Michael Barbella, Managing Editor04.01.22
Poor Elroy Jetson.
George and Jane’s whiz kid was gravely ill and fading fast.
“This is it,” he dazedly tells his mother in the space age cartoon’s 10th episode. “It’s growing black. Quick, where’s a pencil? I gotta make out my will.”
Elroy claims he’s contracted the “Venus Virus” and suggests skipping school. Jane, however, is skeptical and summons a doctor to confirm the diagnosis.
Almost instantly, a physician appears on a large drop-down monitor in the Jetsons’ home and, donning a hand-tied cloth facemask (N95s are curiously non-existent in 2062), examines Elroy virtually. Upon inspecting the boy’s mouth, the doctor ties Elroy’s tummy troubles to his most unusual breakfast—two dozen gumdrops, a pastrami sandwich, and half a pizza (quite the departure from his usual milk, cereal, bacon, and soft-boiled egg).
“Well, it pains me to tell you, but there’s only one known cure,” Dr. Ken Racey informs Elroy. “A full day at school. You’re fine.”
“Awh, phooey,” replies Elroy.
After a brief self-promotion, Dr. Racey (visually) submits his $100 house call bill and signs off, wishing the Jetsons “happy medicine!” before vanishing from the screen.
Sound familiar?
If not, it should. After nearly six decades, healthcare has—finally—fully embraced The Jetsons world of push-button, near-instant virtual medical care. Today’s telehealth visits more or less resemble Dr. Racey’s house call, with appointment times and fees on par with the early 1960s cartoon.
The only difference now is the facemask. (For shame, Hanna-Barbera).
“...the creators of ‘The Jetsons’ weren’t the first to dream up these futuristic inventions,” Paleofuture blog author Matt Novak wrote in the September 2012 issue of Smithsonian Magazine. “Virtually nothing presented in the show was a new idea in 1962... ‘The Jetsons’ and everything they represented were seen by so many not as a possible future, but a promise of one.”
Fulfilling that promise proved difficult, though. Some of the best Jetsons innovations languished for years in development due to technical glitches or inferior technology.
Seiko’s answer to George Jetson’s “video watch,” for example, was doomed by poor screen resolution (users needed external light for optimal quality), while Electrolux’s robotic vacuum was no match for Rosie, as it stopped a few inches short of objects and walls, leaving parts of entire rooms uncleaned.
Telehealth, meanwhile, was technologically impossible without the Internet. Yet the invention alone was incapable of facilitating Dr. Racey-style virtual medical visits without the underlying physical infrastructure (i.e., broadband connectivity), regulations and guidelines, patient privacy policies, reimbursement agreements, multi-state licensing, and widespread accessibility, as well as approval and acceptance from both patients and providers.
The latter two elements transpired rather quickly—seemingly faster than a Dr. Racey appointment, actually—courtesy of the global pandemic. Telehealth use skyrocketed during COVID-19’s initial assault on the United States, with 34.5 million virtual visits documented between March and June 2020, a 2,632 percent increase compared with that same 90-day period in 2019, Centers for Medicare & Medicaid Services (CMS) data indicate. Telehealth visits surged 154 percent during the last week of March 2020, as public health guidance, stay-at-home orders, relaxed federal restrictions, and reimbursement guidance encouraged remote patient-doctor connections.
“COVID-19 accelerated the development of telehealth,” said Antoine Robiliard, vice president of Health Solutions at Withings, one of the world’s largest connected health device firms. “Almost overnight, it showed itself to not only be a safe alternative to meeting in person, but a more convenient way for patients and health professionals to interact.”
Convenience aside, telehealth has more than proven its worth over the last 24 months. It’s helped limit the virus’s spread, lower costs, improve treatment in certain cases, and expand access to care.
Moreover, telehealth—also called telemedicine—provided a critical bridge to care for patients seeking mental/behavioral health services. Not surprisingly, mental health-related conditions rose precipitously during the pandemic as the planet’s masses socially isolated themselves for fear of infection or worse, death. World Health Organization statistics show a 25 percent jump in the global prevalence of anxiety and depression during COVID-19’s first go-round in 2020, with females, younger folks (ages 20-24), and residents in low- and middle-income countries most affected.
