In our perspective, “A digital embrace to blunt the curve of COVID19 pandemic,” we describe the overnight transition to virtual care in our large, academic health system to meet the needs of patients, providers, and staff during Boston’s COVID19 surge in early 2020.  Like so many healthcare providers around the world, teams across Mass General Brigham responded to this public health emergency with resilience and innovation.  We witnessed firsthand clinicians learning on the fly to deliver much of their care through new technology: inpatient nurses performing symptom checks through iPads mounted on IV poles, large teaching teams rounding virtually via collaborative software with remote team members socially-distanced off the wards or at home, critical care teams conducting virtual meetings with family members across multiple locations via videoconference, and outpatient providers using video visits to connect to patients self-isolating at home (often seeing their home environments for the first time).  One colleague recently wrote to me:

I just finished clinic, which was a mix of telephone and video, and just love “seeing” people in their home environments, surrounded by all their personal things and “creatures.”  Today, I had kitties walk across the monitor, saw my patient’s beloved dog, watched a patient walk up the stairs following her total knee replacement, and was even able to have another patient show me the inside of her fridge and her bathroom (checking for DME)-- it was so phenomenal.  I miss being with people terribly but also see the benefit of a mix in the future. Video does let you do a "mini" home visit.

To be clear, we have also seen some of perils of technology, especially when deployed quickly to meet urgent clinical needs.  iPads running video software 24/7 unexpectedly turning off; video outpatient visits that slow down and sometimes fail during peak broadband usage.  More concerning, as we moved more and more care into digital channels, we became increasingly aware of those without reliable access to technology and the fragmentation of care which could possibly worsen, especially as the broader health disparities of COVID19 emerged as an alarming story line.  Much of the work ahead will lie in transitioning the rapidly deployed tools and workflows delivered amid an emergency, to sustainable, hardened care programs which will now be relied upon on likely for years during the new normal of digital healthcare, and which will need to be available to all patients, not just those who speak English and have the latest smartphone connected to home wifi.  We will need community partners such as public libraries to help extend internet access, device loaner programs for those without personal devices, multi-lingual platforms with interpreter integrated access, and software requiring few or no app downloads moving forward to ensure the level of access our patients deserve. 

While the path of COVID19 may be unclear in any given community, and will vary based on government actions and individual decisions, our work as healthcare providers and technology leaders is crystal clear – virtual care is here to stay, but will need thoughtful clinical pathways, reliable support, sustainable reimbursement, and optimal access for all patients for these tools to deliver on their promise.