Telemedicine’s Future Post COVID-19: 9 Healthcare CTOs Weigh In
The current pandemic may have given telemedicine the much needed and deserved push into the mainstream. But, how are healthcare organizations and medical practices adapting to telehealth and what does the future entail?
We asked a few healthcare CTOs three key questions:
- How the current pandemic and evolving technology landscape is going to have an impact on telemedicine?
- What are the important factors to consider before implementing telemedicine in practice?
- What are the current roadblocks in the implementation or adoption of telehealth?
Their responses are insightful in terms of highlighting the true potential of telemedicine and the seamless adoption of telehealth.
1. Rachael Britt-McGraw, Chief Information Officer At Tennessee Orthopaedic Alliance (TOA)
Telemedicine Isn’t Going Away After COVID-19
Telemedicine will be catapulted forward, this is happening even now. Most larger healthcare organizations had either started using some telemedicine techniques or had this teed up as a coming project. But now we have necessarily moved this to the top of the list and we have doctors actually seeing patients every day using this.
The fact that the insurance companies changed their rules so that a telemedicine encounter is equally valuable from an amount allowed to be charged standpoint will allow rapid and permanent adoption of this very efficient and cost-effective method of care delivery. Many of the patients we polled prefer this method of care delivery to having to drive in and wait in a waiting room.
Do you have the bandwidth to carry live video and voice reliably? Also, right now, we are being granted a pass on many HIPAA privacy laws as it is deemed more important to see patients during the COVID crisis, but eventually, those laws will tighten back up and the solution you choose will need to be compliant.
All the roadblocks have been plowed over there are NONE. One can make the argument that more rural people or perhaps even an older generation of people may not have access to telehealth software, but there are quite a surprising number of older people using smartphones, and even that is enough to get the job done.
One really must get out very rural to find an area with no network coverage as well. Telehealth will rapidly become commonplace, and it’s about time, in my opinion.
2. Vishal Yadav, Director of Application Development At Symplr
The COVID-19 Pandemic Has Brought Telemedicine Into A New Light
This ongoing global crisis forced healthcare facilities and state/federal regulatory bodies to turn to alternative options of providing healthcare while limiting exposure to the virus. And telemedicine is presenting itself as the ideal solution to these woes by limiting patient displacement to hospitals, allocating hospital capacity to urgent cases, all while curbing the disease’s spread.
As medical professionals need to stay healthy and disease-free, the need for remote technologies skyrocketed. Both the CDC and WHO are advocating for telemedicine to monitor patients and reduce the risks of them spreading the virus by traveling to hospitals.
The important factors to consider before implementing telemedicine in practice are:
- End to End encrypted communication
- Data Security
- Supporting HIPPA and other critical healthcare regulation compliance
- Ease of use
- Equipe the healthcare institutions with the tools and training required to deliver remote consultations
The current roadblocks in the implementation or adoption of telehealth are:
- Lack of Awareness
- Lack of improper Infrastructure
- Lack of reliability and effectiveness
- Risk of misdiagnosis for certain diseases such as skin issues
- Specific legal, regulatory, and reimbursement challenges
3. Peter Ferr, Chief Information & Security Officer at Advanced Pain Management, LLC
We Have Seen A Slow Adoption Over The Past Month, But Our Number Of Telehealth Visits Continue To Climb Slowly
This current crisis has accelerated the need and requirement for a telemedicine offering. Those that have an established platform and seen an increase in adoption. Those that did not, have to make a decision to implement a Telehealth solution or maintain the status quo with a telephone visit in the interim.
We have found that the providers have to become quick-learners of any solution since they had to learn through online videos and tutorials that we have provided. It has been a challenge, but the forces of nature (COVID-19) have created the urgency and demand for this solution and we need to be there to support our patients.
The patient demographics need to be considered as part of the review of a telemedicine offering. We do not have control over the patient’s environment (i.e. Internet, WiFi, Smart Phones, Laptops, Tablets, etc.).
We also do not know how technically astute our patients may be. The telemedicine solution can be very simple for most of the patient population, but there are still those that will not be able to engage in this technology and others that will require some training, hand-holding, and encouragement to take the first step.
