How to make telehealth services easier—and more accessible—for everyone

However, the ultimate success of telemedicine will depend in large part on the technology — how smoothly patients will find the process, and the digital divide that currently prevents many doctors from offering telemedicine services and patients accessing them — and whether doctors overcome their resistance not being able to lay hands on patients during the exam.

Here’s a look at how some healthcare providers are facilitating the use of telemedicine, and what challenges remain.

Before the visit

Doctors and hospitals have come a long way since the pandemic began, when patients and providers struggled to schedule appointments using Zoom and other video conferencing services. In a recent survey by the consulting firm McKinsey & Co., only 9% of patients who reported negative aspects of an online doctor visit cited technical difficulties as the cause.

Physicians at Texas Children’s Hospital in Houston make more than 14,000 video visits a month, and fewer than 300 fail due to technical errors. Families with telemedicine appointments will receive visit reminders via email and SMS days in advance, which will include video and written instructions in English and Spanish, and the helpdesk phone number. There is also an option to test the audio and video connection. If a connection is of poor quality, the family will be directed to call the hospital helpdesk.

Johns Hopkins Medicine also sees preparation as key to a successful appointment. With so many patients waiting just minutes before an appointment to check in, “there is very little time to identify and resolve technical issues, which reinforces the need to find a way to be a little forward-thinking,” says Brian Hasselfeld, medical director for digital health and telemedicine at Johns Hopkins Medicine in Baltimore.

In response, researchers at Johns Hopkins developed a tool that attempts to identify patients at risk of not being able to complete a video visit. The tool checks if they have an active account on the portal, have completed the online check-in process and recently had a video visit or just a phone visit. If warning signs are spotted, staff can reach out via text, email, or phone to offer assistance before the appointment.

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Inside the portal

Making portals easier to navigate is another major focus of telemedicine. At the beginning of the pandemic, many portals required patients to use a unique link and password for each virtual visit, and some required downloading new software. Now many use a much simpler interface. You use the same credentials every time, after that you can see a list of your doctors and appointments. Click on your appointment and start your visit.

“We found that cognitive overload for patients is high,” said Lee Schwamm, vice president of digital patient experience and virtual care at Boston-based Mass General Brigham. “It’s exhausting, an email, a link, and a password when preparing for an appointment with your doctor.”

Some portals are also trying to make their virtual waiting rooms more patient-friendly. Myra Davis, chief innovation officer at Texas Children’s, says his patients are greeted by a real employee as they enter the virtual waiting room. The hospital system is also trying to make it easier for staff to chat with patients and offer them a call back if the doctor is late.

“Patients tolerate less waiting when they are at home,” said Robert H. Ball, medical director for e-health at Texas Children’s Hospital.

digital divide

While well-funded academic medical centers have invested heavily in hardware, software, helpdesk staff, and social justice initiatives, smaller practices with fewer resources are falling behind when it comes to telemedicine delivery. In a 2021 McKinsey Physician Survey, 45% of physicians surveyed said they had invested in telemedicine during the pandemic, and 41% said they had the technology to seamlessly deliver telemedicine.

“The impetus is tremendous to implement this technology,” says Dr. Ball.

Health systems aim to increase access to telemedicine for disadvantaged groups such as non-white, poor and rural patients. Mass General Brigham’s patient portal is now available in six languages. At clinics in underserved neighborhoods around Boston, a bilingual coordinator encourages patients to register for the portal and teaches them how to navigate the portal and participate in virtual doctor visits. For those without devices, navigators have 2,000 cellular-enabled iPads to borrow. And for those who have a device but poor internet connection, there are plans for coordinators to lend mobile hotspots, devices that would provide cellular-based internet service to a patient’s home.

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The University of Kansas Health System makes some tablets and hotspots available to patients on limited incomes. It also works with rural hospitals to provide rooms with devices and internet access that patients can use to connect with specialist doctors in Kansas City. While some patients own personal electronic devices, the data a virtual appointment can consume could strain their budget, says Jason Grundstrom, the healthcare system’s executive director of continuum of care.

Another issue holding some patients back is a lack of confidence in the process, particularly for patients who haven’t had a telemedicine appointment, says Kristin Rising, director of the Center for Connected Care at Jefferson Health in Philadelphia.

dr Rising says she and her team are working to reach out to patients who would benefit from education and outreach related to telemedicine. “Telemedicine is more accessible for patients and faster to care,” she says. “But the problem is getting people to understand that.”

doctor skepticism

Doctors themselves have some concerns about telemedicine. About two-thirds of physicians surveyed in a McKinsey & Co. survey released earlier this year identified shortcomings in telemedicine that make it difficult for them to do their jobs effectively.

Her biggest criticism: the lack of a physical exam. “There are some conditions where I need a physical exam to make a decision about a patient’s treatment,” said Keith Sale, vice president of ambulatory services at the University of Kansas Health System.

Collecting laboratory samples can also be a challenge. Asking a patient on a virtual visit to go to a nearby lab for a test is much less likely to produce quick and satisfactory results than collecting the sample during an in-office visit.

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Physicians also worry about the future of telemedicine reimbursement. According to research from the Center for Connected Health Policy, only 21 states require commercial insurers to cover telemedicine visits at the same rate as in-person visits.

During the pandemic, the Centers for Medicare and Medicaid Services have relaxed coverage requirements for telemedicine visits and established payment parity for in-person, video, and phone visits. Most commercial insurers did the same. Some of the pandemic-related CMS exemptions expire on October 13, but Congress extended most exemptions through March.

At that point, CMS coverage of telemedicine for traditional Medicare beneficiaries will return to pre-pandemic rules, with some exceptions, unless there is another extension by Congress. Care will again be limited primarily to patients in rural areas, and providers such as physiotherapists and audiologists will be excluded. CMS no longer covers phone visits except for mental and behavioral health, and its reimbursement rate could be lower for telemedicine than for in-person visits. Commercial insurers will make their own coverage decisions, and states will do the same for Medicaid.

On the plus side for doctors, virtual visits have a lower cancellation rate and a doctor can see more patients in the same amount of time.

“There’s going to be, I think, a core of 20% to 25% of the visits that really don’t need to be done in person and probably shouldn’t be… and there will be patient demand for that,” says Dr. Sponge “Covid taught me that we can never be without this ability again.”

This story was published from a wire agency feed with no changes to the text

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