The second meeting of What’s Next was another lively and informative discussion of what people are experiencing related to the Covid-19 pandemic and what we are likely to see moving forward. The participants were from a diverse cross section of society including nurses, physicians, social worker, and several folks from outside of healthcare including an academic administrator, and human rights lobbyist. Also, there were two guest speakers for this session which focused on Virtual healthcare delivery via Telehealth/Telemedicine. Some of the key themes related to Telehealth/Telemedicine advantages, barriers/obstacles, and potential solutions were presented:
EVOLUTION OF TELEHEALTH/TELEMEDICINE
Though the term Telemedicine and Telehealth are used interchangeably the main difference is, Telemedicine has a narrower focus on the curative aspect and Telehealth encompasses the preventative, promotive, as well as the curative aspects (Van Dyk, 2014). In this article, we use the term Telehealth. Telehealth encompasses various technologies to support healthcare delivery from a distance rather than face-to-face care by providing patients better access to healthcare professionals. The Covid-19 Pandemic has elevated Telehealth to an essential tool for delivery of care while adhering to the guidelines for physical isolation.
The technology to provide Telehealth has been available for over 20 years, however its use has been sporadic mainly due to lack of a standard platform that supports interoperability of various systems, multiple communication devices, and data integration across the continuum of care.
A lack of platform integration interrupts the continuity of care. For example, if a patient receives Telehealth services from one service provider but chooses another provider for their next e-visit, then the second physician may not have all the information they need to diagnose the patient’s problem. Although there is continuous advancement in the usage of electronic medical records (EMR) by hospitals and providers, if the EMR system does not coordinate with the platform you are using to provide Telehealth services, you likely will complicate your workflow records.
By using a Telehealth platform that integrates with the hospital/practice EMR, organizations can leverage the established workflows and ensure that the patients’ Telehealth visits are properly documented and updated for future visits.
Reimbursement is one of the key determinants in accelerating the use of Telehealth services. The reimbursement transformation towards value-based payment model that provides incentives for care delivery in the lowest-cost care settings, the identification of and interaction with high-risk persons before disease onset, and the efficient use of integrated care teams all provide incentives for Telehealth growth.
There are financial impacts as Telehealth can be significantly cheaper than face-to-face care in outpatient locations and the Emergency Department (ED). Who gets to realize those savings: the hospital, the insurance company, or the consumer? As was discussed in the first session of What’s Next, the various stakeholders may shift their argument about Telehealth to achieve the results they desire. Ultimately, the decision is likely to be determined by consumers including the patients and businesses that purchase insurance policies based on their employee’s desires.
However, depending on the decision insurance companies and policy makers make regarding reimbursement, hospitals may go back to seeing patient’s face-to-face if it makes more sense economically. Early studies indicate in general consumers like Telehealth, especially younger patients, who like the convenience, and elderly patients who want to avoid crowded waiting rooms where the risk of Covid-19 is high.
People are growing fatigued with the pandemic situation and are becoming increasingly concerned about their personal safety. Telehealth is not only convenient but also reduces the risk of exposure to Covid-19 by avoiding travel and being in busy reception areas. People who frequently access the healthcare system may manifest the most grieving reaction (Kubler-Ross & Byock, 2014) going through denial, anger, bargaining, until they finally reach acceptance. Vulnerable groups (the poor, Native Americans, Nursing Home residents, people with behavioral health issues, and underrepresented minorities) have an increasing risk of not being able to use Telehealth because of lack of access to technology.
One of the analogies that is often used to describe change theory is, the horse is out of the barn. The pandemic has forced us to use Telehealth and providers and patients may not want to go back to the way things were. (Senge, 2006) suggested there is a dynamic tension between the current reality and vision for the future. The ending of the current reality is a bigger step in terms of change than the allure of the new product or system (Bridges, 2004).
Front-line workers are consumed with tasks at hand and day-to-day challenges, which often translates to keeping systems status quo. Telehealth is a higher order approach (Carpenito-Moyet, 2003) requiring discussions and planning for the changing future. (Kuhn, 2014) suggested people will resist change the closer they are tied to the history, or current reality. Thus, the younger generation who are more technically savvy and have less history of accessing healthcare are likely to embrace Telehealth.
One of the interesting unintended consequences of the federal government’s resistance to address the pandemic as a nation is that it has forced states and local governments to address the problems, resulting in the emergence of innovative solutions including Telehealth. (Bridges, 2004) suggested the turmoil of massive changes, creates a ripe environment for innovation as bureaucratic rules are not in place yet to oppose innovation.
