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Q&A with Dr. Hasan Syed on how eConsults improve access to Orthopedic care

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Featured in Healthcare Business Today, November 2020

Learn more about the transformation of specialty orthopedic care, and a focus on eConsult service utilization – a conversation with leading orthopedic surgeon Dr. Hasan Syed on the utilization of telehealth amid the pandemic, in the face of significant changes to Orthopedic Surgery practice.

What’s changed in Orthopedic Surgery during 2020?

The pandemic has had a profound impact on our global economy, and healthcare systems. The US healthcare system has historically been plagued by complex access issues, such as long appointment wait times, lack of coverage for vulnerable populations resulting in delayed and avoided care, and shortage of specialist doctors.

The COVID-19 pandemic brought these issues to a head when abruptly, the healthcare system was forced to essentially close its doors to the general population to pivot and prepare all resources to fight the most significant global pandemic our world has seen since the Spanish flu of 1918. Cancelled elective procedures (definition of elective), delayed (for an indefinite amount of time) non-urgent appointments, and the complete inability for some to access any in-person care was something that had not yet been experienced within our lifetimes.

Orthopedic surgery is one of many specialties covering a large percentage of procedures seen as non-urgent. Day-to-day practice of orthopedic surgery “has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19+ patients.” https://jeo-esska.springeropen.com/articles/10.1186/s40634-020-00255-5

For many health systems and hospitals, this has had a strong impact on in-patient management and procedures. Outpatient visits were limited to exposure of patients and healthcare workers. This resulted in “considerable consequences on post-operative quality of care and the human side of medical practice”, according to The Journal of Experimental Orthopedics.

Technology has played a major role in the pivot of Orthopedic care

Amid unprecedented uncertainty, one thing is certain–that technology and healthcare have a long future together, filled with opportunities to improve the health of our population.

The use of telehealth technology has experienced unprecedented growth to provide a solution to access issues, as hospitals restructure to meet COVID-19 patient needs while adopting preventive strategies to avoid the spread of the infection to non-infected patients. This includes virtual patient care solutions to effectively triage patients, and getting patients access to the care they need, within the most appropriate setting.

About Dr. Hasan M. Syed

Dr. Hasan Syed has been practicing Orthopedic surgery for 10 years, following education at UCLA, Stanford University, Loma Linda University, and Harvard/Brigham & Women’s Hospital. He is double board certified in Orthopedic Surgery 2013, and Orthopedic Sports Medicine 2015.

Currently, Dr. Syed is an Associate Professor of Orthopedic Surgery at Loma Linda University School of Medicine, VA Loma Linda Hospital and team physician for UCR and CSUSB Athletics teams.

Q&A with Dr. Syed

We caught up with one of AristaMD’s contracted Orthopedic Surgeons, Dr. Hasan Syed, on his perspective of how telehealth and eConsults have impacted the delivery of orthopedic care over the past several months.

Q: How much experience do you have in using AristaMD eConsults and what have you found to be the most beneficial aspects of eConsults for both you as a provider and for the patients you treat?

A: I have been working with AristaMD as a contracted member of their eConsult specialist panel for over one year.

The beneficial aspects of eConsults, for me, include being able to provide answers to orthopedic questions in a timely fashion to a primary care team. This allows both the patient and primary care team to know what is urgent and what can be monitored safely within a primary care setting such as primary care. This provides, in most cases, reassurance to the patient and their provider. 

From the perspective of primary care providers, eConsults streamline the planning and delivery of care in an incredibly time-efficient manner. Leveraging this telehealth tool allows for me to provide expertise to more patients than I would have otherwise been able to, especially amid the pandemic when non-urgent and elective procedures and appointments were cancelled.

Q: How has your experience using eConsults changed since the start of the COVID-19 pandemic? Have you increased usage and if so, why do you think that is?

How eConsult utilization has expanded amid the pandemic

A: I have seen more eConsults since COVID 19 pandemic started. Understandably this is likely due to increase in telemedicine and the overall goal of decreasing non-essential face to face contact. Decreasing non-essential face-to-face contact with telehealth tools such as eConsults has the twofold benefit of allowing patients to receive necessary specialty care when they may otherwise have to wait months, as well as decreasing appointment backlogs so higher-acuity patients who need face-to-face appointments can be seen more quickly.

Q: Which types of visits, pre- and post-operative, are often able to be handled by eConsults, and by video telehealth tools?

