Telehealth growth has sped up during the pandemic, but whether it continues long-term is a point of debate among hospital and health system CIOs.
The fate of telehealth rests on several factors, including CMS and commercial payers permanently extending payment benefits for telehealth and virtual care services.
"CMS keeps kicking the can down the road, which has been great for us, but it would be even better if they formally acknowledge and put in stone the payment models, so we aren't worried the reimbursement is going away," said Heather Nelson, senior vice president and CIO of UChicago Medicine. "It'll be a harder sell if the reimbursement isn't there."
Growth also likely will depend on patient demand and clinician comfort with telehealth-appropriate care selection.
"Looking into the crystal ball, I would venture a guess that 20 to 30 percent of healthcare delivery will be virtual within five years," said Audrius Polikaitis, CIO of UI Hospital & Health Sciences System in Chicago. "That prognostication is, of course, tied to an assumption that there is no significant degradation to telehealth visit reimbursement. However, with time, I do expect that percentage to increase."
Mr. Polikaitis also said he sees older generations gradually becoming more comfortable with telehealth as a result of the pandemic, though for now they prefer in-person visits.
"I completely admire how many within this generation have adopted virtual technology, especially as an outcome of the pandemic circumstances," he said. "However, if given a choice, I expect many from this generation to have a higher degree of comfort with traditional in-person care. As time moves on, the future elder consumers of healthcare services will have more comfort with virtual care approaches, and therefore adoption will increase."
Richard Temple, vice president and CIO of Deborah Heart and Lung Center in Brown Mills, N.J., also sees around 35 percent of all outpatient visits becoming virtual in the next half-decade and points to technology as the biggest limiting factor. He said both patients and physicians found aspects of virtual care frustrating, such as limited connectivity and unfamiliarity with telehealth tools.
"In five years, I can foresee a better comfort level with virtual health as well as the maturing of 5G wireless networks increasing speed and dependability of virtual health tools," Mr. Temple said. "I think the future is bright for virtual health, but adoption will be a slower and steadier climb than a rapid transformation of the care landscape."
Tara Matthews, chief information security officer of Einstein Health Network in Philadelphia, sees a higher percentage ceiling on the percentage of virtual care visits in 2025, estimating 35 percent to 50 percent of all healthcare services will be virtual. She also sees industrywide investments being significantly higher to support virtual health initiatives, but it won't necessarily be a seamless transition.
"The challenge for health systems and virtual products is to improve data-sharing and interoperability," she said. "Not to mention cybersecurity risks regarding networks, devices or otherwise. From a physician perspective, workflow redesign will be needed as we move toward a more consumer-centric model. In addition, [we will need] soft skill training to remain connected and provide empathy while engaged in the virtual setting."
Gainesville, Ga.-based Northeast Georgia Health System CIO Chris Paravate said he believes telehealth is another example of how technology is becoming part of daily life for Americans, and over time, patients will expect dynamic and engaging care management. They will have healthcare apps on their phones and prefer that mode of care delivery.
"Exceptional apps with telehealth, among other features, will take our attention, engage us in new ways and help us be accountable for our health and well-being," he said.
Jonathan Witenko, system director of virtual heath and telemedicine, and William Carracino, MD, chief medical informatics officer at Lee Health in Fort Myers, Fla., also see telehealth playing a much larger role in the healthcare system going forward.
"Dr. Carracino and I have conjectured that the only time you'll need to come to the hospital in the future will be for emergency and trauma, major surgery and the ICU," said Mr. Witenko. "Five years is overly optimistic, but it's moving in that direction.
"Ambulatory care has shown the most dramatic evolution, out of necessity, during the last eight months. Patients and caregivers are now expecting it as an option and will transition a sizable percentage to virtual. As tools such as the internet of things, remote patient monitoring, digital peripherals, 5G and kiosks become more readily available and adopted into mainstream, proactive monitoring will grow exponentially."
This "hospital at home" model can drastically change the physical acute care landscape using virtual tools, Mr. Witenko added.
Lonnie Johnson, CIO of KVC Health Systems in Olathe, Kan., echoed that sentiment for organizations of all sizes, stating that health systems are likely to continue building on the rapid digital transformation made during the pandemic.
"Healthcare agencies had to rapidly enhance their knowledge of web-based video conferencing, adjust for mobile-enabling equipment and rethink our security protocols as we extend our networks into the homes of our workers," said Mr. Johnson. "The shift quickly dispelled any fears, concerns and challenges that small to midsize healthcare organizations had about their ability to provide this model of patient care. Most of these agencies have vowed to adopt this as a permanent service."
But not everyone is so bullish on telehealth. Mike Nichols, vice president of SoutheastHEALTH in Cape Girardeau, Mo., sees less than 1 percent of healthcare being delivered virtually five years from now, citing challenges with cybersecurity, insurance reimbursement and patient and physician acceptance of the technology.
Raymond Lowe, senior vice president and CIO of AltaMed in Los Angeles also sees widespread telehealth as dependent on pending reimbursement updates.
"If legislation is unfavorable, we may be at 10 percent utilization, but if legislation is equivalent reimbursement for video, and pay for performance and value-based care progresses, I'd say [we will be at] 30 to 40 percent telehealth delivery in five years," Mr. Lowe said. "If there is additional expansion of reimbursement, that number could exceed 50 percent."
By 2025, health systems will be further along in defining proper workflow for using virtual care to improve the patient experience, especially given the considerable investment in emerging digital health and virtual care technologies, Mr. Lowe said.
"Virtual care will likely be a quick solution to resolve access issues and then to supplement care, provide temporary checkpoints such as post-hospital care, or in-between visits for remote patient monitoring," he said.