The workflow for the providers also changes. The Provider now has to assume the role of the technician, or video expert, conduct the telehealth visit, and complete the charting all in a short period of time. This new workflow takes time to learn and refine. We are now seeing that we are getting past the learning curve and just continuing to encourage our patients to participate in these types of visits.
The adoption and use of a telehealth solution by some is the greatest challenge, both with the providers and the patients. The telehealth visits are limited by time and therefore create additional pressure on the providers as they also become the “IT support” during a visit.
This takes many out of their comfort zone. We have created training materials to send to our patients when they schedule a telehealth visit. What happens during a telehealth session when the camera goes blank? Or the sound doesn’t work?
The session needs to be completed and the provider is left to make a decision to switch to a telephone visit or continue with either video, voice, or some blend of partially working technology.
The remote environment for both the provider and the patient creates challenges that cannot always be remedied with a simple solution. We continue to try and support our patients and providers with the resources and systems to create the best environment that we can offer.
The growth of telehealth is not as fast as expected. It is important to gain the support and trust of your providers to stay with the telehealth program and continue to work with your patients. When the crisis is over, this new method of visits will be the new normal and not the exception.
4. Robert Haley, Chief Information Officer At Collom & Carney Clinic Association
The COVID-19 Crisis Will Finally Give Telemedicine The Exposure It So Desperately Seeks
Healthcare is not the avenue for which patients prefer to “try something new” even when convenience is paramount. Many have heard of telemedicine but have been reluctant to try it. I was recommending telemedicine to a friend and the response was “I need the doctor’s undivided attention”.
I guess he felt a face-to-face visit was the only way to obtain this. Not only have patients been reluctant to cross the great divide from face-to-face to virtual visits, but the providers have been reluctant as well.
The COVID-19 crisis has forced many providers to adopt telemedicine or face an early retirement. The response from providers has been amazing. I have received so many positive responses – “I should’ve done this a long time ago”, “I may switch my entire practice over to telemedicine”.
The providers love the simplicity of it; although they can’t treat everything over a virtual visit. Providers and patients are raving about the convenience and simplicity that telemedicine provides. Fortunately, CMS temporarily lifted restrictions allowing many Medicare and Medicaid recipients to experience telemedicine – a benefit once provided to commercial beneficiaries only.
The COVID-19 crisis has been a horrible overall experience having a tremendous financial impact on physician practices and hospitals, but restitution is saddled on the back of telemedicine.
Implementing telemedicine was a tricky endeavor prior to the COVID pandemic. Without provider buy-in the odds of success were slim, and I would still say the same today. The providers must lead the effort or it will likely fail. Most obstacles to telemedicine have been overcome.
Most payers are paying for the service. Many states have parity laws so providers can expect the same, or close to the same payment for a virtual visit as an office visit. Medicare and Medicaid have continued to be restrictive about how telemedicine can be utilized but those restrictions are temporarily lifted.
I expect CMS to cave to pressure from beneficiaries to keep telemedicine as an option moving forward. Patients are utilizing telemedicine at record rates thanks to the COVID crisis. If I was implementing telemedicine in a practice today I would be concerned about competition.
The market space for providers has typically been a specific geographical area due to the requirement that patients meet the provider face-to-face. Telemedicine completely changes this. Telemedicine companies have no limits on the market, except where telemedicine may still be prohibited.
Large telemedicine companies like Teledoc and MDLive have moved into many markets and gained acute care market share. They are contracting with insurance companies and successfully pulling a lot of patients away from their PCP’s for treatment on acute problems such as UTI’s, cough, pinkeye, etc. Providers must have a strong marketing strategy and negotiate with payers to keep their patients from moving to other telemedicine providers for these lower-level issues.
Many roadblocks still exist to make it difficult for providers to implement telemedicine. Not everything can be treated through a virtual visit. Many conditions require a physical exam to diagnose, rendering telemedicine useless. Providers hoping to offer services in multiple states must obtain a license in each state and in many cases a separate DEA number for each state to prescribe medications.
Medicare and Medicaid have significant limitations for telemedicine visits under normal circumstances. Each state has different rules. Some states make it impossible, or nearly impossible, for out of state providers to render telemedicine services, especially when the patient is at home.
