JULY - 202319Much work is necessary to educate people on various care options and payment sourcesHave you observed any changes in the telehealth sector since the pandemic? It's undeniable that the pandemic pushed virtual care- but mainly synchronous video telehealth ­ onto the main stage of the healthcare sector. Synchronous video telehealth was still a novelty when I began working at Sinai in 2018, mainly because of CMS' payment policies that limited coverage of video telehealth care at home. Those policies had done nothing for providers and/or administrators, many of whom were apprehensive about trying telehealth- and only a few people were interested in learning more about how to use video for their patients.Despite the hesitation surrounding the technology, in early 2019 I launched a video visit pilot in Neurology ­ and was able to convince a handful of providers to join so we could begin experimenting with video visits, primarily with commercially insured individuals that had multiple sclerosis and headache disorders. The pilot was very helpful in allowing a rapid pivot when the COVID pandemic took hold about a year later and the institution decided to use the platform we had been piloting and made it the official institutional platform for video visits. The transition to virtual care was relatively seamless during COVID thanks to the fact that over the preceding year, we had already figured out the operating procedures for video visits that worked for our department and practices. Later in the pandemic, when video visits were running smoothly, I launched another telehealth pilot aimed at collecting more or less continuous data asynchronously from smart devices, in-between visits, to complement care decisions that were being made at each face-to-face episode.What will be the impact of new technologies on the future of medicine?In my opinion, the private sector is driving most of the HIT innovation and charting new territory. While several health institutions have very robust innovation programs, the vast majority of health care institutions that have the resources to innovate either orient themselves predominantly towards obtaining federal grant funds to support research programs, implement vendor software to address a specific need, or limit themselves by restrictions on how institutional patient data is used to develop commercially-oriented innovations. These things make it difficult to transfer many innovations that occur in institutions over to clinical use. New technologies will need to address interoperability ­ EHR systems and their data practically exist in silos right now. Although things exist like Epic CareEverywhere and HL7 FHIR, which is technically EHR-agnostic, I imagine the future will see technology evolve to allow EHR systems more and more efficient integration and in a more widespread fashion. I really think this is important to efficiency and accuracy during consultations and diagnosis as well as reducing cost throughout the healthcare system.Along with COVID-enabled virtual care also came a big push to build out technology like remote patient monitoring (RPM) to support home-based acute care ­ in order to keep less severe patients out of the hospital, or monitor key clinical parameters for patients in-between ambulatory visits. The issues thus far limiting uptake in RPM have mainly been that providers are not totally comfortable with handling the increased amount of data these systems generate, and there is still some question regarding accuracy of measurements. I think we will see many HIT innovations enabling periodic remote vital sign or laboratory parameter measurements without requiring face-to-face, episodic encounters become mainstays in clinical practice ­ by presenting this data to clinical decision makers in a digestible, relevant way that doesn't overburden the clinician. I believe this trend will continue over the next several years, especially given that the US recently introduced a bill for the Telehealth Extension and Evaluation Act, which would extend Medicare reimbursement for several telehealth services for 2 years after the COVID-19 public health emergency ends in May. In neurology specifically, I think the wearable revolution will be particularly revolutionary for lack of a better term. I think we're going to see a lot of continuous monitoring of physical and physiological parameters with wearables integrated into smartphones and watches and rings, which I call passive detection, become more prevalent. Because so many neurological disorders have motor manifestations, we're going to see these wearable physical activity monitors and sensors generate the "digital biomarkers" that may be surrogates for other clinically validated scores or assessment tools or measure a new aspect of neurological disease. We are going to see these become ready for prime time in the
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