Telehealth continues to offer solutions to old and new healthcare challenges, from extending services in rural areas to addressing nursing shortages amid COVID-19. But formidable barriers remain in expanding telehealth.
Overcoming these barriers requires bold thinking and leadership.
During a March virtual roundtable hosted by Becker's Hospital Review and sponsored by T-Mobile for Business, a panel of health system telehealth leaders discussed barriers to adoption and how telehealth can reimagine care delivery.
Four insights:
1. COVID-19 accelerated acceptance of virtual care, but important challenges remain. Those challenges include broadband connectivity, compatibility between devices and operating systems, digital/telehealth literacy, caring for non-English-speaking patients and customer orientation. "There are so many rules and regulations at the state and national level that make telemedicine very difficult," said the director for telehealth of a large nonprofit Catholic health system in the Midwest.
One consequence of lagging regulations was a lot of pre-COVID telehealth programs failed, the director for telehealth of a healthcare network serving rural communities along in the Western U.S. said. The experience taught the organization to innovate without over-relying on regulators. "We implemented continuous remote patient monitoring during COVID and used that to transition into hospital-at-home 'light' [afterwards]," he said. "We don't do it from a CMS-waivered perspective of hospital-at-home, but with the partnership of our EMS agency and a community paramedic program to assist with in-home interventions."
Another challenge was hesitation to change behaviors and care design. While both providers and patients claimed interest in telehealth, each party expressed reservations. "There was this chicken-and-egg thing that was frustrating because there are a lot of ways to show value in virtual care, but it was a matter of getting people to dive in," a technology leader at a healthcare system in the Midwest said.
2. Telehealth ease of use and reimbursement are pain points that must be addressed. Beyond legacy challenges, making sure solutions are easy for patients to use is top of mind for telehealth leaders. "Two years ago, patients weren't doing virtual at all and now we are throwing 10 to 15 different virtual tools at them, which is incredibly confusing. It's on us to help the patients navigate," said a virtual health leader at a 40-hospital health system in the Atlantic region. A medical director from this organization added that unless providers promote those tools in a way patients trust, patients may get the impression telehealth is subpar care.
Therefore, organizations must ensure telehealth tools are reliable and providers are properly trained and compensated when using telehealth. Baron Kuehlewind, healthcare industry solutions advisor at T-Mobile, said insurers are increasingly aware of those expectations and some are adapting by providing members with iPads for telehealth visits, as well as reassessing how they reimburse for such visits.
3. Telehealth can transform care delivery within the hospital. Hospitals are using telehealth to access specialists in areas where they don't have a specialist on staff. This occurred at one of the largest nonprofit health systems in the South-Central region of the U.S. and enabled virtual transplant hepatology evaluations during the pandemic; other hospitals have done the same for tele-stroke, tele-neurology, tele-infectious disease, tele-psychiatry and tele-ICU consultations. "Maybe all you need is the clinician [to have] access to that patient, who may not require transfer but only the skill and expertise from a diagnostic or guiding evaluation and treatment [perspective]," a medical director at a 52-hospital health system the West said.
Looking to the future, participants expect telehealth use to mature to the point where a single solution can be leveraged across multiple use cases, clinical conditions and patient scenarios, as well as to alleviate nursing, specialist and other staff shortages. "We're trying to take a broader look at the technology in our facilities and figure out how we can utilize it more ubiquitously and have whoever needs to 'remote in' to see a patient," the director of virtual care at the nonprofit Catholic health system in the Midwest said.
4. Successful vendor-health system collaboration requires creativity and flexibility. Telehealth solution providers that aim to partner with healthcare organizations must think creatively about how they can accommodate health systems' needs and facilitate integration between various patient devices and healthcare platforms.
"Patients are looking for a bring-your-own-device, I-can-integrate-anything-with-anything model," the virtual care director from the Midwestern health system said. "Some of the best partnerships we've had with vendors are those where they're listening to the problem we're having or the workflow we're trying to achieve and are willing to be innovative with us and not just bolt on a tool they already have on the shelf."
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