The Digital Frontier: Virtual Care After Natural Disasters
Virtual care is a growing facet of the medical world, with 77% of Americans indicating interest in it. If utilized in response to natural disasters, it could help keep hospitals from being overrun, treat patients who would otherwise be unable to seek care due to inclement conditions, and generally, improve both access to and quality of health care during such times.
Natural Disasters in the U.S.
Each year the United States faces natural disasters, and while many are predictable, their aftermath often presents unforeseen challenges. Hurricanes cause the most damage, but by definition natural disasters also include wildfires, drought, severe weather, flooding, tornadoes, and some winter storms. Between 2013 and 2016 natural disasters cost the United States between $18 billion and $34 billion annually. In 2017 the costs totaled a record $195.2 billion following major storms including Hurricanes Irma and Maria. Costs in 2018 topped $91 billion, making it the fourth most expensive year for natural disasters. 2018 also broke the record for most single disasters with losses exceeding $1 billion; 14 total with 1 drought event, 8 severe storm events, 2 tropical cyclone events, 1 wildfire event, and 2 winter storm events. Despite the scale of funding currently allocated to natural disaster management, there are numerous aspects of preparation and response policies which could be improved. Access to and quality of healthcare is a major issue during all types of natural disasters, as inclement weather, damaged infrastructure, and other factors prevent potential patients and medical staff from reaching care centers. Virtual care services enable patients to seek efficient, confidential medical advice from certified physicians anywhere they have wireless, internet, 4G or LTE connection capability.
In the past 16 years New Orleans, eastern Kentucky, and central/eastern Massachusetts have suffered serious and financially costly storms and natural disasters with greater frequency than almost any other area of the country. Each area endures different types of natural disasters, New Orleans with tropical storms and hurricanes, eastern Kentucky with severe weather, tornadoes, flooding, and Massachusetts with severe winter storms. Due to their varied disaster types and the frequency with which they experience such events, FEMA and HHS should allocate $105,000 for a trial of providing discounted virtual care services to individuals affected by natural disasters in these three areas for a period of one year. The breakdown of funds designates $35,000 to each of the three areas, covering up to half of a ‘visit’ to a virtual care physician. As average price for a visit ranges from $15 to $75, depending on insurance type and status, the aforementioned funds would cover approximately 1,000-2000 visits in each area. An initial run of this size would ensure funds are not over-allocated; people are often wary of new technologies, and a larger trial run could lead to a large number of virtual slots going unused and wasting valuable dollars. Agencies should disburse the funds across 5-10 virtual care companies, to spread risk and decrease the chances that a technical issue or other systematic factor prevents individuals from utilizing the service.
In order to access the discounted rates, individuals would enter their street address and zip-code on the virtual care portal entry page, which would recognize or deny their location as being part of the impact zone at declared by FEMA. The agencies should also encourage NGOs already incorporated into the National Response Framework, such as the American Red Cross, to establish virtual care platforms. Such expansions could further promote the virtual care platform, and support improved quality of and access to care at no additional cost to the government.
As previously mentioned, virtual care can be accessed from anywhere there is a charged device with internet capability. This access can help reduce issues of hospital crowding and the use of limited resources and time on patients with non-life-threatening injuries. It can also prevent people from putting themselves in further danger by leaving a safe area and entering inclement conditions to attempt to reach a care center because they are unsure if they or a loved one need immediate medical attention. Virtual care visits typically last less than fifteen minutes, and doctors can; assess cuts, burns, and bruises for severity; help a pregnant woman discern if she is in labor and guide her through the next steps; determine if chest pain or anxiety is cause for emergency care; guide individuals through putting an injured limb in a makeshift sling or splint; provide necessary dietary alterations or pharmaceutical advice; etc. Most virtual care companies employ physicians who speak hundreds of languages, meaning that language is not a barrier to care as it may be during an in-person medical visit.
The US Army utilizes virtual health platforms throughout their Europe based operations, and for soldiers stationed in remote locations across the globe. Dr. Steve Cain, the Army’s Virtual Health Deputy for Regional Health Command Europe (RHCE) said of the program, "We have an ever-expanding group of people we need to care for. Virtual health provides us the capabilities to do so." Physicians involved in the programs reported they experienced no changes in the quality of care provided, with soldiers also indicating the service was more convenient and less expensive than alternatives. A 2017 study of virtual care visits in Canada found that 93.2% of participants rated their virtual visit as high quality and 91.2% reported it was “very” or “somewhat” helpful in caring for their health issue.
There are potential pitfalls within the trial as well. Cell towers may be damaged during the disasters, leading to difficulties accessing the virtual portals. The four major carriers - Verizon, Sprint, AT&T and T-Mobile - have taken steps to protect against this, and after Hurricane Harvey 98% of Verizon customers’ cellular service remained in tact. The technological aspect of care is likely to be challenging for elderly patients navigating it on their own, or possibly to individuals seeking care under duress. Individuals whose homes were damaged or who had to flee suddenly may not have their insurance information and may be reluctant to pay higher costs for care without their plan information. Additionally, medical records may be lost in the disasters, and if individuals are unsure of their medical history or current medications, providing safe quality care can become difficult. Individuals who are unfamiliar with virtual care may find it an untrustworthy source of medical advice, leading to low use rates and failure of the trial. While hospitals and care centers may push back against the loss of patients, their revenue source, researchers found “…. only 12 percent of telemedicine visits replaced an in-person provider visit, while 88 percent represented new demand.” Even a slight drop in patients may allow them to better care for the considerable remaining inflow they will experience post-disaster; and possibly avoid damaging lawsuits and credit reviews which typically plague care centers post natural disasters.
Every year the frequency and often severity of disasters grow, leaving trails of devastation in their wake. Virtual care provides an immediate, accessible solution to relieving part of the disruptions of quality of and access to healthcare which arises in the wake of natural disasters. By funding a trial in three different part of the United States, researchers will be able to track who uses virtual care, and also who benefits the most from it. Virtual care is growing in government and public healthcare systems. For those facing the consequences of natural disasters, it represents the possibility of faster, safer, and more efficient healthcare.