TelemedicineTelehealth: Can We Do Better?

A few years back, before COVID changed everything, telehealth was an intriguing alternative to in-office healthcare to which a handful of medical practices were committed. As I said, COVID changed everything.

Telehealth practices are something that the American Medical Association (AMA) looks at in its annual Benchmark Study. In the 2018 study, the AMA found that 14.3 percent of physicians were part of a practice that used video conferencing to connect with its patients. In 2020, that number rose to 70.3 percent.

While it is safe to say that the dramatic increase in the use of telehealth came because physicians had to and not because they necessarily wanted to, it also is safe to say that telehealth is not going away. The COVID-19 Telehealth Impact Study carried out by the COVID-19 Healthcare Coalition with help from the AMA revealed that 79 percent of patients who used telehealth in 2019 and 2020 were very satisfied with the care that they received via telehealth and that 73 percent will continue to use telehealth in the future. Of the physicians surveyed in the study, 68 percent said they were personally motivated to increase the use of telehealth.

These recent studies demonstrate expectations on both sides of the video screen and that concerns need to be addressed. Patients are concerned with the quality of the encounter, the potential fragmentation of the visit (ie incorporation into their EMR) and the quality of the physician engagement (ie look at the keyboard). According to the COVID-19 Telehealth Impact Study, 64 percent of physicians are concerned about the technology challenges of access to high quality broadband and the appropriate device that telehealth poses for patients. Equally important are the physician concerns which include medical liability exposure, integration with electronic health records (EHRs), financial feasibility and clinician dissatisfaction with the added burden of a new workflow. As concerns compound, questions arise as to whether telehealth can truly increase the quality and outcomes of care.

As a seasoned professional in the field of community based healthcare systems, I believe the root of those concerns lies in a misunderstanding of telehealth and whether it should overlay the “traditional model” of healthcare. When Electronic Health Records (EHRs) were introduced, the digital transformation in the world of healthcare occurred over the course of years. There was time to design, implement, and train to the new processes. The result was not ideal though and too some extent we fatigued and accepted the end result. Navigating who did what and where is resided in the electronic tool was challenging. Not only was information exchange impacted but the workflows of individual providers were also impacted. The teams (physicians, nurses, case managers, therapy, etc,) became siloed. We added more solutions and continued to fragment the workflows and the team.

We introduced telemedicine quickly into an environment that was not ideal. By simply implementing technology like video conferencing with an EMR system into a challenging workflow missed the big picture. The addition of this complexity to the disengaged the workforce and adding to the shortage of the care delivery team.

To pause and redesign effectively, frontline clinicians with experience need to be empower by their leaders to build and test and integrated solution. Most likely only a part of the solution can be attacked. The spread of this new workflow and process should not take place until it has been tested in pilot sites and the results demonstrate it is clearly better. Once an idea has been determined to be better a communication strategy with a clear message and people capable of persuading others in the target population are needed. This is the first phase of an iterative process.

Telehealth tools can certainly improve customer care and engagement, as our experience during the COVID-19 pandemic has shown. It has the potential to boost efficiency and effectiveness. But to simply implement technology like video conferencing and EMR systems misses the bigger picture. The move toward telehealth has the potential for digital transformation in healthcare, but before add more technology we need to look back and question, can we do better?

– Dr. Mark Kestner serves as the Chief Innovation Officer for MediGuru. Since 1990, Dr. Kestner has had leadership roles in the military, university systems, integrated delivery systems as well as extensive experience in community-based healthcare systems.