As the COVID-19 pandemic continues to disrupt the provision of in-person medical care, medical providers have continued to adapt to ensure that patients are receiving comprehensive care in the safest way. As an update to a previous blog post, we provide a current assessment of the literature on the provision of care during the COVID-19 pandemic, with an emphasis on the incorporation of telehealth into orthopedic care. Telehealth has become increasingly prevalent in orthopedic surgery, and is becoming more widely accepted by clinicians. As Hurley et al. (2021) find, 85% of orthopedic surgeons reported using telemedicine during the COVID-19 pandemic, with 75% expressing satisfaction with its use. Below, we summarize recent writings on the topic, including three articles written by partners at Hartford HealthCare, Trinity Health of New England, Rothman Orthopaedic Institute, and New England Baptist Hospital:

McGrath, Mikayla, Bronwyn Spira, John Grady-Benson, Paul Bruning, Kenneth Kress, Robert Belniak, Gregory J. Golladay, and Dhanur Damodar. “The Impact of the COVID-19 Pandemic on Physicians’ Perception of Digital Health in Orthopedics.” Journal of Orthopaedic Experience & Innovation 3 (May 25, 2021): 21452.

While digital health has grown in the past ten years, its use was often seen by many medical professionals as something that could aid in care provision, but was not a necessity in that provision. With the introduction of challenges to seeing patients face-to-face during the COVID-19 pandemic, the use of digital health tools has become a necessity in how clinicians deliver care, including in orthopaedic surgery. In a survey of health professionals across a variety of healthcare organizations, the authors find the following when asking about providers’ adoption of these digital health tools:

Physicians are shifting to interacting with their patients increasingly through telehealth; 92% of those surveyed noted that they used telehealth tools to interact with patients during the pandemic.

Providers are spending more of their working hours on technology; this is especially true for those who did not utilize this technology prior to the pandemic.

Respondents believe that the use of digital health technologies will be a mainstay in healthcare moving forward. As one physician noted, “A lot of us have realized that maybe these in-person visits are not necessary and maybe they take risk and time and cost patients money and inconvenience and so forth. And so I suspect that we’re going to have wider adoption of this and certainly with the patient’s permission if you will, it’s something that we’ll do more often.”

Despite these positive findings, the authors do note that there are barriers to the adoption of widespread digital health technology, including uncertainty in policy (on the part of state and federal regulations) and reimbursement (as payors, including the Centers for Medicare and Medicaid Services, determine what they will and will not reimburse users for). Hospitals and other healthcare providers should continue to work to ensure that digital technologies are utilized in ways that best serve patients.

Moving forward, the authors believe that digital health tools will help providers make positive care decisions, as they allow for patient personalization, predictive analytics, and real-time dashboards and benchmarking. Clinicians using these tools will be able to determine the best care plans for patients moving forward in real-time by using data around them, thus improving the patient care experience.

Henry, Tyler W., Daniel Fletcher, Alexander R. Vaccaro, and Pedro K. Beredjiklian. “Evaluating Patient Interest in Orthopedic Telehealth Services Beyond the COVID-19 Pandemic.” Cureus 13, no. 7 (July 2021): e16523. https://doi.org/10.7759/cureus.16523.

Patients have come to appreciate the ease with which they can use telehealth for orthopedic medical services during the COVID-19 pandemic, leading Henry et al. (2021) to investigate whether this interest is directly a result of the pandemic, or a shift that was apparent prior to spring of 2020. The authors find that while interest in orthopedic telehealth was on the rise prior to the COVID-19 pandemic, this interest has increased quickly during the pandemic and continues to increase. Interest in this type of medicine seemed most pronounced in Northeastern and Southeastern states, and hand surgery received the most searches for telehealth. It is evident that even beyond the pandemic, patients appreciate the ease that telehealth provides them in accessing medical care.

Puzzitiello, R. N., Moverman, M. A., Pagani, N. R., Ryan, S. P., Salzler, M. J., Jawa, A., & Menendez, M. E. (2021). Public perceptions and disparities in access to telehealth orthopaedic services in the COVID-19 era. Journal of the National Medical Association, 113(4), 405–413. https://doi.org/10.1016/j.jnma.2021.02.007

Using an online crowdsourcing method, this study looked at public perceptions and attitudes towards virtual healthcare for orthopedic procedures. Most respondents said telehealth visits were a convenient form of healthcare delivery and a greater majority would prefer them over in-person visits. The main drawback to using telehealth with orthopedic care is the lack of physical contact during a musculoskeletal exam. For the respondents in the study, a greater percentage of people said virtual visits would be better for routine follow ups as compared to initial assessment visits and first postoperative visits. Within this group, there is a selection however that had difficulty utilizing the telehealth technology due to lower income and poor health.

Conclusion

As these studies revealed, telehealth is widely accepted by physicians and patients for orthopedic care. Using telehealth for orthopedic care is more desirable than in-person office visits as they save time and are safer exposure-wise for the patient and the provider. Even before the COVID-19 pandemic, telehealth was already starting to be used, the pandemic just pushed it to the forefront. Telehealth has changed how patients want to interact with their provider and how they assess the value of a provider visit (Waddill, 2021). Utilizing telehealth does bring about some additional questions in its impact on value-based care as telehealth and in-person care are not the same but telehealth has “increased savings for bundled payment programs when providers implemented it for rehabilitation after joint replacement surgery” (2021). Overall, the value of telehealth has increased significantly since the COVID-19 pandemic and Avant-garde Health is eager to work with the ongoing trajectory of value-based care.

