The COVID-19 pandemic rapidly accelerated healthcare providers' adoption of telehealth, but the jury is still out on whether it will remain a key part of healthcare delivery after the pandemic subsides.
Below, nine health IT executives from hospitals and health systems throughout the country share what changes they think need to be made to ensure telehealth's staying power post-pandemic.
Editor's note: Responses have been edited lightly for clarity and style.
Michael Elley, CIO, Baptist Health (Little Rock, Ark.): There are several factors (of which I will name three) that need to be in place for continued utilization, and those factors differ some between our ambulatory and inpatient settings. One, reimbursement needs to remain consistent or near-consistent to in-person clinic visits. Two, the technology needs to integrate within the EMR and not require the providers to access another app. Third, the healthcare system or clinic really needs to market this capability to their patients, as well as ensure their schedules are built out to allow for telehealth visits.
Mark Amey, CIO, Alameda Health System (Oakland, Calif.): My belief is that there are three things that are going to need to occur to ensure that telehealth is a permanent part of our healthcare fabric.
First, payers must continue to reimburse for telehealth visits. This has been approved with emergency orders, but there are questions on whether this will become permanent. The sooner this is addressed and resolved, the sooner organizations can make sure they are investing in permanent — not temporary — solutions. My personal opinion is that there should be reimbursement for both phone visits (at a basic rate) and video visits (at the same rate as an in-person visit). This would help ensure the appropriate investment and behavior in encouraging video visits, which have the greatest positive impact with patients.
Second, the technology needs to be simple enough to not inhibit clinician workflow and encourage good behavior — especially in using video visits. Currently both in my professional and personal life, I see too many clinicians quickly give up on video visits and flip to a phone visit. This is largely due to the technology being too complicated to walk each patient through and taking too much time to initiate for clinicians whose schedules are already overloaded. Clear directions need to be developed that are patient-facing to help support the patient in being ready to meet their provider in a virtual manner. Those instructions need to be pushed to patients in advance of their visit.
Lastly, patients need to expect and demand this type of engagement from their care providers. This means that the technology needs to be simple for the patient and the patient needs to be comfortable in seeing their care provider through a virtual visit. I believe the foundation of this has already been laid as patients have learned the convenience of telehealth.
Heather Nelson, senior vice president and CIO, UChicago Medicine: From my perspective, the best way to ensure telehealth remains a key part of healthcare delivery is to ensure the reimbursement and payment methods stay in place and even be enhanced as more and more patients want to have access to this model of care. We need those blanket waivers issued by CMS during the public health emergency to be made permanent. If we keep extending a few months at a time, it does not allow healthcare systems the confidence that we can continue this delivery of care, as well as invest in supporting technologies and operations.
Zafar Chaudry, MD, senior vice president and CIO, Seattle Children's: Telehealth must continue to remain a part of an enhanced patient experience strategy post-pandemic for healthcare systems. In order to achieve sustainability the following areas have to be addressed:
The COVID-19 federal emergency policy changes need to remain in force, and be made permanent, such as no restrictions on originating sites, no restrictions on clinicians furnishing telehealth services from their home and clinicians not needing to be licensed in the state where the patient is located. Also, HIPAA compliance should be enforced.
Medicare and Medicaid beneficiaries should remain covered without restrictions. Reimbursement rates have to stay on par with physical visits too. Private payers tend to follow whatever Medicare does.
Some medical specialties work better than others for telehealth, such as telepsychiatry. Data collected on visits should be analyzed by healthcare systems to determine what specialties are best suited for telehealth moving forward.
Not all patients have access to high-speed internet and/or hardware to consume telehealth services. Programs need to be set up to help with this inequity.
Chris Panagiotopoulos, chief technology officer, LifeBridge Health (Baltimore, Md.): Looking past COVID, key challenges will be optimizing use of telehealth with existing clinical workflows and systems to streamline the provider and patient experience. From an access perspective, the permanent lifting of geographic and site-of-service restrictions will allow telehealth services to continue to be delivered nationwide.
Steve Garske, PhD, CIO, Children’s Hospital Los Angeles: Children’s Hospital Los Angeles was prepared for our telehealth requirements when COVID-19 hit. The collective clinical and information services teams did a spectacular job to quickly expand our telehealth capacity, which enabled continued healthcare access along with balancing safety for our patients, families, staff and clinicians during the pandemic. This experience has taught us that telehealth will remain as a key part of our healthcare delivery model long after the pandemic. We anticipate that at least 15 percent to 20 percent of our visits will remain telehealth, with even more in certain specialties.
