health

Sanford Health has said it’s using some of a recent $300 million donation from its chief benefactor, credit card mogul and billionaire T. Denny Sanford, to develop what it’s calling a virtual hospital, although what it’ll do remains under development.

“All we’re trying to do with the virtual hospital is identify a way for us to care for our patients without them having to come to us, or a way to identify which ones need to come to us and which ones don’t,” Cauwels said.

Both Manney and Tolar, at the U of M Medical School, say they’re convinced a big part of the future of telehealth is health informatics -- working with personal devices such as smartphones and smart home devices like Amazon’s Alexa to monitor health, make wellness recommendations, and seamlessly send data to a patient’s medical records without requiring a visit to a health care facility.

“This is almost like real-time, always-on, perpetual digital physical, and the telehealth can actually deliver this beautifully in a way that we’ve never had before,” Tolar said. “I think the telehealth and the digital transformation is the insult, almost, to the system that is big enough, that can reposition us to preventative care, to really keep people out of hospital rather than in hospital.”