Telehealth and Telemedicine

1. How has the adoption of telehealth and telemedicine evolved over the past few years, particularly during and after the COVID-19 pandemic?

Prior to the COVID-19 pandemic, telehealth and telemedicine were considered novel inventions. Telehealth was slowly gaining traction in some minor acute care and specialty services and within correctional medicine. Some health systems and insurers invested early in this technology however utilization was relatively low. Some patients and caregivers alike felt this means of providing care was not equivalent to receiving bedside in-person care.

During the pandemic, the world was turned upside down and patients were not receiving care at all. Organizations all over the world quickly developed systems, protocols, and workflows to provide patient care using telemedicine. The acceleration of telehealth adoption was driven by social distancing measures and the demand for remote care. With the rapid increase in volume, healthcare providers became much more comfortable with using this technology.

The experiences of the COVID-19 pandemic proved that quality care could be provided even when the care provider was miles away. The support from insurance providers in providing increased reimbursement for these services saved the lives of many patients who would have otherwise not received care.

Since the pandemic, telehealth has become an essential component of care. Policy changes and integration of telehealth into value-based care models and population health strategies have led to increases in investments related to creating a stronger and more robust telehealth infrastructure.

Healthcare organizations have continued to utilize telehealth as an extension of services provided to patients. In some populations, telehealth is a tool used to provide care to consumers looking for convenience. In other areas, these services have become a vital part of care delivery, offering an opportunity to provide care in remote areas and helping to address clinician shortages.

2. What are the primary benefits that patients and healthcare providers experience from using telehealth services?

From the patient perspective, telehealth services provide convenience as well as an increased sense of autonomy. Patients can attend a doctor’s visit while out of state or even out of the country.

Advantage HCS Data Analytics Advisor, Aaron Valleroy states “one major benefit of telehealth for patients is the flexibility of scheduling. Telehealth services often offer more availability which can drive increased patient encounters.”

Having the ability to see your doctor while in the comfort of your own home, or during your lunch break at work, without having to travel is an attractive feature for many consumers. Telemedicine options have also been helpful for family members who are able to attend appointments with loved ones and ask questions of the physician without being in the same geographic space.

Dr. Allison Jordan, Advantage HCS Telemedicine Advisor says, “Telemedicine visits are the new form of “house calls.”  Seeing the patient in their home environment provides a lot of data that you would not always receive when a patient is coming into the clinic.”

This technology can also benefit the economy. Creating a space for employees to attend clinical visits virtually, can lead to a decrease in absenteeism which has been shown to cost companies billions of dollars each year in the U.S.

Dr. Jordan adds, “Many patients do not have a “sick leave benefit” and do not get paid if they don’t work. With a strong Wi-Fi connection, they are able to keep up with medical appointments and discuss problems early, before they get worse.”

Healthcare providers benefit from increased efficiency with streamlined workflows. Some have seen a decrease in “no shows.”  Providing the patient the autonomy to choose appointment times that are most convenient for them has shown a decrease in missed appointments.

Remote Patient Monitoring has also created space to better address population health through data driven insights and protocols that assist with monitoring a patient’s health outside of the clinic or hospital.

The addition of telemedicine has brought about significant improvements in the work-life balance of healthcare providers as well. This technology has allowed many clinicians to work flexible hours and do so remotely. In this case, work is being scheduled around life situations, instead of always trying to make plans around the work schedule.

3. Can you discuss the key technological advancements that have significantly impacted the effectiveness and accessibility of telemedicine?

One of the major improvements in technology that has given way to increased use of telemedicine has been the increase in broadband internet connectivity and access to affordable smartphones. These changes have increased the utilization of telemedicine in remote areas of the country as well as areas where economic constraints would otherwise make these tools unattainable.

Efforts to increase broadband connectivity will result in continued increases in utilization in areas of greatest need.

In addition, advancements like cloud computing, EHR integration, and Artificial Intelligence will continue to improve the effectiveness and efficiency of telemedicine platforms.

4. How do you address the concerns regarding data privacy and security in telehealth platforms?

Protection of patient privacy and security is of utmost importance. Organizations must develop comprehensive security controls to protect both the patients and organizations from risk.

This may include end to end encryption, multifactor authentication, blockchain technology, and secure data storage solutions to maintain compliance with regulations such as HIPAA, GDPR, and CFR.