Clinician’s license portability and interstate licensure a key building block to the scalability of Telehealth programs. To tackle Covid-19 situation, state officials have taken a number of emergency actions to ease the rules on Telehealth, including allowing out-of-state providers to treat residents and in-state providers to treat those in other states. But we need standardized rules and regulations for Telehealth programs across the nation on a permanent basis to avoid malpractice concerns for clinicians regarding different liability laws, statutes of limitations, standards of care or damage caps, and medication prescription across state lines.
One important goal for the early adopters of Telehealth must be to educate legislators to the importance of creating laws that are user friendly to Telehealth. For instance, most metrics today are based on hands-on encounters. How do we get legislators and insurance companies to alter the metrics to view Telehealth as a legitimate medical intervention? Research is also needed to prove that outcomes with Telehealth are as good or better than face-to-face encounters. Consequently, that may be offset by special interests’ groups who may benefit from Telehealth not expanding.
FUTURE OF TELEHEALTH
Telehealth has probably reached the tipping point (Gladwell, 2014) and is here to stay. There probably is no going back to the way things were. Unfortunately, Telehealth is another technology that was thrown at people as a temporary fix, although there are certain diagnoses such as emergency stroke care where Telehealth is already state of the art. Telehealth has also become standard practice in rural area where shortages of providers exist, Behavioral Health, Radiology, and in ICU’s on the off shifts. There is some pushback around Telehealth because of the lack to attention to orienting staff and consumers. Work will need to be done around the logistics, finances, and existing rules for the use of Telehealth. Higher education must look at orienting future clinicians to the use of Telehealth as it becomes more of a standard practice.
“Keeping the patients where they are” is the key advantage of using Telehealth – this provides an opportunity for the clinicians’ to see a patient in their home environment, where unique challenges or enhancements to care may exist. In general, it is often cheaper to care for patients at home, and it is less disruptive for the patient. Similarly, large university hospitals can care for patients at their home community hospital using Telehealth, rather than making costly and risky transfers to larger hospital.
There are likely to be secondary innovations to enhance the use of Telehealth such as new applications for smartphones, computers, and wearable sensors with wireless monitoring capabilities to ease access to Telehealth; expansion of clinicians who can come into the home and take vital signs, draw blood, or administer minor procedures.
Bridges, W. (2004). Transitions: Making Sense of Life's Changes, Revised 25th Anniversary Edition. Cambridge, MA: Da Capo Press.
Carpenito-Moyet, L. J. (2003). Maslow's hierarchy of needs-revisited. Nursing Forum, 38(2), 3-4.
Gladwell, M. (2014). The Tipping Point. New York, NY: Time Warner.
Kubler-Ross, E., & Byock, I. (2014). On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and
Their Own Families. New York: Scribner Publishing.
Kuhn, T. S. (2012). The Structure of Scientific Revolution: 50th Anniversary Edition (4 ed.). Chicago: University of Chicago Press.
Senge, P. M. (2006). The fifth discipline the art & practice of the learning organization revised
edition. New York: Random House.
Van Dyk, L. (2014). A Review of Telehealth Service Implementation Frameworks. International
Journal of Environmental Research and Public Health, 11(2), 1279–1298.
ABOUT THE HOSTS
Saravana “Samy” Govindasamy is a success-driven, entrepreneurial leader with 20+ years of progressive experience in management, strategy, innovation, and technology consulting Samy has held executive leadership positions and spearheaded innovative enterprise-wide transformation programs/projects in excess of across the full continuum of care for medium and big health systems by establishing PMO/innovation centers using design thinking and agile methodologies.
Samy also possesses Big 4 consulting experience. Throughout his consulting career, Samy has built a reputation for achieving bottom line results, effectively aligning business and technology needs, and leading and developing high-performance teams for Fortune 50 global organizations.
Samy’s educational background includes a Doctorate in Business Administration, Fox School of Business, Temple University, Philadelphia, USA, Master of Business Administration, and a Bachelor of Engineering. Samy holds Project Management Professional (PMP) and Lean Six Sigma in Healthcare certifications.
Samy has published papers in refereed journals and has delivered professional speaking engagements in the areas of healthcare innovations, strategy, operations management, project/program management and process improvement.
Michael Grossman has been a nursing leader for over 40 years in a variety of clinical settings. Grossman is certified as a Nurse Executive Advance-Board Certified (NEA-BC) and Nurse Manager Leader (CNML). He has worked in a variety of roles including staff nurse, clinical nurse specialist, manager, director, coordinator of leadership development, and nurse entrepreneur.
Grossman is a frequent national speaker on a variety of topics including leadership, change, quality improvement, teamwork, and working with emotionally difficult patients and families.
Grossman earned his doctoral degree in management of organizational leadership from the University of Phoenix. He is a graduate of Widener University where he received his BSN and MSN in Emergency and Critical Care nursing. He also has a BA from Temple University in Psychology.