Op-ed on Telehealth and Climate Resiliency

COVID-19 Telehealth Charts Path Forward to Triple-Aim and Climate Resiliency By Pranav Jayaraman, MPH, Medical Student at Texas Tech Health Science Center at El Paso's Paul L. Foster School of Medicine

“This could have been a telehealth appointment” might become the new “this meeting could have been an email.” Many U.S. healthcare institutions during the COVID-19 pandemic have reduced in-person visits and increased the use of telehealth services to mitigate the transmission of the virus and overcome capacity limitations. This change has also been seen at The University of Texas at Austin’s University Health Services (UHS), with most initial visits during the first year of the pandemic conducted via telehealth and in-person follow-ups utilized as necessary. While many students have been less than happy about virtual classes, UT-Austin students have instead embraced the switch to a virtual medium for campus healthcare, indicated by 98% overall satisfaction. Without a notable drop in patient satisfaction or quality of care, this begs the question: Why revert back completely to in-person visits after the pandemic? Through reduced environmental impact and improved patient-provider experiences, telehealth presents a much-needed opportunity to make progress towards the triple aim of healthcare, which calls for better care for individuals, populations and reduced per-capita costs. Lessons learned at the UHS may demonstrate an approach that tackles these challenges of climate change and quality improvement.

Relating to climate change, there is a increasing need to reduce the environmental footprint of healthcare and mitigate its harm to public health, asx the US healthcare system itself contributes to 10% of healthcare carbon emissions and 405,000 Disability Adjusted Life Years (DALYs), annually. As terminal waste disposal is an important player in environmental pollution and the production of greenhouse gas, steps taken to divert waste and prevent inter-stream contamination are critical. In order to better understand barriers to staff adherence to waste-disposal protocol, I conducted a quality improvement survey with the UHS clinical staff in the summer of 2020. A recurring theme in the responses was that the main barrier to adherence was not indifference to sustainability initiatives, as 97% of staff indicated favorable attitudes, but rather the concern that sustainability-related tasks would hinder clinical efficiency.

The expansion of telehealth services presents an avenue to achieve such efficiency. For example, telehealth can reduce waste and emissions generated through healthcare, particularly from travel and the use of on-site resources as well as reduce patient “no-shows”, making the entire process easier for staff. Reduced volume of waste would make sorting clinical waste less cumbersome, lower contamination-related fines, and allow providers to focus on the paramount priority of patient care.

At the UHS clinics, students and staff alike benefit from this new arrangement. Renee Mathews, a Nurse Manager at the UHS who has been involved in the general medicine clinic’s transition to telehealth, similarly, reflects there have been fewer late arrivals and no shows to visits. Before the switch, one of Mathews’ main responsibilities in the general medicine clinic was managing equipment and ordering resources. In this new medium of care, she says “with virtually zero supplies in the general medicine unit”, she does not spend any time managing inventory, freeing her to help with other clinical efforts. “It’s a big time-saver not to have to order your supplies and keep track of the inventory checking expiration dates”, Mathews adds. Beyond more time to devote to patient care, providers also enjoy being able to take visits from the convenience of their own home, and not needing to commute. 

Telehealth expansion does not come without its drawbacks as the concern of health equity cannot be ignored. Barriers to access, such as lower digital literacy among elderly, rural, and ethnic minority patients, can further exacerbate health disparities. While improvements in digital literacy and accessibility should be targeted until such improvements arrive, the expansion of telehealth and offering it to those who can access it still would help these vulnerable populations. This is particularly relevant as lack of access to reliable transportation can contribute to missing timely screening, care, and treatment, especially for those un/underinsured. Additionally, those who elect to take their visit via telehealth will free up capacity, resources, as well as increase throughput to better serve those patients who cannot access telehealth or find the medium unsuitable for their healthcare needs.

Whereas previously at the UHS, patients needed to come in person for general concerns, students who returned to their homes all over Texas, have had expanded access to these telehealth appointments. Additionally, 80% of students indicated they would use telehealth as an option when in-person visits resumed, further demonstrating the viability of the approach above. 

While not intended to supplant in-person care, success at the UHS may provide a framework for retaining some processes in a virtual medium. Further adoption of this telehealth approach at other healthcare institutions post-pandemic, may provide the apt climate and quality solution for the times, ultimately improving patient experiences, reducing unnecessary healthcare costs, and environmental harm to the planet.

Pranav Jayaraman, MPH works for the University of Texas at Austin’s University Health Services, where he conducts quality improvement research on implementing sustainability in healthcare initiatives, and currently is an MD candidate at the Paul L. Foster School of Medicine.  

Pranav Jayaraman