That massive spike in anxiety and depression spawned an equally gargantuan increase in related telehealth visits. Overall behavioral health services claims ascended 6,500 percent from January 2020 to February 2021, with anxiety claims soaring 3,000 percent, depression claims expanding 2,500 percent, and substance abuse claims ballooning 1,400 percent, a LexisNexis Risk Solutions Health Care report concluded.
A good portion of all those claims came from new patients seeking treatment for the first time, the report found. The document also revealed the extent of telehealth’s disconnect with mental health services before COVID-19: Pre-pandemic telehealth claims data averaged 16,000 patients per month but rose exponentially to 1,020,000 per month from March 2020 through February 2021.
“Prior to the pandemic, telehealth was hugely underutilized for mental health services,” the report stated. “The spike in mental health telehealth medical claims from January 2020 to February 2021 acknowledges the impact the pandemic has had on accelerating the use of telehealth as a treatment option.”
Other data imply that option has barely decelerated since COVID-19’s American debut. Kaiser Family Foundation (KFF) research shows telehealth remaining a preferred treatment choice for mental health and substance use disorders despite an overall decline in virtual outpatient care.
Analyzing data from 126 million patients, KFF found that telehealth delivered 40 percent of behavioral health outpatient care in 2020, up from a pre-pandemic 1 percent. Last year, as overall telehealth usage fell, virtual behavioral health-related visits remained steady, slipping only slightly to 36 percent.
“Telehealth solutions were not created during the pandemic, they’ve been around for several years. The development and adoption of telehealth solutions were accelerated because of the pandemic,” Glooko CEO Russ Johannesson noted. The Palo Alto, Calif.-based firm provides remote patient monitoring (RPM) and data management solutions for diabetes and related chronic conditions. “The definition of telehealth has also been rapidly evolving. It can be anything from a telephone call with a nurse, a video chat with a doctor, or a remote patient monitoring connection. The pandemic forced the rapid adoption of many of these capabilities. With clinical offices being locked down in the early part of the pandemic, virtual visits became the only way to provide care. We saw demand for telehealth increase and when offices opened back up, in-clinic visits started to return, but remote syncing and remote care continued to rise. In many ways, the genie is out of the bottle on telehealth, it’s not going away.”
Certainly not. Telehealth has become too valued of a care tool now to recede into its pre-pandemic shadow. The technology has captured both patients’ hearts and patrons’ wallets, scoring a 91 percent satisfaction rate among Medicare beneficiaries and $17.6 billion in 2021 funding. Telehealth also has commanded Amazon’s respect: In February, the e-commerce mega-giant launched its virtual health service (Amazon Care) nationwide, ending a gradual rollout that began more than two years ago.
The company hatched Amazon Care as a pilot program in Washington State in September 2019. The initiative—accessed by mobile app—offers free on-demand telehealth consults with medical professionals via chat or video conference in less than 60 seconds, according to the company. The app is available only on mobile devices with iOS 13 and above or Android 6 and above; it cannot be accessed on tablets or computers.
The virtual visits are reserved for routine (non-emergency) medical issues including allergies, cold, flu, or COVID-19 symptoms; chronic condition care management; minor injuries; pre-pregnancy planning; preventive care; prescription requests/refills, stress management; sexual health; and insomnia.
“If you look at the average time to schedule and see a primary care doctor, it’s about 21 days,” Babak Parviz, an Amazon vice president and Amazon Care architect, told the press last summer. “We’ve lowered that to 60 seconds. This is quite different from anything we’ve had in the past.”
It’s also quite different from anything presently being offered. Besides the virtual option, Amazon Care provides in-person services as well for patients with more complicated health conditions. The program dispatches a nurse practitioner when necessary to perform physical examinations or draw blood.
Amazon is expanding in-person services this year to 20 U.S. cities, including Chicago; Miami; New York, N.Y.; and San Francisco. The in-person option already exists in Arlington, Va.; Austin; Baltimore; Boston; Dallas; Los Angeles; Seattle; and Washington, D.C.
Amazon executives tout the expansion as a means to improve healthcare access and treatment, and foster an unconventional approach to medical science. In the short term, however, it is more likely to bolster the company’s profile among consumers and patients longing for face-to-face clinician contact.