Some malpractice insurance carriers have strict guidelines for how telemedicine services can be offered. Technology is another significant barrier. Many patients live in rural areas where high-speed Internet service is not available. DSL internet is not always ideal for telemedicine because of the slower upload speeds which affect the quality of the video feed to the provider.
Time Will Tell If Practices Use Telemedicine As A Long Term Solution
The pandemic has increased the telemedicine adoption. What was a service that few took advantage of during normal business operations, is now the primary way physicians are seeing patients. Most medical practices are not as technology-driven as the learning curve is perceived as high and the movement to change is feared by those, not as technologically savvy.
Now that using telemedicine is the only way some medical professionals can see patients, it has escalated its use tremendously. I believe a good number of practices will as the more use of technology will allow medical staff and patients to become more familiar with the product.
The first thing to look at is your demographics. If a large part of the patients does not have smartphones, computers with cameras, then even the best solution will not work. Another item to be aware of is there will be issues, there always are with technology. Someone is not going to be able to login to a session, provide payment online, a mic on mute, etc.
Expect some learning curves with technology and the end-users. Some of the successful practices reach out to patients before a call to troubleshoot issues before the medical sessions. Choose a solution that is secure and as easy to use as possible to be safe and shorten the learning curve.
The issues facing us are the reimbursements for using the technology. Without the ability to be paid for the service most [professionals are not adopting the tool. Another issue that is affecting our state is the rural areas. Adequate broadband coverage limits the ability to have a tele-session and prohibits the availability of service.
For those that might have broadband another issue facing adoption is that lower-income individuals do not have limited funds for broadband or unlimited data plans via cell service.
Implementation issues that face healthcare workers are also present. Typically healthcare staff have limited technical skills and implementing and maintaining a system presents challenges for them. For the providers, it is a different workflow that can cause challenges. Training and having a good comfort level with technology is a key factor for success.
There Are Definitely Promising Applications Of Telemedicine
Overall, I think that the current pandemic has definitely opened the eyes of many physicians and other medical professionals to the capabilities of telemedicine and telehealth.
Like many healthcare professionals, I am excited about the prospects of telemedicine. However, to ensure long term success, developers and service providers of telemedicine solutions and applications must focus on the specific requirements and success factors for each use case.
That is, what is required for patient monitoring and check-ins will be basic. What is required for the use of telemedicine for complex medical procedures is much more difficult and complex.
You need to understand the specific use case(s) that you want to apply telemedicine to. The end-to-end process needs to be well defined and vetted with the appropriate stakeholders (i.e. information technology, healthcare provider/clinical, biomedical devices operations/engineering, etc.).
Subsequently, you need to apply and follow an SDLC or similar life cycle for developing, implementing, and maintaining the solution over time. This is not unlike how you would ensure the long term success of other solutions that involve the deployment and use of information and related technologies.
Also, there should be well established high level, top-down support for, and confidence in, the telemedicine use cases in question.
As with any technology solution, comprehensive requirements gathering and solution design are vital components. What could be a roadblock potentially is to ensure that both the provider and patient perspective is thoroughly reviewed and vetted during these key phases.
For many physicians and clinical staff, this is a new approach to providing care. This is likewise true for patients, who will have a broad range of circumstances and conditions that need to be considered. Additionally, telehealth/telemedicine use cases that are too complex may end up being too difficult to implement.
7. Brian Gillespie, Chief Technology Officer at Bardavon Health Innovations
The Current Pandemic Has Forced Sweeping Changes In Regulations In Reimbursement For Telemedicine
The surge in adoption should be an excellent proving ground for the effectiveness of telemedicine, which we hope will pave the way for these emergency changes to become permanent.
Specific to our market of physical therapy and telerehabilitation, Bardavon believes that technology will continue to evolve to include objective remote measures such as AI-powered range-of motion detection that can allow for patient outcomes that are comparable to in-clinic care.
There are four key factors that I believe need consideration when you choose telemedicine for your practice: regulatory environment, reimbursement/payor adoption, appropriate services, and defining best-suited patients.
