Paradigm shift: Outpatient services after COVID

By R. David Frum, FAIA, FACHA

Hilary Goodwin, Dean of the UW's School of Public Health, is quoted in a recent PSBJ article stating "It's time for us to shift … to reality thinking about this is the new normal: How are we going to live with this for the next couple of years …". Even if we assume that we would be back to the "old normal" in two years it is anticipated that we may well be facing such pandemics at a five-year frequency. This suggests that the current reality of prevention of the spread of the virus is here to stay.

The need for direct, personal interaction is clearly a part of who we are as humans. However, in the past few months, in response to the virus, our society has discovered that it can function independent of a central location, using voice, video, and data channels in lieu of face-to-face interaction. The virtual communications can take place anywhere while the personal meeting requires dedicated spaces. Those spaces, though, are in dispersed locations.

Unlike other businesses, the healthcare organizations require greater attention in balancing the personal vs. the virtual care. The trust developed between the care provider and the client/patient is essential to successful diagnosis and treatments. This is particularly true among older adults who did not grow up with virtual communication tools around them. However, more of us are willing to communicate virtually we get accustomed (and are born into them).

Healthcare organizations have been working over the past few years on moving services out of the hospitals into outpatient facilities, such as clinics, ambulatory surgical centers, and rehabilitation facilities. The pandemic has sped up this process and is taking it further, dispersing clinics further and offering providers alternative locations from where they can practice telehealth.

Clinics can disperse their operations in a similar way to hospitals by moving less intensive procedures into ambulatory facilities (ambulatory surgical centers, infusion centers, etc.). Conceptually, the way for the organization of clinics is diagrammed below:

The use of telehealth combined with the trend to decentralize services suggests a different alignment of services. In this scenario all facilities are reduced to their minimum size. This is achieved by reduction in the number of exam rooms in clinics, due to telehealth and by maximizing the use of exam rooms by various providers over the week (no dedicated exam rooms). The reduction in size of the care centers allows for more of them to be located closer to the patients’ location. In the current dense urban and suburban areas, it is easier to obtain smaller spaces where such centers can be located.

While some telemedicine can be done from the providers’ residences, a conveniently located telehealth center would be better equipped with equipment, acoustical separation, and necessary support services. Such centers can be located independently of the clinics/hospital or attached to them. More complex diagnostic and treatment (D&T) spaces need to remain in/near the hospital for efficiency of operation. Less intensive ones can be located within the neighborhood centers, such as imaging, lab, infusion, etc. The concept is to accelerate the shift of services from the hospitals to care centers (clinics) and from centers to the home. Ultimately, with the advancement in the use of wearable and personal technologies, greater and greater portions of the care could be provided without the physical contact.