Although telehealth’s breakout moment is far from over, the techology’s use has been waning with declining coronavirus caseloads, rising workplace reopenings, and a slow crawl back to “normal.”
Consumer and physician satisfaction with telehealth fell last year from its 2020 peak: A Rock Health survey found 43 percent of consumers more contented with live video calls than in-person care (down 10 percent) and 58 percent of doctors viewing telehealth more favorably than they did before COVID-19 (down 8 percent).
Similarly, an October 2021 poll by NPR, the Robert Wood Johnson Foundation, and T.H. Chan School of Public Health at Harvard revealed that nearly two-thirds of telehealth users—64 percent—would have preferred an in-person meeting with a clinician.
“Despite the advances in technology like artificial intelligence and machine learning, we think healthcare is delivered human-to-human,” Johannesson said. “Telehealth is not, and should not, be considered a replacement for in-person care. It’s a scalable supplement to in-person care. If you step back and look at it from a more holistic perspective—there are increasing numbers of patients with diabetes who need treatment and a decreasing number of providers who can treat them over time (i.e. the shortage of endocrinologists, nurse educators, etc.). This is where technology-enabled solutions can be transformative and allow us to treat and triage more patients, especially those persons with diabetes who are cared for by their PCP. We need to leverage these technologies to help support and enable the patient-provider connection. A future where people only interact with a chatbot is something I hope we never see. We will continue to focus on empowering the human connection between providers and patients.”
The best conduit for that connection, experts say, is a hybrid healthcare model that combines virtual and in-person care delivery. The Mayo Clinic devised such an approach through its Hybrid Care Hotel, established at the organization’s Jacksonville, Fla., facility in July 2020. The Hotel offers patients both virtual and in-person care after surgery or low-risk medical procedures.
Conceived during a COVID-19 surge in the Sunshine State, the Mayo Clinic’s hybrid setup combines limited in-person daytime monitoring of surgical and other procedural patients by a registered nurse with paramedic staff availability. Patients are continuously monitored via biometric devices, an in-person nurse, and a remote clinical team; the technique saves convalescents money (no hospital stay) and helps optimize nursing resources, a critical factor during COVID-19.
Hotel “guests” have lauded the program upon checkout—87 percent gave their stay a positive rating and 94 percent were likely to recommend the hybrid platform to others.
“It’s important that we focus on virtual care not as a replacement for in-person care, but rather as a way to enhance and supplement in-person visits,” stated Jessica Shandrowski, director of Product Management at Carium, a Petaluma, Calif.-based virtual care technology developer. “A hybrid model that balances virtual and in-person care based on patient preference and medical necessity is the future of healthcare. The goal of this model is to communicate efficiently with patients while improving outcomes, reducing costs, avoiding unnecessary travel, and easing hospital capacity. The end result will be a new continuum of care that delivers [medical] care at the right time and place.”
Orchestrating that delivery could prove challenging though, as numerous hurdles are clogging the path to telehealth’s post-pandemic longevity. One of the biggest barriers is the lack of a solid digital infrastructure—i.e., high-speed internet, widespread mobile device access, and high-quality electricity supply—in low- and middle-income countries.
That foundation is significantly more solid in richer nations but still prone to cracks. Healthcare IT infrastructures are already strained by network requisites for large-scale initiatives like electronic health records (EHRs) and operational process automation. Adding telehealth systems to the mix (with video, audio, and data stream combinations) will only exacerbate the already high-bandwidth demand.
“Health organizations need to ensure their technology infrastructures mature along with the addition of virtual care solutions so these initiatives can scale and be successful for the long term,” Christine Storm, general manager of Virtual Care Solutions at Royal Philips, told Medical Product Outsourcing. “Now that pandemic-level patient loads have started to subside, health systems can focus on stabilizing their infrastructures. To successfully support patients in a variety of care settings, health organizations need robust, interoperable, and reliable solutions that inform data-driven decisions. To help with this, healthcare organizations have been looking to technology partners that can help with implementing foundational technology infrastructures from the ground up to support this long-term digital transformation.
For example, Philips’ secure, scalable cloud technology platform—Philips HealthSuite—helps to connect massive systems of information and fragmented sources of data onto one continuous platform. This provides health systems with the capabilities they need to unlock and integrate data from various sources like the imaging department or laboratory—allowing for seamless interaction with this data and the ability to gain actionable insights from it.”