Evan Weatherspoon, Advantage HCS Technology Advisor says organizations should consider adopting Service Organization Control Type 2 (SOC2) compliance measures and utilizing products that are common criteria certified to ensure data is being kept secure.

Preparing for potential emergency situations through incident response planning, cybersecurity awareness training, routine security audits and testing can help organizations identify and address potential vulnerabilities. The clinical team should be familiar with all acceptable use policies and the code of conduct that governs telemedicine practice in their organization.

Healthcare providers can assist in these efforts by “locking” patient rooms to keep others from joining an appointment by mistake. Healthcare providers should always ensure they are in a private location when meeting with a patient to help ensure patient privacy.

5. What are the biggest challenges healthcare providers face when integrating telemedicine into their existing practices?

One challenge healthcare providers face when integrating telemedicine into an existing practice is developing a new clinical workflow which allows for adequate transitions from in-person to telemedicine appointments.

The transition may seem easy to some, whereas others may struggle. It is important to provide an adequate amount of training and education to healthcare providers and other staff members prior to implementation.

In addition to healthcare providers, patients will also need education and guidance on how appointments are structured and a general orientation on how to use the technology.

As with any new process, it may take time for all parties to become acclimated to the new workflow. Close monitoring for quality and safety and having a backup plan are important during this early stage.

6. How do telehealth services impact the patient-doctor relationship, and what strategies can be used to maintain a personal touch in virtual consultations?

Telehealth services can improve the patient-doctor relationship by allowing the doctor more time to spend with the patient. Once you remove the time it takes to travel to the clinic, waiting in the waiting room, room the patient, etc., providers have a bit more time to reinforce important points by utilizing best practice communication skills like maintaining eye contact, monitoring and responding to body language, and engaging in active listening.

For healthcare providers working from home, a recent study in JAMA Network found patients preferred to see a background displaying diplomas or a solid color background over seeing a bedroom or kitchen in the background. Keeping the patient’s experience in mind can help with building trust during a telehealth visit.

It is important to remember that virtual visits may not be appropriate for every patient and every clinical situation. Some patients may prefer an in-person experience, Many healthcare providers feel certain symptoms and diagnoses require a traditional, in-person visit. And, at this point, most procedures still require the clinician performing the procedure to be in the same space as the patient (although, over time, rapid advancements in technology are likely to augment the current practice in this space as well).

7. In what ways has telemedicine improved healthcare access in rural and underserved communities?

For members of rural, tribal, and other underserved communities, telemedicine does not just mean more convenient medicine. It may be the difference between whether or not a patient receives care at all.

Improvements in internet infrastructure and bandwidth, along with the addition of new satellite technology has decreased the cost barrier, increasing availability of telemedicine in remote areas.

Telemedicine has significantly improved the health of those living in these remote communities by increasing access to primary and specialty care. Studies have shown timely interventions and routine monitoring are leading to improvements in health outcomes in these patient populations.

Telehealth is leading to increased access to care in other vulnerable populations such as the differently abled, elderly, and those with limited mobility.

Telemedicine is addressing shortages in the healthcare workforce by bringing care to the patient and allowing healthcare providers a better work-life balance.

8. What role does telehealth play in managing chronic diseases and long-term health conditions?

Remote patient monitoring is changing the way we manage chronic diseases. These devices allow healthcare providers exponentially more patient data points than ever before. We now have a better understanding of what is happening with patients when they are outside the four walls of the hospital or clinic. Do they seem to be compliant with their medications? Are they responding to treatment as expected? Is the patient beginning to deteriorate?

The increased volume of data also allows for tracking and trending as opposed to initially reacting to a measure that may be falsely or fleetingly abnormal. Blood pressure monitoring is a great example. Remote patient monitoring offers a better line of sight to the patient’s condition, helping to differentiate between long standing uncontrolled high blood pressure and white coat hypertension isolated to the clinic visit.

However, if not managed correctly, all this data could seem overwhelming to a healthcare provider. It is important to create workflows that include defined triggers for when to send alerts to the clinical team as well as clinical decision trees with guidance as to what process to follow once the data is received.

9. How do insurance providers view telemedicine, and what is the current state of insurance coverage for telehealth services?

Insurance providers have a favorable view of telemedicine. This technology helps to cut down costs to organizations while offering many of the same benefits. Advantage HCS Emergency Services and Telemedicine Advisor, Dr. Oga Obie says, “The COVID-19 pandemic brought about a decrease in regulatory barriers to providing telehealth services along with an expansion of both government and commercial payer coverage and reimbursement.”