RESOURCES DIGEST

Study Name: The Use and Acceptance of Telemedicine in Orthopedic Surgery During the COVID-19 Pandemic

Published: June 7, 2021

Authors: Eoghan T. Hurley (Department of Orthopedic Surgery, NYU Langone Health), Jonathan D. Haskel (Department of Orthopedic Surgery, NYU Langone Health), David A. Bloom (Department of Orthopedic Surgery, NYU Langone Health), Guillem Gonzalez-Lomas (Department of Orthopedic Surgery, NYU Langone Health), Laith M. Jazrawi (Department of Orthopedic Surgery, NYU Langone Health), Joseph A. Bosco, III (Department of Orthopedic Surgery, NYU Langone Health), and Kirk A. Campbell (Department of Orthopedic Surgery, NYU Langone Health)

Link: https://www.liebertpub.com/doi/full/10.1089/tmj.2020.0255

Study Name: The Impact of the COVID-19 Pandemic on Physicians’ Perception of Digital Health in Orthopedics

Published: May 25, 2021

Authors: Mikayla McGrath (Force Therapeutics), Bronwyn Spira (Force Therapeutics), John Grady-Benson (Hartford HealthCare Bone & Joint Institute), Paul Bruning (Florida Spine Associates), Kenneth Kress (Northside Hospital), Robert Belniak (Trinity Health of New England), Gregory J Golladay (Virginia Commonwealth University Health), Dhanur Damodar (University of Miami)

Link: https://journaloei.scholasticahq.com/article/21452-the-impact-of-the-covid-19-pandemic-on-physicians-perception-of-digital-health-in-orthopedics

Study Name: Evaluating Patient Interest in Orthopedic Telehealth Services Beyond the COVID-19 Pandemic

Published: July 20, 2021

Authors: Tyler W Henry (Orthopaedic Surgery, Rothman Orthopaedic Institute), Daniel Fletcher (Division of Hand Surgery, Rothman Orthopaedic Institute), Alexander R Vaccaro (Orthopaedic Surgery, Rothman Orthopaedic Institute), and Pedro K Beredjiklian (Division of Hand Surgery, Rothman Orthopaedic Institute)

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8375001/pdf/cureus-0013-00000016523.pdf

Study Name: Public perceptions and disparities in access to telehealth orthopaedic services in the COVID-19 era

Published: April 2, 2021

Authors: Richard N Puzzitiello (Department of Orthopaedic Surgery, Tufts Medical Center and New England Baptist Hospital), Michael A Moverman (Department of Orthopaedic Surgery, Tufts Medical Center and New England Baptist Hospital), Nicholas R Pagani (Department of Orthopaedic Surgery, Tufts Medical Center and New England Baptist Hospital), Scott P Ryan (Department of Orthopaedic Surgery, Tufts Medical Center), Matthew J Salzler (Department of Orthopaedic Surgery, Tufts Medical Center), Andrew Jawa (New England Baptist Hospital), Mariano E Menendez (Department of Orthopaedic Surgery, Tufts Medical Center and New England Baptist Hospital)

Link: https://pubmed.ncbi.nlm.nih.gov/33814179/

Study Name: Value-Based Care Challenges, Opportunities for Payers in 2021

Published: August 5, 2021

Author: Kelsey Waddill

Link: https://healthpayerintelligence.com/news/value-based-care-challenges-opportunities-for-payers-in-2021

If you are interested in reading more about the impact of COVID-19 and orthopedic surgery more than a year into the pandemic, we have gathered a list of additional studies and articles that may be of interest:

Study Name: Lessons Learnt from Managing Orthopaedic Trauma During the First Wave of the COVID-19 Pandemic at a UK District General Hospital

Published: May 18, 2021

Authors: B. A. Patel (Stoke Mandeville Hospital), S. F. Green (Stoke Mandeville Hospital), C. Henessy (Stoke Mandeville Hospital), F. Adamu-Biu (Stoke Mandeville Hospital), K. Davda (Department of Trauma and Orthopaedics, Buckinghamshire NHS Healthcare Trust), R. Chennagiri (Stoke Mandeville Hospital), R. Kankate (Department of Trauma and Orthopaedics, Buckinghamshire NHS Healthcare Trust) & Y. Ghani (Stoke Mandeville Hospital)

Link: https://link.springer.com/article/10.1007/s43465-021-00419-0#citeas

Study Name: Assessment of the Efficacy of Telephone Medicine Consultations in Trauma and Orthopaedics During COVID-19 Using the Ashford Clinic Letter Score

Published: March 13, 2021

Authors: Marjan Raad (Trauma & Orthopaedics, Darent Valley Hospital), Sebastian Ndlovu (Trauma & Orthopaedics, Darent Valley Hospital), and Daniel Neen (Trauma & Orthopaedics, Darent Valley Hospital)

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041488/

Study Name: Applying changes made during the COVID-19 pandemic to the future: trauma and orthopaedics

Published: April 6, 2021

Authors: Hafiz Muhammad Umer (Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust), Hafiz Javaid Iqbal (Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust), Mark Webb (Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust), William James Harrison (Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust)

Link: https://www.magonlinelibrary.com/doi/full/10.12968/bjhc.2020.0113