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. 2020 Jun;13(3):125–126.

Impact of COVID-19 on Telehealth

PMCID: PMC7370821  PMID: 32699574

Abstract

In response to the COVID-19 pandemic, in April 2020 the Association for Value-Based Cancer Care (AVBCC) introduced a series of webcasts titled “COVID-19 Impact on the Cancer Care Delivery Ecosystem.” The following articles highlight some of the presentations that addressed the impact of the novel coronavirus on healthcare stakeholders during and beyond this pandemic.

Telehealth (or telemedicine) has emerged as an essential component of healthcare during the COVID-19 crisis. In a wide-ranging discussion, a panel of experts discussed the current benefits and ongoing challenges of this technology, as well as its potential impact on patients and practices in the years to come.

“It's taken this crisis to push us to a new frontier, but there's absolutely no going back,” said the moderator of the discussion, Rick Lee, Executive Chairman, Healthy Platforms and CancerLife, Philadelphia, PA, as he referred to the speed with which patients and providers have embraced telemedicine. He provided a summary of the changes that have occurred since the beginning of the pandemic, including decisions by the Centers for Medicare & Medicaid Services (CMS) that have allowed for the expanded use of telehealth services. These changes have led to a significant increase in the number of telehealth visits that have occurred, which has contributed to the widespread acceptance of this modality.

Although telemedicine is now widely accepted, there are certain complexities related to its administration and practice that must be appropriately managed for continued success.

“Having regulatory experience is imperative, in particular during this time when things are very fast-moving and fast-paced and we're seeing changes in CMS rules and regulations almost biweekly,” said Chevon Rariy, MD, Director, Telehealth, Cancer Treatment Centers of America, Chicago, IL. In particular, she noted that “medical records maintenance is key” when deploying a telehealth program that is embedded within a larger healthcare system.

Brian Leyland-Jones, MD, Chief Medical Officer, National Foundation for Cancer Research, pointed out that in the delivery of specialized healthcare in a rural environment, where patients were required to travel up to 500 miles to a clinic, systems were already in place and functioning well. “We have all adjusted so rapidly,” he said.

During the discussion, the experts also considered the ways in which telehealth services can be used to address patients' needs beyond the immediate impact of the coronavirus. For example, the use of telehealth services for patients with illnesses other than cancer is a potential area of expansion. It is already being used in some programs to mitigate loneliness among patients whose illness or geography results in social distancing that is not solely pandemic-related. “Loneliness is disease agnostic,” said Karen Keown, RN, Co-Founder, Vida Healthcare, referring to these patients.

The panelists also explored how telemedicine could potentially affect clinical trials and other multidisciplinary applications. “There is a concern that they cannot get enough patients into clinical trials, and it's hurting research. And then there's the retention aspect.” Rethinking protocols could have a positive impact on areas of research going forward, said Bob Gold, Chief Behavioral Technologist and Chief Executive Officer, GoMo Health, Englishtown, NJ.

Although proposed expansions in telemedicine show promise, none are without drawbacks. One crucial factor is the extent to which payers would be open to covering these services.

Webcast host Burt Zweigenhaft, PhD, D.Litt, Founder, AVBCC, acknowledged that coverage for telehealth may be more complex in a post–COVID-19 environment. “I'm hoping that the combination of government, private enterprise, and providers will be the solution,” he said.

Am Health Drug Benefits. 2020 Jun;13(3):125–126.

Cancer Research During and After COVID-19

The COVID-19 crisis has far-reaching implications for research in healthcare. A panel of experts explored the detrimental effects of the pandemic on the career development of research students, potential changes in the availability of clinical trials, and the anticipated shortfall of future funding for healthcare research. The session was moderated by Rob Butcher, Chief Executive Officer, Swim Across America, a charity that raises money for cancer research and funds 57 laboratories around the country.

Jedd Wolchok, MD, PhD, FASCO, Chief, Immuno-Oncology, Memorial Sloan Kettering (MSK) Cancer Center, who supervises a National Institutes of Health–funded Swim Across America Laboratory at MSK, opened the discussion with an assessment on how professional life in New York City has been affected by COVID-19.

“For the first time in the 23 years that I have been part of the Swim Across America Lab at Memorial Sloan Kettering Cancer Center, we had to essentially shut down the lab,” said Dr Wolchok. Although the laboratory is very slowly being reopened, the pandemic has had a wide-ranging impact, especially on graduate students, many of whom had to leave New York City for a period. “For our youngest generation of scientists, this has been a very significant event,” he said.

Julie Saba, MD, PhD, Professor of Pediatrics, University of California, San Francisco, agreed, saying that she is concerned about the graduate students in the very earliest stages of their career development who represent the next generation of cancer biologists. “I'm worried about how they are being affected by the disruption of the last couple of months…but also by the kind of conditions under which research is going to be resumed and reestablished,” Dr Saba said.

“Make no mistake about it, the pandemic is having, and will continue to have for the foreseeable future, a significant impact,” said Richard Schilsky, MD, FACP, FSCT, FASCO, Senior Vice President, Chief Medical Officer, American Society of Clinical Oncology. Enrollment in national clinical trials are down, and “many institutions have shut down their entire clinical trial portfolio or large portions of it.” These factors will slow down the completion of many clinical trials and “some may never resume,” he noted.

Dr Schilsky added that these disruptions will add to the complexity of evaluating outcomes, necessitating that researchers do not introduce bias into the interpretation of time to progression in trials.

Maurie Markman, MD, President, Medicine and Science, Cancer Treatment Centers of America, introduced the idea that the pandemic crisis may require systemic changes to current practices that “transform how clinical research is done in the United States.”

Tom Lynch, MD, Chief Executive Officer and President, Fred Hutchinson Cancer Research Center, Seattle, WA, also spoke to the many challenges in conducting long-term research trials and how the virus has added additional pressure. He said that these pressures have “caused us to look differently at how we get things done.”

“Zoom calls and working remotely have been effective for faculty who are writing grants and analyzing data,” Dr Lynch noted, adding that the inability to meet in person and losing the personal connection with coworkers has been difficult.

“We've gone from a system of face-to-face healthcare in cancer to one that undermines that, called ‘social distancing,’” said Craig Eagle, MD, Vice President, Medical Affairs Oncology, Genentech. However, he added, the “current system of face-to-face healthcare imposes its own limits.”

With the expansion of telemedicine, the way may be opened to more diverse inclusion in clinical trials of patients who, in Dr Eagle's words, “truly reflect the disease.”

Articles from American Health & Drug Benefits are provided here courtesy of Engage Healthcare Communications, LLC

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