“For many insurance agencies, telehealth services are covered and welcomed,” says Advantage HCS Insurance Advisor, Ebonee McNeil.

10. What are the regulatory hurdles and policy considerations that need to be addressed to facilitate the growth of telehealth?

During the height of the COVID-19 pandemic, healthcare organizations saw a shift in reimbursement models for telemedicine services. Danyal Davis-Hurd, Advantage HCS Healthcare Finance Advisor notes, many of these shifts have continued in this post pandemic era. However, threats to the reimbursement model could make investing in creating a strong telemedicine infrastructure unattractive and even unfeasible for some.

Other hurdles include restrictions on practicing across state lines, requiring physicians to obtain and maintain multiple licenses to practice in different states. As Dr. Allison Jordan, Advantage HCS Telemedicine Advisor states “while there are federal rules about practicing telemedicine, there are also state rules regarding prescribing that need to be followed.”

11. How can healthcare providers ensure the quality and reliability of telemedicine services compared to in-person visits?

There is a burden on the healthcare provider to provide the same quality of care to a patient during a telemedicine visit as would be received during an in-person visit. Having a clear understanding of the goal of the visit is important. Many providers have created symptom and diagnosis-based algorithms that help dictate when a patient is eligible to be seen through a telemedicine service vs requiring the patient to come into the clinic.

A strong internet connection for both parties is important to avoid disruption and miscommunication.

A thorough review of the patient’s history is important to ensure the healthcare provider is operating with the knowledge of important historical information.

During the visit, the healthcare provider should keep a pulse of how the visit is progressing. There may be situations in which a request to reschedule or conduct the next visit in person is appropriate. Providing patients with information about what to expect and how to prepare for a telehealth visit ahead of time can be useful in mitigating avoidable distractions.

12. What impact does telehealth have on healthcare costs for both providers and patients?

Telehealth can reduce healthcare costs in multiple ways including decreased overhead costs of maintaining an office space and hiring other staff members.

There is also a reduction in cost to the patient by removing the need for travel and loss of income from related to taking time off from work. The relief to the patient can be both monetary as well as a decrease in the psychological burden that some patients feel about “getting ready to go to the doctor’s office.”

For systems that have historically provided funds for transportation, the introduction of telehealth has created significant cost savings, allowing for reallocation of funds to other areas of need along the healthcare continuum.

13. How do you foresee the future of telehealth evolving over the next decade, and what emerging technologies might shape this future?

Telehealth is here to stay. The consumer’s demand for care that is convenient, accessible, and right on time will continue to drive solutions in this space.

Evan Weatherspoon, Technology Advisor for Advantage HCS says “Sensor and self-diagnostic technologies will evolve significantly with the new 5 and 3 nanometer fabrication process for modern chips. This will usher in an era of new and improved sensors that can be placed on and within the body and provide unprecedented amount of real time health data that could only previously been obtained in the hospital or office.”

The addition of smart devices, wearables, virtual reality, virtual care platforms, remote patient monitoring, digital therapeutics, and automation using artificial intelligence models such as deep learning and natural language processing, will only increase over the next decade. These, along with other emerging technologies will continue to shape the way healthcare is delivered and received around the world.

14. Can you share any success stories or case studies that highlight the positive outcomes achieved through telehealth and telemedicine?

I have encountered many, especially in the younger, more tech savvy generations, who have stated they would not make an appointment to see a healthcare provider if it required showing up in person for each visit.

As for a success story… a physician colleague spoke of a patient suffering from paralyzing anxiety who was unwilling to leave his home. He was able to utilize telemedicine visits to receive the behavioral health care that he required. Through these visits he was able to open up increasingly more and saw improvements in his mental health.

As the patient became more comfortable, he began to speak about other symptoms he was experiencing, including leg pain. The astute physician was able to connect the patient’s symptoms of leg pain and other cardiovascular risk factors and recommended he follow up with a primary care physician. The patient agreed, and through further work up the patient was diagnosed with significant atherosclerotic disease (blockage in the arteries) of both of his legs. He underwent emergent limb saving vascular surgery and avoided the likely fate of undergoing amputations of both legs, had his symptoms not been identified in time.

Telemedicine truly changed this man’s life.