Telehealth has unarguably become a ubiquitous part of the healthcare industry’s vernacular these days. For many, the past year has included a forced conversion of business processes and even business models. The medical community at large has been required to take a much more distanced approach to patient interaction. This paradigm shift has obviously not been without its inherent frustrations. There is no replacement for what can be learned sitting next to the patient, being in the same room, looking someone physically in the eyes, and listening to the tone in their voice as they explain presenting symptoms. Human interaction is undeniably integral to providing quality point of care.

While it certainly has been challenging, there have also been some surprising upsides to this emerging industry standard including increased operational efficiencies and reductions in overhead. So, as the total percentage of vaccinated adults continues to rise, and CDC guidelines continue to loosen, how can medical professionals be at the leading edge of telemedicine, providing the highest quality point of care possible? What does the optimal patient experience look like in the near future? How should we adapt our thinking about healthcare and the modalities by which it is delivered?

The Problem with Telehealth
As you know, or will certainly come to find out, there are as many definitions for Telehealth and Telemedicine as there are readers of this article. Telehealth software platforms and videoconferencing apps such as Zoom, or FaceTime have barged into medical practices requiring physicians and healthcare staff to figure out how to maintain a high level of care with the patient being beamed in from a different zip code. There has been a constant challenge to maintain patient privacy and HIPAA compliance as patient data started streaming through the cloud on a regular basis. Questions around billing codes and modifiers for reimbursements leave us in a cloud of confusion. But of more consequence than the technical, billing or compliance difficulties involved, the limitations in the actual diagnosis and treatment of patients are substantial and critical. Phone consultations and video calls can only provide so much diagnostic context. There is a great potential for patients to experience a reduced level of primary care when that point of care is delivered simply over the phone or the computer screen. The healthcare industry is running up against the limitation of telehealth when the presenting issue is less than obvious, or the real issue doesn’t visibly present itself at all. These limitations are real and must be dealt with. In performing market research on telehealth, I spoke to a Physician’s Assistant who’s own father’s legs had to be amputated after repeated telehealth visits and an inattentive facility staff failed to reveal significant bed sores and atrophy lurking under the covers. Professionals within the industry must find a way to bridge the gaps that remote health screenings have unintentionally created.

The Persistence of Telehealth
Despite this realization, video conferencing has become an ingrained part of how we as an entire society now communicate. The persistence of this medium of communication seems inevitable. We conduct business, keep in touch with friends and family, even celebrate holidays over the internet. More and more businesses are dumping the costs associated with brick-and-mortar offices and embracing the remote workforce. Patient populations are becoming more fragmented and isolated with an increasing hesitancy to wait in ER waiting rooms, doctor’s offices, and urgent care lobbies. This online, remote reality will only continue to expand. The telehealth market is rapidly expanding based on the explosion of demand that has remained well into 2021. This forces medical professionals to adapt more quickly than they might otherwise prefer to operate and accelerates the adoption of new technologies and business processes. Nevertheless, healthcare providers must understand the climate and environment within which they work and adapt to provide the highest quality of care possible given the circumstances.

Putting Medicine Back in Telemedicine
Almost everyone in healthcare is facing these tough decisions on how to structure the delivery of healthcare in this dawning era, but what is the best way forward? What will distinguish one provider from another in terms of quality of care within this new paradigm of practice?

Hybrid Patient Experiences.

As the dust settles on the pandemic in the U.S. the healthcare professional must combine personal, high-quality point-of-care with the advantages of telehealth technology to create the optimal environment for patient exams. These hybrid patient experiences will include a mix of solutions including medically assisted point-of-care, remote consultations, remote monitoring devices, wearable technologies, etc. Video conferencing alone is simply not a comprehensive diagnostic tool for the healthcare professional. Telehealth must remain a means of communication, not a tool for diagnosis. Thorough, in-person examinations by a nurse or medical assistant with remote professional support provided by a physician will lead to improved diagnosis, better patient care, and ultimately, increased patient satisfaction. While patients are leery of waiting rooms and large groups of random people, they are more likely to welcome a single, fully vaccinated medical professional into their home for one-on-one, personal medical care. There are many reasons why sometimes it is simply better to deliver healthcare outside of the hospital. Hospital at Home®, an in-home, acute care solution for elderly patients developed by Johns Hopkins University continues to grow in popularity and effectiveness and can serve as a model for the industry as a whole. Excerpted from the Johns Hopkins Solutions website, “Hospital at Home® is an innovative care model for adoption by health care organizations that provides hospital-level care in a patient’s home as a full substitute for acute hospital care. The program is being implemented at numerous sites around the United States by VA hospitals, health systems (including Presbyterian Health System), home care providers, and managed care programs as a tool to cost-effectively treat acutely ill older adults, while improving patient safety, quality, and satisfaction.”
This acute care model can be easily adapted for routine and diagnostic visits as well. Video from high-definition dermatoscopes can stream from the home to the clinic. High-quality audio from digital stethoscopes can be heard through headphones thousands of miles away. 12-Lead EKG readings can be transmitted in real-time and graphed on the doctor’s screen while a PA physically attends to the patient. Technology now allows a doctor’s black visiting bag to more closely resemble Marry Poppins’ carpet bag, full of tricks and treats. Don’t ask your patient to settle for a phone call when circumstances call for much more.

A Demanding Market
Hesitation to visit hospitals and doctor’s offices is not the only reason to seriously consider a hybrid patient experience model. Certainly, if overall business volume drops because the patient withdraws to the home, healthcare must go to the home. But the market is changing outside the influence of a pandemic as well. Think about it, we can already buy cars, get mortgages, write our wills, and have our groceries delivered online. In fact, we can have almost anything we want delivered to our houses in two days. On-demand consumerism is pervasive throughout our economy and has now found its way into medical offices and hospital systems. There is a growing expectation from society to consume healthcare in the medium and location of their choosing. And the emerging market of healthcare consumers won’t settle for less than stellar medical care. They will simply “swipe left” and find a more progressive physician.

With the rise in the number of remote workers and a boomer generation that is doing everything in their means to reside in their own homes for as long as possible, this home-based, medically assisted telemedicine model provides a healthy balance between service and safety, between efficiency and efficacy.

To be clear, there is no one model that addresses everybody’s use case. We must do the work of finding the right combination of tools to provide a level of care we are proud of, one that best serves the patient and leads to better health outcomes over time. As a community of healthcare professionals, we must be the leaders in an effort to put medicine back in telemedicine.

Bret Williams
CSI Health