By Emmanuel Opati, MBA, MHA, PMP, Assistant Administrative Director, Office of Telemedicine, Johns Hopkins Medicine
To be blunt, there is no future of healthcare without telemedicine.
Until March 2020, telemedicine was on the periphery of healthcare in the US. Many health systems viewed telemedicine as novel or experimental, with about a five to ten year gap to becoming a mainstream healthcare delivery modality. As a result, significant investments were not made to support telemedicine’s systems or infrastructure.
To everyone’s surprise, telemedicine became not only the safest way to provide care – but the only way for providers to look in the eyes of their patients and see their smiles since the global pandemic started.
Today, telemedicine is no longer viewed as novel or experimental, but rather it has become a healthcare delivery modality that has been used by millions of patients across all demographics.
It is estimated that telemedicine accounts for about 25% of ambulatory visits. This means that telemedicine has a critical role in advancing access to care. JD Power recently reported that US health plans were able to meet member needs during the pandemic using telemedicine. Generation Y and Generation Z are the groups that had the highest contact with their health plans.
Perhaps the most exciting part of the study is that, for this demographic, COVID-19 had minimal impact on their telehealth utilization behavior. Going forward, now that telemedicine is widely available, these groups will expect that option for their own care, care of their parents, and care for their own children.
The biggest barrier healthcare systems have faced in adopting telemedicine is that they were built for in-person, face-to-face encounters. Business plans, workflows, and staffing models are all based on in-person encounters. When COVID-19 halted in-person visits, many healthcare systems quickly pieced together telemedicine programs using the in-person infrastructure. This resulted in patching legacy and outdated systems to get telehealth up and running. Since the programs were not designed for virtual care, they will not realize the financial and operational benefits of efficiency and scale. For instance, some healthcare systems have legacy Electronic Health Records (EHR) systems that do not have basic telemedicine features like a waiting room, on-demand scheduling, patient notifications, or the ability to integrate language interpretation service.
There is no future of healthcare without telemedicine, though telemedicine has challenges that must be addressed.
Telemedicine has a significant role in the future of healthcare because “technology has become less of a barrier to telemedicine.” Providers and patients are not the barriers to telemedicine. Instead, the barrier to telemedicine in some healthcare systems is the lack of support from leadership. Leaders of some healthcare systems do not understand that virtual practices are a real threat to healthcare systems – especially the ambulatory business line. The virtual practices “are taking patients away from traditional brick-and-mortar practices because of their convenience and ability to perform medical care in the low overhead environment.” As such, systems that do not offer these services will have patients that seek them elsewhere.
Inpatient services are still insulated from this competition because of the rules and reimbursement policies surrounding activities performed in regulated spaces. However, startups are chipping away some of these services by inventing home monitoring devices. Initially, most of these services were self-pay, but states are making changes to make care more accessible and convenient.
One inpatient service that is ripe for disruption is the patient safety monitoring program, also known as ‘sitters’. Healthcare systems spend millions every year paying staff to watch patients in rooms – one staff to one patient. However, they would save a lot of money by leveraging telemedicine. There is no reason to have one staff cover only one patient when you can have one staff who could cover six or more patients by leveraging telemedicine.
There is no future of healthcare without telemedicine, though telemedicine has challenges that must be addressed. Like the healthcare industry, COVID-19 has forced us to confront health inequities within telemedicine. When physician offices converted to virtual offices overnight, many patients were effectively shut out of the healthcare system. This primarily impacted those who didn’t have access to things like digital devices and high-speed internet – both of which are scarce among those residing in underserved communities, the elderly population, and others. To address these access issues, many healthcare professionals resorted to reaching patients solely by telephone. It is best to have both audio and video during a telemedicine visit.
Although telemedicine has established itself as a healthcare delivery modality, some healthcare systems have not embraced it. To some, telemedicine is synonymous with the Public Health Emergency (PHE), and believe that it will end as soon as the PHE ends.
Telemedicine will not end with the PHE and is central to the future of the business of healthcare.