Philips HealthSuite interacts seamlessly with other cloud-based tech such as Salesforce Health cloud and Amazon Web Services, according to the company. The platform also supports professional healthcare solutions, personal coaching apps, and Philips consumer devices as well as those from other open programs.
Philips has augmented its HealthSuite platform with additional capabilities over the past few years. At HIMSS22, the company unveiled Philips HealthSuite Interoperability and Philips Enterprise Performance Analytics Performance Bridge, both of which are currently pending FDA 510(k) clearance.
HealthSuite Interoperability connects third-party systems and enables seamless data workflows to streamline efficiency, enabling Philips to “deliver integrated informatics solutions to help improve clinical workflow, enhance patient care, and optimize enterprise management,” the company stated in a March 14 news release. The platform supports all relevant data types and formats, including DICOM (Digital Imaging and Communications in Medicine) images, genomics, pathology, laboratory data, Health Level Seven International standards, formats and definitions for exchanging and developing EHR messages, and Fast Healthcare Interoperability Resources standards.
Enterprise Performance Analytics Performance Bridge expands operational insights and deep analytics beyond radiology to cardiology departments to enhance efficiencies and help improve point-of-care effectiveness. The solution gives clinicians access to near real-time data on departmental performance through an interactive dashboard.
Future HealthSuite updates will target the Philips Electronic Medical Record and Philips Acute Care and Anesthesia Workspace, the company said.
A reliable infrastructure and interoperable solutions, however, are essentially pointless without digitally literate users. “In many cases, the technology is difficult and clunky. Often, patients are forced to download an application in order to participate in a telehealth visit, and those applications are not always intuitive and easy to use,” asserted Jeff Donnell, president of Enterprise Health, a Fort Wayne, Ind.-based a provider of occupational and employee health software solutions. “For patients who are not tech-savvy, this can be a significant usage barrier, and a negative experience can sour an individual on the value of telehealth. On the provider side, telehealth functionality may be separate from and/or not well integrated with the provider electronic health record solution, creating more work and a less-than-pleasing user experience.”
A more pleasant experience is possible via tailored content that matches patients’ digital literacy levels, and open (working) non-cellular telephone lines for providing telehealth users with individualized guidance on new systems.
“While health technology is an enabler of telehealth, it is also a potential barrier to realizing its full potential,” Robiliard said. “One the one hand, everyday home devices are increasingly able to provide medical-grade information previously only available in clinical settings and on the other, the same technology is daunting to those that can benefit from it most. Devices must be extremely easy to use and increasingly will have to work straight out of the box with no setup if, like Withings devices, they are going to capture accurate data on a daily basis. It has to be about reducing frictions, integrating seamlessly into clinical workflows, and creating great experiences for the patient.”
Certainly, great (patient) experiences will help ensure telehealth remains popular in the near future. But regulatory and reimbursement changes are needed as well to guarantee the technology’s long-term survival, industry pundits contend.
Telehealth use exploded during COVID-19 as social distancing mandates, lockdowns, and fear forced patients to remotely access necessary medicinal services. State and federal governments temporarily relaxed numerous regulations to unleash the technology’s full potential but many of the eased rules are slated to expire with the public health emergency.
For telehealth to remain an integral part of 21st century healthcare, these temporary regulatory modifications must be made permanent. Reimbursement is particularly critical, as providers will likely not offer telehealth services without adequate coverage.
“Reimbursement (or lack thereof) has changed since the pandemic, especially for clinicians monitoring vital signs,” said Sean Hägen, principal and founder of BlackHägen Design, a Dunedin, Fla.-based product design firm. “Telehealth insurance reimbursement is likely to remain indefinitely and with the hopes that even more reimbursement codes are approved over time, this certainly improves access to care.”
While telehealth reimbursement could very well become as enduring as its in-person counterpart, its exact structure is far from certain. As the technology evolves, so too, will reimbursement models.
Virtual-first health plans, for example, are gaining in popularity, according to an August 2021 McKinsey & Company report. These evolving plans lack a universal definition but share some common traits, including:
George and Jane’s whiz kid was gravely ill and fading fast.
