Telehealth as a strategy to build outpatient care resilience during extreme weather
This scoping review of 14 studies reveals that while telehealth currently serves as adaptive infrastructure to address various patient and system vulnerabilities during extreme weather, there is a critical unmet need for purpose-built disaster telehealth integrated into formal preparedness planning to enhance outpatient care resilience.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a hurricane tears through a coastline or a wildfire chokes a valley, the immediate dangers are obvious: the wind, the water, the flames. But for the millions of people living with chronic illnesses like diabetes or heart disease, the true threat often arrives later, in the quiet disruption of daily medical care. When roads are blocked, clinics are closed, or power lines are down, the routine management of these conditions can vanish, leaving patients vulnerable to crises that could have been prevented. Health systems are now tasked with a difficult challenge: how to keep the lights on for patient care when the physical world around them is breaking down. The answer many are turning to is telehealth, the use of phones and internet connections to deliver medical advice. However, while we know these tools exist, we have not fully understood how they function when the weather turns extreme, or whether they are truly ready to protect the most vulnerable among us.
A team of researchers from Stanford Health Care and the Veterans Affairs health system set out to map exactly how telehealth has been used during these chaotic moments. They did not run a new experiment with patients; instead, they gathered and analyzed fourteen existing studies that documented what happened when real storms, floods, and fires struck. These studies covered a wide range of events, from the massive hurricanes that hit the Gulf Coast to the wildfires in California and even a severe snowstorm in Japan. The researchers looked at thousands of patient encounters, ranging from small local clinics to health systems serving millions of people, to see how doctors and patients managed to stay connected when the ground beneath them felt unstable.
What they found was a story of improvisation rather than preparation. In every single case they reviewed, the telehealth tools were not built specifically for disaster response. Instead, health systems took the technology they already used for routine checkups—phone lines, video calls, and secure online patient portals—and repurposed them to handle the emergency. It was a flexible approach, like using a standard office phone to call for help when the main switchboard goes down, rather than having a dedicated emergency line installed beforehand. The most common tool was the simple telephone call. Because it does not rely on high-speed internet or complex video equipment, it proved to be the most reliable way to reach patients when infrastructure failed. In one instance during a wildfire in California, phone visits were actually more effective than video calls because the fire had damaged the broadband networks needed for video. These calls allowed doctors to triage urgent needs, refill medications, and monitor stable patients who could not leave their homes.
Beyond the phone, the researchers saw how other digital tools filled the gaps. When clinics closed due to flooding or evacuation orders, direct-to-consumer platforms allowed patients to access urgent care from anywhere, often bringing in doctors from other states who were not normally allowed to practice in that region. Patient portals, the secure websites where people usually check their lab results, became lifelines for sending bulk messages about clinic closures or answering questions about floodwater exposure. In one study involving a massive hurricane, a health system used its existing portal to automatically reschedule thousands of missed appointments, a task that would have been impossible to do manually. These tools helped maintain the continuity of care, ensuring that a patient with high blood pressure did not go without medication simply because their local pharmacy was inaccessible.
However, the review also highlighted a significant gap in how these systems are designed. The researchers found that while telehealth is excellent at adapting to a crisis once it happens, it is rarely built to prevent the crisis from causing harm in the first place. The technology was almost always an "add-on" to normal operations, not a core part of disaster planning. This means that when a storm hits, health systems are scrambling to figure out how to use their existing tools rather than having a dedicated, robust system ready to go. The study suggests that this reactive approach leaves a hole in our safety net. For example, patients who were already familiar with using telehealth before a disaster were less likely to end up in the emergency room afterward, suggesting that building these habits and systems in advance could save lives. Yet, the researchers noted that the people who need these tools the most—those in rural areas, the elderly, or those with limited access to technology—are often the ones who struggle to use them.
The authors conclude that for telehealth to truly build resilience, it must move from being a convenient alternative to a deliberate strategy. This means health systems need to invest in infrastructure that can survive power outages, such as networks that work on cellular signals, and create permanent rules that allow doctors to cross state lines during emergencies without waiting for special waivers. They also emphasize the need to enroll high-risk patients into these systems before a disaster strikes, ensuring that when the weather turns, the connection is already there. The evidence shows that telehealth works, but it works best when it is not an afterthought. By treating these digital connections as essential as a hospital bed or a generator, health systems can ensure that the care people need does not disappear when the weather does.
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