In the initial phase of the COVID-19 pandemic, patients were afraid to go to the doctor in person. As a result, the number of face-to-face encounters plummeted. Many nonurgent issues were delayed, but acute issues needed to be addressed and telehealth was the main way to deliver that care.
Even as patients have returned to in-person care, there is still a widespread demand for telehealth.
“Patients got a taste of the convenience, lower cost, ease of access and efficiency of telehealth,” says David Cameron, M.D., a family medicine physician in Denver. “Also, during the subsequent COVID-19 delta and omicron surges, telemedicine was able to assist in managing the unprecedented spike in volume of patient visits.”
During the pandemic, many practices embraced telehealth for the first time. A big factor in this was that insurers were widely reimbursing for telehealth care — it wasn’t that physicians and patients didn’t want it before, it’s just that a clinic couldn’t easily get paid for a telehealth visit.
Monique White-Dominguez, M.D., an internist and lead physician consultant at Sameday Health, a personalized care provider with more than 50 clinics in 15 states, says sterile medical offices and the coldness of the space can make patients uncomfortable when they seek care. Telehealth solves this issue and, in her view, was a long time coming.
“At its core, telehealth is about access. Everyone should be able to access quality, personalized care when they need it — whether they live five minutes from [a clinic] or somewhere rural where the closest medical office is hours away,” she says. “Telehealth enables this to become a reality by creating a new touchpoint between patients and providers and ensuring that patients’ whole-body needs are being cared for.”
David Maleh, M.D., an internist with MDVIP in Wilmington, Delaware, notes that virtual visits provide some advantages over telephone and even in-person visits.
“Being able to read a patient’s face and body language, which you cannot do over the phone or when a patient is wearing a mask in the exam room, is important,” he says. “Some other benefits have been the ability to assess a patient’s living arrangement for fall risks, for instance, and having a patient’s family members, such as their adult children, participate in the visit. They give another perspective, which can provide a better sense of what’s going on with the patient.”
Telemedicine is here to stay and many physicians are wisely investing in better platforms in an effort to take their telehealth care to the next level.
Christina Chen, M.D., a family medicine physician and medical director at Bright.md, a leading company in asynchronous telehealth, says one thing that the pandemic made clear is that there really isn’t much that can’t be done virtually or online. Patients want the technology that powers their daily lives to power their health care as well, she says.
Recent strides in integrating various telehealth tools are certainly making work flows more seamless, but there is still work to be done.
“Out of necessity during the early days of the pandemic, health systems scrambled to adopt digital solutions, but now that the dust has settled a bit, we need to make sure that those solutions play well with each other and with each organization’s EHR (electronic health record),” Chen says. “Your digital front door needs to connect seamlessly with your chatbot and online scheduling systems. Your video visit vendor should communicate well with your EHR, and so on and so forth. Ideally, all of these tools working together leads to a better experience not only for patients, but also for the providers caring for those patients.”
Unfortunately, the industry isn’t there yet. Results of a recent study by telehealth company Amwell showed that nearly 1 in 4 clinicians say video visit work flows are not at all or hardly integrated with their organization’s existing systems.
“With all of the advancements we’re making in technology, integration with EHRs and existing clinical work flows is a must-have for telehealth solutions — and those platforms and digital tools that aren’t addressing this are going to be left behind,” Chen says.
Advancing telehealth
The pandemic disrupted health care delivery and forced health care systems to develop and integrate telehealth into the rest of their system. Some advancements include the ordering of studies such as laboratory tests, radiology tests and proctored COVID-19 testing.
Additionally, home telehealth equipment has allowed for a more robust telehealth offering because providers can obtain vital signs, examine patients’ ears, and listen to their heart and lungs.
Technological advancements have been key in pushing telehealth forward.
“Patients are the best experts on what feels normal for their bodies, and coming off a global pandemic, they’re more attuned to these feelings than ever before,” White-Dominguez says. “Many of them have even begun to use wearable devices that enable them to track aspects of their health in real time. As a result, patients are more empowered to seek out care when they deem it necessary through convenient telehealth opportunities, and they can share any pertinent information that has been unveiled through their wearable devices.”
Allison Edwards, M.D., family physician and medical director of Sesame Care, notes that higher-quality video and audio and better software have made visits easier to conduct and allow better insights than a platform such as Skype.
“Software has blossomed to recognize that we need both security and usability, and the crucible of COVID-19 has accelerated the development of great telehealth platforms,” she says. “Plus, more tech is in the home as technology continues to pervade our daily lives — from remote patient monitoring tools to simpler items (such as blood-pressure) cuffs, thermometers and pulse oximeters.”
Maleh sees telehealth becoming a bigger part of how medical practices function and how patients receive health care on a regular basis.
“For example, my patients come in to the office for the MDVIP Wellness Program, which is their extensive annual physical,” he says. “However, follow-up care, such as blood pressure checks for a (patient with hypertension), weight checks to monitor weight loss, and reviewing laboratory reports, could be done virtually.”
Overcoming challenges
One of the biggest challenges with telehealth is getting elderly patients to utilize the platforms.
“We saw during the pandemic that many of them don’t have a computer (and some don’t have) Wi-Fi,” Maleh says. “There is a steeper learning curve for a patient in their 80s versus one in their 50s, and it takes additional time and encouragement to increase telehealth adoption among older patient populations.”
Also, although there are federal laws around telemedicine and reimbursement, there are also state-specific policies. This can be challenging and confusing for patients who see multiple providers in different states.
And unlike years ago when there were limited options, today patients have multiple virtual care options such as asynchronous visits, scheduled video visits, on-demand video visits and messaging with a provider.
“As a patient, the abundance of choice can be confusing and overwhelming,” Chen says. “(Although) technology is changing health care as we know it and expanding more immediate access to medical services, we need to be wary of not introducing new barriers to seeking care. Providers can mitigate this risk by educating their patients with all relevant information and directions that will lead to a seamless patient experience via telehealth.”
Medical Economics | July 27th, 2022