“This is it,” he dazedly tells his mother in the space age cartoon’s 10th episode. “It’s growing black. Quick, where’s a pencil? I gotta make out my will.”
Elroy claims he’s contracted the “Venus Virus” and suggests skipping school. Jane, however, is skeptical and summons a doctor to confirm the diagnosis.
Almost instantly, a physician appears on a large drop-down monitor in the Jetsons’ home and, donning a hand-tied cloth facemask (N95s are curiously non-existent in 2062), examines Elroy virtually. Upon inspecting the boy’s mouth, the doctor ties Elroy’s tummy troubles to his most unusual breakfast—two dozen gumdrops, a pastrami sandwich, and half a pizza (quite the departure from his usual milk, cereal, bacon, and soft-boiled egg).
“Well, it pains me to tell you, but there’s only one known cure,” Dr. Ken Racey informs Elroy. “A full day at school. You’re fine.”
“Awh, phooey,” replies Elroy.
After a brief self-promotion, Dr. Racey (visually) submits his $100 house call bill and signs off, wishing the Jetsons “happy medicine!” before vanishing from the screen.
Sound familiar?
If not, it should. After nearly six decades, healthcare has—finally—fully embraced The Jetsons world of push-button, near-instant virtual medical care. Today’s telehealth visits more or less resemble Dr. Racey’s house call, with appointment times and fees on par with the early 1960s cartoon.
The only difference now is the facemask. (For shame, Hanna-Barbera).
“...the creators of ‘The Jetsons’ weren’t the first to dream up these futuristic inventions,” Paleofuture blog author Matt Novak wrote in the September 2012 issue of Smithsonian Magazine. “Virtually nothing presented in the show was a new idea in 1962... ‘The Jetsons’ and everything they represented were seen by so many not as a possible future, but a promise of one.”
Fulfilling that promise proved difficult, though. Some of the best Jetsons innovations languished for years in development due to technical glitches or inferior technology.
Seiko’s answer to George Jetson’s “video watch,” for example, was doomed by poor screen resolution (users needed external light for optimal quality), while Electrolux’s robotic vacuum was no match for Rosie, as it stopped a few inches short of objects and walls, leaving parts of entire rooms uncleaned.
Telehealth, meanwhile, was technologically impossible without the Internet. Yet the invention alone was incapable of facilitating Dr. Racey-style virtual medical visits without the underlying physical infrastructure (i.e., broadband connectivity), regulations and guidelines, patient privacy policies, reimbursement agreements, multi-state licensing, and widespread accessibility, as well as approval and acceptance from both patients and providers.
The latter two elements transpired rather quickly—seemingly faster than a Dr. Racey appointment, actually—courtesy of the global pandemic. Telehealth use skyrocketed during COVID-19’s initial assault on the United States, with 34.5 million virtual visits documented between March and June 2020, a 2,632 percent increase compared with that same 90-day period in 2019, Centers for Medicare & Medicaid Services (CMS) data indicate. Telehealth visits surged 154 percent during the last week of March 2020, as public health guidance, stay-at-home orders, relaxed federal restrictions, and reimbursement guidance encouraged remote patient-doctor connections.
“COVID-19 accelerated the development of telehealth,” said Antoine Robiliard, vice president of Health Solutions at Withings, one of the world’s largest connected health device firms. “Almost overnight, it showed itself to not only be a safe alternative to meeting in person, but a more convenient way for patients and health professionals to interact.”
Convenience aside, telehealth has more than proven its worth over the last 24 months. It’s helped limit the virus’s spread, lower costs, improve treatment in certain cases, and expand access to care.
Moreover, telehealth—also called telemedicine—provided a critical bridge to care for patients seeking mental/behavioral health services. Not surprisingly, mental health-related conditions rose precipitously during the pandemic as the planet’s masses socially isolated themselves for fear of infection or worse, death. World Health Organization statistics show a 25 percent jump in the global prevalence of anxiety and depression during COVID-19’s first go-round in 2020, with females, younger folks (ages 20-24), and residents in low- and middle-income countries most affected.
That massive spike in anxiety and depression spawned an equally gargantuan increase in related telehealth visits. Overall behavioral health services claims ascended 6,500 percent from January 2020 to February 2021, with anxiety claims soaring 3,000 percent, depression claims expanding 2,500 percent, and substance abuse claims ballooning 1,400 percent, a LexisNexis Risk Solutions Health Care report concluded.
