At both the recent AIMed Healthcare Executives virtual conference and AIMed webinar: Telemedicine and Virtual Care – How COVID changed the World took place in July, many healthcare leaders acknowledged the ongoing pandemic accelerated the adoption of technology and remote medical visits.
According to Professor Thierry Mesana, President and Chief Executive Officer of the University of Ottawa Heart Institute, in the past, 90% of the consultations took place at the institution were conducted face-to-face and only about 10% were virtual but now, the reverse is happening. He is glad that patients no longer have to wait a long time before they can meet with their cardiologists. Dr. Nick Patel, Chief Digital Officer of Prisma Health echoed the comment.
He believes automation was never driven by technology but needs. As such, many worried the rapid telehealth adoption may actually be short-lived. Particularly when face-to-face visit at the clinic goes back to its original capacity as the COVID-19 situation taper or when the pandemic comes to an end.
Challenges of keeping telehealth on the table
Dr. Michael Weiss, Vice President of Population Health at Children’s Hospital of Orange County (CHOC) pointed out operational model and reimbursement as the major hurdles. He said right now, the Federal government is more relax on regulations around telehealth. However, it is unclear whether virtual visits will continue to be paid at the same rate as in-person care in the long run. In-person visits is where a bulk of costs come from for certain health systems especially since the number of employers is not likely to cut even after telehealth adoption.
In Texas and Arizona, some of the US states hardest hit by COVID-19, insurers had already planned to scale back telehealth while some are setting deadlines on when they will remove coverage. On the other hand, some are faced with a significant volume of catch-up work as patients had already experienced significant delays for in-patient care over the past few months. Some providers also find it challenging to balance between in-patient and virtual care for patients with two or more medical conditions and require primary care physicians and specialists to work collaboratively in delivering a sound care plan.
As mentioned by Dr. Arlen Meyers, President and Chief Executive Officer of the Society of Physician Entrepreneurs (SoPE) and Emeritus Professor, University of Colorado School of Medicine, healthcare involved many stakeholders and all of them have different objectives using virtual care. Patients want convenience; physicians want quality care; healthcare leaders want to reduce administrative chore, lower the cost of operation and better management of bed utilization and other processes in the hospitals. These gaps in values and expectations are challenging providers to find a sweet spot for long-term planning and scaling
What does telehealth need?
Dr. Weiss said we have not yet identified the quality metrics around telehealth that the healthcare system needs to be monitoring. One way of doing so is via measuring outcomes. For example, a group of pediatric diabetic patients requiring four in-person visits each year could be randomly assigned into having just in-person visits or a mixed of two in-person visits and two virtual visits. Physicians could then measure and judge the outcomes before deciding whether patients will truly benefit from telehealth.
Dr. Patel added the importance of infrastructure and engagement. He explained it is common to find areas without affordable internet access or computers equipped with cameras and they are often the biggest hinder to adopt and scale virtual care. Besides, it is important to educate physicians. Some of them have been daunted by the decades use of electronic health records (EHRs) which are widely believed to be one of the main sources of physician burnout. So, adding yet another technology or new workflow which they think will add to the burden will not encourage adoption.
Ultimately, as Dr. Peter Liu Chief Scientific Officer and Vice-President of Research at the University of Ottawa Heart Institute highlighted the need to utilize data. He said patients love virtual care because they no longer have to drive their cars and wait for their turns at the clinics which can be exceptionally tedious during winter. Yet, data is not available to prioritize patients based on their profile and predict how they may turn out in the near future.
Ideally, there should be digital platform, which not only brings in patients and physicians to virtual care but also other services within the community, all in synchronized and non-synchronized manner and linked the information back to the EHRs, so that care can be delivered in a more flexible manner and not just dependence on hospital and home, but anywhere in between too. However, as reimbursement remains a giant leap, real virtual care may not be ready to open for all anytime soon.