Even as the restrictions start to ease up, it’s a trend that executives at UnityPoint Health expect to continue.

UnityPoint Health — BerryHill Center has seen patient-provider encounters through virtual methods quadruple for behavioral and mental health care, going from about 400 encounters in March to about 1,700 in April, according to executive director Aaron McHone. Virtual encounters for other health care needs account for about 25% of all visits in the Fort Dodge region, said Jennifer Crimmins, vice president of ambulatory for UnityPoint’s Fort Dodge region.

With about 5,000 encounters each week, that means visits happening through the webcam number about 1,250.

“We saw it was a change coming, but the current situation has accelerated it,” said Dr. Lincoln Wallace, vice president medical director of UnityPoint.

One notable change in the technology that was already employed before is the location. At BerryHill, the 400 encounters in March were done through a room located at BerryHill’s clinic. Now, they’re done in the comfort of the patient’s own home as Iowans limit their physical contact outside the home.

UnityPoint uses technology similar to what many patients are already familiar with, thanks to the explosion of Skype, FaceTime, Facebook Messenger and other video chat services that have become as ubiquitous as the smartphone. The difference in the platforms they use — such as Amwell, Vidyo Connect and Doximity — is simply a matter of security to ensure patient privacy.

In recent years, the telehealth technology’s widespread implementation has been a boon, particularly for rural hospitals and clinics with few providers in the area needing behavioral or mental health services. Most providers on telehealth, whether they’re physicians or nurse practitioners, are physically located somewhere in Iowa. Those who are not are still licensed to practice in Iowa.

“I think it’s here to stay,” Wallace said. “A number of people are comfortable with the technology and increasing numbers prefer that convenience.”

He said UnityPoint will continue to support patient preferences if they grow to like telehealth more over the coming months. The surge of virtual visits in the region is significant, given that UnityPoint wasn’t doing a substantial portion of primary care services that way before COVID-19.

“This is not a short-term thing,” McHone said, telling The Messenger that he expects COVID-19 to be a looming factor for at least the next 12-18 months, or until most of the population is vaccinated. “I foresee a need for this type of telehealth technology throughout that cycle.”

For BerryHill, McHone described the current use of telehealth as a transition, noting that its inherent value has become even more attractive to patients and providers alike during the pandemic. For those who may struggle with transportation, a common hindrance with BerryHill patients, virtual visits suit most of their needs even better.

The executive director also said that the added privacy of being seen in your own home instead of a clinic helps mitigate the inherent stigma attached to seeking mental health care for many patients. For now, adequate face-to-face appointments have been reserved for those experiencing a mental health crisis.

“It brings care right to the patient,” Crimmins said.

Assuming insurance accommodations continue, the trends with telehealth could continue beyond 18 months. In light of coronavirus restrictions that temporarily restricted clinic access for non-emergent needs, UnityPoint’s executives said that most insurance companies changed their rules to allow coverage of telehealth visits. McHone said that’s a change from previous rules that would typically only allow for payment when the patient conducted a telehealth visit at a physical clinic location.

“I think (insurance providers) will continue to cover telehealth visits because they get a lot of feedback that it’s really how patients want their health care experience,” Crimmins said.

“We’re trying to do as much as possible with video interaction,” Wallace said, noting that younger generations may grow to prefer to access most health care services that way.

But the reliance on that technology might not come without downsides. The dynamics of communicating over video calls might affect how doctors approach care, compared to in-person visits.

“There are things you pick up just from direct visual observation and non-verbal communication that are hard to get over (virtual visits),” Wallace said. “It’s not ideal, but much of what’s being forced upon us is not ideal.”

For hands-on procedures that don’t lend well to being done over video, like necessary lab work and injections, McHone said that patients still have access to the clinic, which now has much fewer patients in the waiting room than normal.

“We can offer that safely without exposure (to COVID-19),” he said.

Other innovations on both sides of the UnityPoint campus in Fort Dodge have blossomed during the public health crisis, as well.

BerryHill now offers a walk-in Mental Health Crisis Center, staffed with nurses, social workers and mental health therapists from 10 a.m. to 10 p.m., seven days a week, at the clinic’s east entrance facing the hospital.

McHone said the service, started April 3, is critical as public health needs affect mental health needs, too.

“The general thing most (patients) are going through now is relating to grief, and realizing that we are in a new normal — and that’s hard,” McHone said, analogizing some reactions with patients to the stages of grief as they deal with the new realities of the pandemic.

“If a patient needs medical services, they really should get them,” he said, whether it’s at the crisis center or the emergency room across the street. “My biggest concern with this current pandemic is that people with warning signs of conditions like a heart attack or stroke are not getting the care they need. It can get worse quickly.”

At Trinity Regional Medical Center, the virtual waiting room has popped up as a new option for patients. Using a text message or app on your smartphone, patients alert the clinic when they’ve arrived. When their exam room is ready, a staff member escorts them from the entrance, limiting their exposure to others in the waiting room. UnityPoint also has the capacity in Fort Dodge to treat patients with respiratory symptoms separately or have them wait in separate areas.

“It’s very intentional, environmental details to ensure separation for care,” Crimmins said, noting that masks and personal protective equipment are at the forefront of their radar as a tool to keep clinics safe.

On Monday, Gov. Kim Reynolds lifted the ban on elective procedures. UnityPoint is in the process of developing operational plans to resume elective procedures that prioritize health and safety. Conservation of supplies, testing and PPE will be factored into those decisions.

Patients who had appointments cancelled due to COVID-19 can expect a call from their provider’s office soon when there is scheduling availability. A Tuesday press release from UnityPoint said that some patients will be expected to get tested for COVID-19 two days prior to their procedure and remain quarantined until their appointment. Current visitor restrictions will remain in effect.

“As we move forward with reinstating elective services, our plan includes monitoring things like PPE, testing availability and the number of cases in the community,” said Leah Glasgo, president and CEO of UnityPoint Health — TRMC.

“We’re starting to encourage folks to reassure them clinics are safe and clean for care,” Wallace said. “Our clinics are a safe place, I truly believe that.”