A good portion of all those claims came from new patients seeking treatment for the first time, the report found. The document also revealed the extent of telehealth’s disconnect with mental health services before COVID-19: Pre-pandemic telehealth claims data averaged 16,000 patients per month but rose exponentially to 1,020,000 per month from March 2020 through February 2021.
“Prior to the pandemic, telehealth was hugely underutilized for mental health services,” the report stated. “The spike in mental health telehealth medical claims from January 2020 to February 2021 acknowledges the impact the pandemic has had on accelerating the use of telehealth as a treatment option.”
Other data imply that option has barely decelerated since COVID-19’s American debut. Kaiser Family Foundation (KFF) research shows telehealth remaining a preferred treatment choice for mental health and substance use disorders despite an overall decline in virtual outpatient care.
Analyzing data from 126 million patients, KFF found that telehealth delivered 40 percent of behavioral health outpatient care in 2020, up from a pre-pandemic 1 percent. Last year, as overall telehealth usage fell, virtual behavioral health-related visits remained steady, slipping only slightly to 36 percent.
“Telehealth solutions were not created during the pandemic, they’ve been around for several years. The development and adoption of telehealth solutions were accelerated because of the pandemic,” Glooko CEO Russ Johannesson noted. The Palo Alto, Calif.-based firm provides remote patient monitoring (RPM) and data management solutions for diabetes and related chronic conditions. “The definition of telehealth has also been rapidly evolving. It can be anything from a telephone call with a nurse, a video chat with a doctor, or a remote patient monitoring connection. The pandemic forced the rapid adoption of many of these capabilities. With clinical offices being locked down in the early part of the pandemic, virtual visits became the only way to provide care. We saw demand for telehealth increase and when offices opened back up, in-clinic visits started to return, but remote syncing and remote care continued to rise. In many ways, the genie is out of the bottle on telehealth, it’s not going away.”
Certainly not. Telehealth has become too valued of a care tool now to recede into its pre-pandemic shadow. The technology has captured both patients’ hearts and patrons’ wallets, scoring a 91 percent satisfaction rate among Medicare beneficiaries and $17.6 billion in 2021 funding. Telehealth also has commanded Amazon’s respect: In February, the e-commerce mega-giant launched its virtual health service (Amazon Care) nationwide, ending a gradual rollout that began more than two years ago.
The company hatched Amazon Care as a pilot program in Washington State in September 2019. The initiative—accessed by mobile app—offers free on-demand telehealth consults with medical professionals via chat or video conference in less than 60 seconds, according to the company. The app is available only on mobile devices with iOS 13 and above or Android 6 and above; it cannot be accessed on tablets or computers.
The virtual visits are reserved for routine (non-emergency) medical issues including allergies, cold, flu, or COVID-19 symptoms; chronic condition care management; minor injuries; pre-pregnancy planning; preventive care; prescription requests/refills, stress management; sexual health; and insomnia.
“If you look at the average time to schedule and see a primary care doctor, it’s about 21 days,” Babak Parviz, an Amazon vice president and Amazon Care architect, told the press last summer. “We’ve lowered that to 60 seconds. This is quite different from anything we’ve had in the past.”
It’s also quite different from anything presently being offered. Besides the virtual option, Amazon Care provides in-person services as well for patients with more complicated health conditions. The program dispatches a nurse practitioner when necessary to perform physical examinations or draw blood.
Amazon is expanding in-person services this year to 20 U.S. cities, including Chicago; Miami; New York, N.Y.; and San Francisco. The in-person option already exists in Arlington, Va.; Austin; Baltimore; Boston; Dallas; Los Angeles; Seattle; and Washington, D.C.
Amazon executives tout the expansion as a means to improve healthcare access and treatment, and foster an unconventional approach to medical science. In the short term, however, it is more likely to bolster the company’s profile among consumers and patients longing for face-to-face clinician contact.
Although telehealth’s breakout moment is far from over, the techology’s use has been waning with declining coronavirus caseloads, rising workplace reopenings, and a slow crawl back to “normal.”