To ensure telehealth remains long-term, we all need to do the following: further improve the experience with upgraded technology, strong IT training, and new technologies; continuously upgrade, integrate and improve our telehealth systems, moving more to artificial intelligence/machine learning and Internet of Things in the future; work to further formalize and standardize federal and state reimbursements for telehealth professional fees and facility fees, given the hospital investment in the technology to make telehealth possible; advocate for parity in reimbursements for mental health services delivered by telehealth, which has increased access to this resource limited service; further partner with local/national partners to provide broadband access for those who lack meaningful digital connectivity, and therefore enhance equity in access to telehealth services; and begin partnering with community-based organizations to provide shared telehealth locations close to home.
Ash Goel, MD, senior vice president and CIO, Bronson Healthcare (Kalamazoo, Mich.): Telehealth needs to be supported with policy reform that addresses the current drivers of the public health emergency as well as the continued evolution of technology, which will allow both clinicians and patients to deliver and receive care in the most efficient way. One of the most important parts of this is continued support from payers to reimburse services with appropriate use cases designed to encourage and improve clinical efficiency and the patient care experience.
Integration of telehealth technologies into a broad spectrum of offerings such as acute care, chronic care management, remote monitoring, social management, employee and employer-based services with a business model that supports this is essential. The technical platforms have to evolve to become flexible and yet integrated into existing EMRs to minimize friction, understand the patient experience and be UX design-centric.
Audrius Polikaitis, CIO and assistant vice president of health information technology, UI Health (Chicago): The pandemic presented a break-out moment for telehealth. Wholesale adoption of virtual care was no longer a choice, but a necessity. Debates on the merits, challenges and risks of telehealth quickly ended, and the discussion instantly shifted to how quickly can we all stand up a platform. As has been discussed in many forums, continuing reimbursement for healthcare services delivered via telehealth will fundamentally be the key driver of long-term adoption.
Over time as they age, the younger generations of patients (digital natives) will become the more frequent consumers of healthcare. For them, telehealth will be a natural extension and perhaps full replacement of in-person healthcare visits. Thus, the long-term future of virtual care is quite optimistic.
However, for now, the older consumers of healthcare services come from a generation to whom this is all very new. They are challenged with the effective use of the mobile devices in their hands. We collectively need to find better strategies to assist our older patients with their most basic technology challenges, since this is a very real barrier to their successful use of telehealth services today.
Tom Gordon, senior vice president and CIO, Virtua Health (Marlton, N.J.): Telehealth during the pandemic was a great resource to make sure patient care continued and that patients had timely access to care. As it turns out many providers as well as patients have become accustomed to this new virtual environment and are now embracing this use of technology — even those who never obtained healthcare remotely before.
Even though telehealth rapidly gained adoption during the pandemic, we are now seeing adoption decline slightly as patients start to return to see their providers in person. That said, telehealth has now become a permanent and viable tool as we come out of this pandemic. To ensure telehealth remains a persistent model of healthcare delivery, it is important to focus on the issues that can make telehealth usage challenging in the current environment.
There are some complex issues that need to be addressed to stabilize and grow the telehealth function that include: improving the financial impact and reimbursement for remote care, better integration into a new improved clinical workflow that seamlessly integrates into the health system EMR, continued lowering of regulatory barriers that have prevented adoption in the past and a drive towards the provision of more care in the patient's home through a focus on hospital-at-home and integration of patient monitoring and care devices.
It is important that reimbursement continues to have improved financial impact to both providers and health systems. It is also imperative that the traditional way of delivering clinical care is reimagined to more seamlessly integrate multi-modal care delivery be it in the home, remotely or in the traditional hospital setting. Telehealth and remote patient monitoring tools need to be better integrated into EHR platforms and improve the "digital front door" into healthcare. This technology should be seamless to the patient, including "one click" to get to the provider and associated critical services and resources.
Additionally it is important that we support clinicians to learn a new “web-side manner” to support some of these new and modern workflows. Lastly, the regulatory challenges that still persist from the past need to be addressed to further embrace this new way of delivering care to avoid additional adoption issues.