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Telehealth has kept many providers afloat during COVID-19, but there are challenges and limitations

While many have survived in part by offering remote services, more is needed to keep patients engaged and comfortable with virtual care.

Jeff Lagasse, Associate Editor

Telehealth has changed the way healthcare providers do business, and for many it has provided a lifeline of sorts as organizations seek to replace lost revenue from canceled and delayed elective procedures and other service lines. Many months into the pandemic, though, some of telehealth's limitations are becoming manifest, from occasionally inconsistent communication to making patients feel safe in seeking care remotely.

While on balance telehealth has been a boon for the industry, new data shows there are areas ripe for improvement.

The data comes courtesy of Luma Health, which offers a patient engagement platform. It found that the remote care modality is indeed gaining traction. A full 83% of providers say they've increased their use of telehealth, while 60% said that more than one-fifth of their appointments are currently being conducted via telehealth.

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Ninety-one percent of providers say they've begun offering telehealth to promote social distancing and to make patients feel safer, and a full 88% said they expect the increased use of telehealth to remain permanent, even when the public health crisis ends.

"We'd been talking about telehealth for years, and it never really took off as it had been promised. But now we were suddenly thrust into the COVID world, and for better or worse we were forced to deliver care over telehealth," said Dr. Tashfeen Ekram, Luma Health's cofounder and chief medical officer.

"Six to eight months later, what we've realized as a nation is we are a lot more comfortable doing health over a teleconferencing format than we previously had been. I think a lot of that was because we did it out of necessity. If there's a silver lining to COVID, it helped us make that jump, that leap of faith."

Yet telehealth isn't a cure-all, at least not in its current form, and that's reflected in the continued struggles among hospitals and providers. According to the data, 27% of providers expect the coronavirus to cause care disruptions and appointment cancellations for at least another year, and one in four healthcare organizations are at risk of closing in a year or less. Thirty-two percent are operating at below 60% capacity.

"Certain types of healthcare are better delivered virtually, and some of them are not – and having been thrust into this, it gives providers a better sense of what that is," said Ekram. 

THE CHALLENGES

One issue that has arisen is caring for patients with chronic conditions. Many who struggle with chronic ailments are delaying their access to care because they self-report a preference for seeking such care in person.

About 67% of patients say they're at least somewhat likely to continue delaying nonessential exams, screenings or procedures during the next six months due to concerns about the coronavirus. Thirty-eight percent of patients report that their health has been negatively impacted because they're nervous about being exposed to the virus, and are avoiding doctors as a result.

A potential area of improvement in the way telehealth is currently practiced is in how communication takes place. Most such interactions take place in real time, but for the managing of chronic diseases, implementing asynchronous communication capabilities can allow physicians to touch base with patients over a secure messaging portal, for example. The definition of "telehealth" can in fact be broadened to include these non-real-time communications, thereby making patients more comfortable while minimizing the frequency of in-person visits.

"Physicians think of care as episodic, but it's not," said Ekram. "Physicians are looking at ways to bridge the gap between episodic moments, and leveraging technology is a great way to do this. Diseases don't go away between episodes of care. This can help patients keep track of their conditions and make sure they don't get in trouble."

Follow-up care can be performed fairly easily through telehealth since there's seldom a physical exam involved in such interactions. But one of the technology's weaknesses is in the initial evaluation, which is usually better handled in person, since they're longer visits intended to give the physician a baseline for what the patient is experiencing. With so many electing to delay care, that poses a challenge for providers.

Another of telehealth's limitations is that not all providers are equally capable of implementing it. Smaller practices often don't have the resources to shift between practice models. When the pandemic began in the U.S., organizations had to switch their volumes to telehealth visits. After switching back and forth, many are now in hybrid model, with some patient interactions handled remotely and some in person.

The practices that have fared best are the ones that were already on the verge of adopting some of this technology. The transition was smoother, and they were better able to financially weather the storm because their patients were already educated on the benefits of telehealth and are more comfortable with it, both in theory and in practice.

Many practices adopted telehealth quite rapidly and didn't initially figure out how to adopt it smoothly into their existing workflows, said Ekram. They would schedule a virtual visit and then 10 minutes before the appointment they would task someone on staff with calling a patient or sending them a link to the visit. That created a lot of work for practices, especially in the beginning, and they're only now discovering how to make the experience more seamless for both staff and patients.

"They just kind of threw bodies at it," said Ekram. "Now they're saying they need to actually make sure it's something that's scalable. As practices look to switch more of their patient volume to telehealth visits, they're thinking, 'How can we streamline this with our existing workflow so it's not extra work for our scheduling staff and administrative staff?'"

THE POWER OF COMMUNICATION

Communication is paramount to making patients feel more comfortable, he said, and it's important that patients understand what COVID-19 precautions their providers have in place. Only 10% say they've been educated on their hospital or practice's safety precautions, and Ekram's hypothesis is that many are delaying care because they haven't had the proper communication.

"We were always afraid of over-communicating with the patients, but this is one of the areas where it's really important to do that," he said. "In an isolated, virtual world, communication becomes even more vitally important. This can be a mix of in-person or automated outreach."

Luma Health's data suggests other, non-telehealth ways in which patients can be made more comfortable. Sixty-four percent, for instance, would feel better if hospitals designed a separate entrance and treatment area of the building for COVID-19 patients; 57% would like to see social distancing enforced in lobbies and waiting areas; and half would like to see scheduling adjusted so that fewer patients are in lobbies and waiting areas at once.

Ekram said the future of telehealth will be determined in part by reimbursement models and how payers will be willing to reimburse providers for their remote care. He offered the personal example of a colleague, an endocrinologist who has been performing virtual visits for some time and now conducts 90% of his interactions remotely. But he does many things in between these visits – checking on diets, medication adherence and the like – and isn't being reimbursed for those things. 

"He's got work to do, and as a responsible provider he does the work that's needed between each visit, but unfortunately for him he doesn't get reimbursed for it," said Ekram. "In order for us to adopt these other ways of virtually managing patients, the incentives need to be aligned in the right way, and they're not."

Yet despite these challenges and barriers to adoption, Ekram expects that patients and providers will continue to see a lot of value in virtual visits.

"You can drop down costs, deliver better care and drive up patient satisfaction," he said. "Telehealth does those three things. We may be able to solve some of the core issues we were seeing in our healthcare system and find that delicate balance. Providers just have to be nimble and be able to shift volumes from one place to another."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com