Consumer and physician satisfaction with telehealth fell last year from its 2020 peak: A Rock Health survey found 43 percent of consumers more contented with live video calls than in-person care (down 10 percent) and 58 percent of doctors viewing telehealth more favorably than they did before COVID-19 (down 8 percent).
Similarly, an October 2021 poll by NPR, the Robert Wood Johnson Foundation, and T.H. Chan School of Public Health at Harvard revealed that nearly two-thirds of telehealth users—64 percent—would have preferred an in-person meeting with a clinician.
“Despite the advances in technology like artificial intelligence and machine learning, we think healthcare is delivered human-to-human,” Johannesson said. “Telehealth is not, and should not, be considered a replacement for in-person care. It’s a scalable supplement to in-person care. If you step back and look at it from a more holistic perspective—there are increasing numbers of patients with diabetes who need treatment and a decreasing number of providers who can treat them over time (i.e. the shortage of endocrinologists, nurse educators, etc.). This is where technology-enabled solutions can be transformative and allow us to treat and triage more patients, especially those persons with diabetes who are cared for by their PCP. We need to leverage these technologies to help support and enable the patient-provider connection. A future where people only interact with a chatbot is something I hope we never see. We will continue to focus on empowering the human connection between providers and patients.”
The best conduit for that connection, experts say, is a hybrid healthcare model that combines virtual and in-person care delivery. The Mayo Clinic devised such an approach through its Hybrid Care Hotel, established at the organization’s Jacksonville, Fla., facility in July 2020. The Hotel offers patients both virtual and in-person care after surgery or low-risk medical procedures.
Conceived during a COVID-19 surge in the Sunshine State, the Mayo Clinic’s hybrid setup combines limited in-person daytime monitoring of surgical and other procedural patients by a registered nurse with paramedic staff availability. Patients are continuously monitored via biometric devices, an in-person nurse, and a remote clinical team; the technique saves convalescents money (no hospital stay) and helps optimize nursing resources, a critical factor during COVID-19.
Hotel “guests” have lauded the program upon checkout—87 percent gave their stay a positive rating and 94 percent were likely to recommend the hybrid platform to others.
“It’s important that we focus on virtual care not as a replacement for in-person care, but rather as a way to enhance and supplement in-person visits,” stated Jessica Shandrowski, director of Product Management at Carium, a Petaluma, Calif.-based virtual care technology developer. “A hybrid model that balances virtual and in-person care based on patient preference and medical necessity is the future of healthcare. The goal of this model is to communicate efficiently with patients while improving outcomes, reducing costs, avoiding unnecessary travel, and easing hospital capacity. The end result will be a new continuum of care that delivers [medical] care at the right time and place.”
Orchestrating that delivery could prove challenging though, as numerous hurdles are clogging the path to telehealth’s post-pandemic longevity. One of the biggest barriers is the lack of a solid digital infrastructure—i.e., high-speed internet, widespread mobile device access, and high-quality electricity supply—in low- and middle-income countries.
That foundation is significantly more solid in richer nations but still prone to cracks. Healthcare IT infrastructures are already strained by network requisites for large-scale initiatives like electronic health records (EHRs) and operational process automation. Adding telehealth systems to the mix (with video, audio, and data stream combinations) will only exacerbate the already high-bandwidth demand.
“Health organizations need to ensure their technology infrastructures mature along with the addition of virtual care solutions so these initiatives can scale and be successful for the long term,” Christine Storm, general manager of Virtual Care Solutions at Royal Philips, told Medical Product Outsourcing. “Now that pandemic-level patient loads have started to subside, health systems can focus on stabilizing their infrastructures. To successfully support patients in a variety of care settings, health organizations need robust, interoperable, and reliable solutions that inform data-driven decisions. To help with this, healthcare organizations have been looking to technology partners that can help with implementing foundational technology infrastructures from the ground up to support this long-term digital transformation.
For example, Philips’ secure, scalable cloud technology platform—Philips HealthSuite—helps to connect massive systems of information and fragmented sources of data onto one continuous platform. This provides health systems with the capabilities they need to unlock and integrate data from various sources like the imaging department or laboratory—allowing for seamless interaction with this data and the ability to gain actionable insights from it.”
Philips HealthSuite interacts seamlessly with other cloud-based tech such as Salesforce Health cloud and Amazon Web Services, according to the company. The platform also supports professional healthcare solutions, personal coaching apps, and Philips consumer devices as well as those from other open programs.