The majority of healthcare regulations are ever changing and telemedicine is no different. This patchwork of change at the federal, state, and local levels must be well understood and continually monitored by every practice.
Practice owners must also carefully consider whether their payor base is willing to adopt and reimburse for telemedicine. As adoption of this technology grows, the financial models will become clear that this is a viable option.
We know that telemedicine is capable of delivering high-quality outcomes. But practice owners must determine whether the services they deliver through telemedicine are appropriate and whether the patient is a good candidate.
Not all patients are well-suited for telemedicine. Knowing these risks Bardavon has developed the Bardavon Therapy Services Pathway so Providers can determine patient suitability for telemedicine. The Bardavon Therapy Services Pathway sets patients on the best clinical path for their unique situation—virtually, in a clinic or a blend of the two.
Currently, most telehealth platforms focus on the telephonic aspects of a virtual visit, which of course, addresses the immediate need for social distancing. But for long-term adoption and implementation of telehealth, the technology must evolve to include objective remote measures. Those advancements could span advanced uses of smartphones and existing IoT devices such a smart watch, or a purpose-built device such as AI measurement tools, or in-home smart testing kits.
Along with the massive increase in the utilization of telemedicine, I believe the pandemic will rapidly accelerate its normalization
In other words, once the general population realizes that telemedicine is equally effective but cheaper and more convenient, it will become the default preference for many people seeking non-urgent care.
Complementary technologies like remote patient monitoring (RPM) will see mainstream adoption. Prior to the pandemic, providers and payers were already looking for ways to use RPM to reduce complications and costly readmissions after hospital discharge. But with the pandemic, RPM will play a critical role in keeping patients healthy in the safety of their homes, especially for highly vulnerable populations like the elderly. And RPM will rapidly advance and take on new forms, with sensors being incorporated into wearables and commonly used household items.
Our wearable, the Tango Belt, is a good example of this. It’s a unique belt for older adults that incorporates advanced sensors and airbags to protect and alert in the event of a fall, and also monitors function through measures like postural sway.
One of the remaining challenges many of these technologies have is their dependence on reliable internet connectivity. This can become a significant hurdle in rural settings, and also in specific populations such as older adults living without internet access. Recent advancements like 5G and public-private partnerships will continue to close this gap.
9. Corey M. Zeigler, Chief Information Officer At Helio Health
With all of the speedbumps taken away, telemedicine adoption has advanced more in 3 months than it did in the last 3 years.
We Are still working through some of the challenges but we’re also learning a lot and able to try, fail, learn, and apply a lot quicker than we could in the past. I think the general public is more accepting virtual interactions because they’ve had to do so in their private lives as well as in their healthcare lives.
From ordering food, to interacting with family and friends, to teleworking/telecommuting, all aspects of their lives have been touched by this. The barrier of a patient not being able to access this technology is becoming a thing of the past.
Not all care is as conducive to Telemedicine equally. Pick your modalities that are the easiest to implement and make sure they are a standard part of your care continuum before moving on to others.
You will learn some simple workflow/convenience tips and tricks as you interact with your patient population with these simpler implementations that you can take and apply to the more complex ones. Interactive video is obviously the baseline, but once you start adding peripherals to other technologies you introduce a lot of points of failure.
Think about what your patient would want first from your service without having to travel there. Follow-ups for outpatient services for example, are very conducive to a tele-visit; telepsychiatry and medication renewals are all great examples of services that are very easy to implement over telemedicine.
A virtual physical exam with a tele-presenter, stethoscope, ultrasound and other diagnostic equipment is on the more complex gradient and it’s something I would try to do last. We’re still all scared of the payment system circling back to the previous paradigm. With the differences among states between coverage and payment parity, to the modifiers and complexities around telehealth, the payer side is the biggest barrier.
You only need to ask yourself if I was getting a capitated fee to take care of my patients, would I not offer them a medicine to keep them healthy? If the answer is yes then the payer system is the obvious barrier that needs to be focused on. There still is a lack of understanding that even though this mechanism will cost a little bit more on the low acuity/less expensive side of healthcare, those early interventions should pay off in spades in cost reductions On the higher acuity side, if we believe the literature on population health management