A: The following types of care are often able to be handled effectively through use of telehealth:

    1. Post-operative imaging – patients who have had MRI, CT or X-rays who need feedback or more information about post-surgical treatment plans
    2. Patients who have had fractures that need follow up scans to progress their activity and weight bearing status.
    3. Patients who are being seen for the first time for soft tissues and joint injuries, that can be addressed through a good clinical history as well as standard radiographic images that can be reviewed digitally.

The value of telehealth for pre-operative care

Q: In your experience, how have eConsults benefitted orthopedic patients?

How eConsults have benefitted patients with orthopedic needs, and their providers

A: I’ve found that eConsults allow primary care physicians to take care of orthopedic issues much more thoroughly, within the primary care setting–particularly when it comes to the management of minor fractures that don’t require surgical intervention. 

By running a case through an eConsult, they can get an answer regarding the necessity to refer and/or treatment plan that can be safely executed in the primary care setting.  A common example includes something such as a small avulsion fracture in that ankle that, many times, can be treated with simple bracing. 

Another helpful aspect of eConsults for primary care physicians is to have imaging reviewed by a specialist in orthopedics, then find out what the next step would be–whether it’s something that can simply be managed with further continuation of conservative management, such as physical therapy, bracing activity modification, or if it needs to be sent to our clinic for an in-person evaluation. 

Finally, eConsults are specifically effective for the management of most soft tissue injuries. For the majority of the cases, the musculoskeletal system can be treated conservatively without requiring an in-person orthopedic appointment. For the minority of cases needing in depth evaluation, the ability of primary care physicians to quickly consult orthopedic specialists via the eConsult platform is invaluable in expediting patient care. eConsults are highly effective in empowering the primary care physician to deliver higher level of care.  

Q: Can you speak to how telehealth/eConsults are an asset during a time like this where access to healthcare is strained and patients are worried about risking exposure?

A: eConsults are indispensable as it saves the patient time and provides timely care to issues that would routinely have taken several days to weeks to have addressed. It reduces in person visits while providing answers to patient-related issues: reduced in person exposure in outpatient clinic settings helps to reduce the risk of COVID exposure.

Q: How do you see technology making a sustained impact on the healthcare system. And, from your perspective, what would be needed to maintain this momentum?

Maintaining telehealth momentum

A: Looking ahead, I would hope to see sustained utilization of telehealth solutions that have proved invaluable to maintaining healthcare operations during this time of immense stress. Continued innovation and utilization of tools that improve operations, efficiency, access and patient experience will be a sustained method of healthcare improvement.

Telehealth has made an unbelievable impact on the delivery of healthcare. Particularly during the COVID pandemic, it’s really energized, people to actually use it as a primary method of obtaining healthcare. The majority of patients I interact with have found it to be a much better experience than they thought it was going to be. This has created momentum for more telehealth to come into use as we move into the future.

I think the biggest factor within telehealth’s momentum to keep going in the patient– that joy and comfort of getting their answers for questions in a timely fashion. Nothing can beat telehealth– being at home, or in a place where they can easily access technology to connect with a primary care physician or a specialist. This part isn’t going to change even after the pandemic is complete.

I think what will help to maintain momentum going forward will be people having access to technology. Currently most everyone has the technology at their fingertips that they need–that technology being having a smartphone or a computer. Reaching the point where specialists and primary care physicians who have not yet warmed up to using telehealth will do so, will allow the power of telehealth to grow in ways that we can’t even imagine. Medicine will change for the better–from what we’ve learned and what we’ve gained through telehealth now, and going forward.

Read more from Dr. Hasan Syed

Abdelmegeed, M.,Lohman, E.,Daher, N.,Kume, J.,Syed, H. M. J Sport Rehabil – 2019 Jan 25

Abdelmegeed, M.,Lohman, E.,Daher, N.,Syed, H. M. J Back Musculoskelet Rehabil – 2019 Jan 15

Zaman, S. U.,Syed, H. M. JBJS Case Connect – 2016 Apr 01

Volokhina, Y. V.,Syed, H. M.,Pham, P. H.,Blackburn, A. K. Orthop J Sports Med – 2015 Nov 05

Von Keudell, A.,Syed, H. M.,Canseco, J. A.,Gomoll, A. H. Knee Surg Sports Traumatol Arthrosc – 2013 Sep 6

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