Philips has augmented its HealthSuite platform with additional capabilities over the past few years. At HIMSS22, the company unveiled Philips HealthSuite Interoperability and Philips Enterprise Performance Analytics Performance Bridge, both of which are currently pending FDA 510(k) clearance.
HealthSuite Interoperability connects third-party systems and enables seamless data workflows to streamline efficiency, enabling Philips to “deliver integrated informatics solutions to help improve clinical workflow, enhance patient care, and optimize enterprise management,” the company stated in a March 14 news release. The platform supports all relevant data types and formats, including DICOM (Digital Imaging and Communications in Medicine) images, genomics, pathology, laboratory data, Health Level Seven International standards, formats and definitions for exchanging and developing EHR messages, and Fast Healthcare Interoperability Resources standards.
Enterprise Performance Analytics Performance Bridge expands operational insights and deep analytics beyond radiology to cardiology departments to enhance efficiencies and help improve point-of-care effectiveness. The solution gives clinicians access to near real-time data on departmental performance through an interactive dashboard.
Future HealthSuite updates will target the Philips Electronic Medical Record and Philips Acute Care and Anesthesia Workspace, the company said.
A reliable infrastructure and interoperable solutions, however, are essentially pointless without digitally literate users. “In many cases, the technology is difficult and clunky. Often, patients are forced to download an application in order to participate in a telehealth visit, and those applications are not always intuitive and easy to use,” asserted Jeff Donnell, president of Enterprise Health, a Fort Wayne, Ind.-based a provider of occupational and employee health software solutions. “For patients who are not tech-savvy, this can be a significant usage barrier, and a negative experience can sour an individual on the value of telehealth. On the provider side, telehealth functionality may be separate from and/or not well integrated with the provider electronic health record solution, creating more work and a less-than-pleasing user experience.”
A more pleasant experience is possible via tailored content that matches patients’ digital literacy levels, and open (working) non-cellular telephone lines for providing telehealth users with individualized guidance on new systems.
“While health technology is an enabler of telehealth, it is also a potential barrier to realizing its full potential,” Robiliard said. “One the one hand, everyday home devices are increasingly able to provide medical-grade information previously only available in clinical settings and on the other, the same technology is daunting to those that can benefit from it most. Devices must be extremely easy to use and increasingly will have to work straight out of the box with no setup if, like Withings devices, they are going to capture accurate data on a daily basis. It has to be about reducing frictions, integrating seamlessly into clinical workflows, and creating great experiences for the patient.”
Certainly, great (patient) experiences will help ensure telehealth remains popular in the near future. But regulatory and reimbursement changes are needed as well to guarantee the technology’s long-term survival, industry pundits contend.
Telehealth use exploded during COVID-19 as social distancing mandates, lockdowns, and fear forced patients to remotely access necessary medicinal services. State and federal governments temporarily relaxed numerous regulations to unleash the technology’s full potential but many of the eased rules are slated to expire with the public health emergency.
For telehealth to remain an integral part of 21st century healthcare, these temporary regulatory modifications must be made permanent. Reimbursement is particularly critical, as providers will likely not offer telehealth services without adequate coverage.
“Reimbursement (or lack thereof) has changed since the pandemic, especially for clinicians monitoring vital signs,” said Sean Hägen, principal and founder of BlackHägen Design, a Dunedin, Fla.-based product design firm. “Telehealth insurance reimbursement is likely to remain indefinitely and with the hopes that even more reimbursement codes are approved over time, this certainly improves access to care.”
While telehealth reimbursement could very well become as enduring as its in-person counterpart, its exact structure is far from certain. As the technology evolves, so too, will reimbursement models.
Virtual-first health plans, for example, are gaining in popularity, according to an August 2021 McKinsey & Company report. These evolving plans lack a universal definition but share some common traits, including:
- Accessing primary care services remotely at first
- Emphasizing primary care services with virtual care as the initial point of contact
- Deploying informatics based on claims data and other sources
- Providing active care coordination with concierge-style support to help guide patients to the best clinical setting and lower-cost, high-quality providers.
- Employing clinically integrated health coaches to help patients take ownership of their health goals.
