Telemedicine for Radiation Oncology in a Post-COVID World

Abstract

National payment and privacy policies instituted during the COVID-19 pandemic have accelerated the incorporation of telemedicine into routine radiation oncology practice for many institutions. Although telemedicine has the potential to revolutionize radiation oncology, it is unclear what role it should play moving forward, especially once these temporary policies expire and the risk of COVID-19 transmission falls. Existing literature suggests that telemedicine broadly improves access, saves time and money, and is well regarded by patients and providers. These benefits must be counterbalanced by the technical and administrative burden posed by new technology and the physical examination restrictions posed by the physically separated interaction. We describe a model for a hypothetical "Virtual Radiation Oncology Clinic" workflow that would minimize the number of visits patients must make to a physical radiation oncology facility. We also examine qualitative clinical, operational, and economic implications of shifting toward a remote practice. Now that the technology and pathways to virtual care have been developed, they are likely here to stay in some capacity. It is crucial that we generate and rely on evidence to inform policy and to determine how to best incorporate telemedicine to benefit patients and advance clinical practice.

Impact of Changes in EHR Use during COVID-19 on Physician Trainee Mental Health

“…For example, telemedicine interactions have changed the mechanism of physicianpatient interactions and are associated with increased administrative burden. [52][53][54][55] Telemedicine interactions are "touchless," where physicians can no longer perform a physical exam or collect vitals. Instead, they rely on the patient's record for collecting information utilizing past medical history, notes, and video-based communication for their reasoning and clinical decision making.…”

Implementation of a stereotactic body radiotherapy program for unresectable pancreatic cancer in an integrated community academic radiation oncology satellite network

“…The integration of the electronic medical record, medical imaging and radiation treatment planning system allowed for prospective QA of nearly every aspect of this QI initiative. The investment in this IT infrastructure made prior to the SARS-CoV-2 (COVID-19) pandemic has paid off in dividends, having paved the way for virtual QA that adheres to Center for Disease Control and Prevention (CDC) guidelines for social distancing [27] .…”

“…Furthermore, locally-advanced pancreatic cancer patients have often received substantial amounts of immunosuppressive chemotherapy which places them at disproportionate risk of morbidity and mortality from COVID-19. Establishment of a telemedicine platform for select patients, including QA for SBRT patients, would help to mitigate this risk for immunocompromised patients [27] . Another factor contributing to interest in hypofractionated radiation treatment regimens is the impending implementation of episode-based reimbursement and the radiation oncology alternative payment model (APM) [29] , [30] .While COVID-19 delayed the APM rollout, strategies such as pancreas SBRT that provide efficacy while reducing resource utilization are expected to provide a more favorable cost structure than other more resource intensive strategies such as long course chemoradiation.…”

Radiation oncology practice during COVID-19 pandemic in developing countries

“…However, for exams and investigations, the patient still has to present to the clinic in person. Proper planning to make the clinical visit worthwhile should be performed[ 12 , 13 ].…”