Telehealth – A Missed Opportunity?

The doctor’s office waiting room is an age-old concept. We have waiting rooms because patients need to arrive early to ensure that the clinic runs on time and at near-full capacity. But clinics rarely run to schedule, so we end up wasting lots of time queuing to see a scarce, expert resource - the doctor.

So, why have waiting rooms at all? The honest answer is that doctors paid for visits in time-based chunks need patients to see them, and we need somewhere to put those patients whilst they wait. It’s simple, and as long as we keep paying for this model of care, the waiting room won’t be going anywhere.

But our payment models are indeed changing. In light of COVID-19, telehealth reimbursement models have exploded, and membership-based direct primary care models are enabling virtual care delivery that doesn’t require patients to drive to appointments and sit in a waiting room. Though it has taken a global pandemic to institute change, the industry is starting to see transformations that have been much needed – and long overdue.

The Rise of Virtual Care Has the Potential to Transform Care Delivery

In addition to eliminating the waiting room, the rise of telehealth – and the virtual care technology solutions that come with it – is also opening the door to several other healthcare delivery transformations.

Take, for instance, the way that doctors diagnose their patients. Today, doctors are asked to see and manage patients with little or no upfront context as patients can book themselves in with whomever they like without any kind of long-standing relationship. This lack of patient context can result in doctors managing each patient slightly differently and, with their own version of best practice having evolved over time without benchmarking, can result in markedly different management outcomes and even diagnostic processes.

Because doctors use a combination of experience and protocol to arrive at decisions, the time they invest per patient can vary widely, especially when they start from scratch every time. Patients often don’t have the opportunity to provide adequate context for their visit, so they will steer the doctor towards their perceived problems rather than their actual problems – disambiguating this is all part of the skill of being a trained medical professional. Equally, given the perception by patients that their medical experience is a service they are paying for rather than anything else, it is hard even for trained medical professionals to avoid the need to give the patient what they want, rather than what they need, particularly if the economic incentives are for volume of care performed not value of care delivered.

So, perhaps a way to begin to resolve this is to use technology to learn more about a patient upfront, even before the appointment is scheduled. This would ensure the patient sees the correct clinician and the visit is focused on their precise needs. Further, we could use this same technology to assist clinicians in their decision-making process by ensuring a consistent approach to the intake process that allows us to ask structured questions to include or exclude certain information, well before the visit itself takes place, providing for a more meaningful conversation face to face, whether in person or virtual.

Layering this structure into the normal care process, we already see the possibilities from the rapid introduction of remote visits that can be used to triage patients in a standardized form, probably with nurses assessing suitability. These sorts of models will be particularly beneficial in primary care where doctors are stretched thin.

As we start to look at models such as these, it is the hybridization of virtual and physical care that yields the most interesting opportunities for the future. We all believe that we don’t have enough PCPs to meet demand in the US today, but what if the model of care were different and much of the health maintenance were performed in this proactive, remote model instead? What would the demand on PCPs look like then? In the UK since March of this year, all PCP appointments are now preceded by a tele-triage call to determine if a doctor actually has to be involved at all. In many cases, this saves the patient time as they can be given simple guidance, or their medications renewed without taking up a precious visit. This change was made to keep COVID patients away from physical contact but it’s likely that it will remain a permanent change.

What is certain is that we can’t assume analog ways of working will persist in a digital first care model, and the journey towards a fully virtualized experience doesn’t have to be done in one step, but can be considered piece by piece, for example:

Gathering patient context over digital communication channels – even something as simple as an e-survey distributed through automated text messages, a form of communication that we are all familiar with already.

Algorithmically triaging patients, based on information in their EHR, as well as real-time information shared through digital communication.

Automatically directing patients to the right care setting to see the correct type of clinician and in the appropriate appointment format, whether face-to-face, by video, or by phone. The form of engagement that could consider any number of factors – not only the type of care they need and their risk status, but also things like their anxiety levels or engagement preferences.

Managing patients according to AI-based protocols to consistently ensure the right information has been collected.

This digitization of care models will happen – there’s no doubt about that – because the underlying technology is already available to us. The adoption of techniques like these will happen much faster than people think.

Refocusing Towards Virtual Care Operating Models

To make this change more permanent, a deeper redesign will ultimately be needed and though many leading healthcare institutions are industry mammoths that are slow to change, they are beginning to recognize that their culture and systems are not set up to deliver cohesive virtual care journeys. Many are bogged down in siloed units, focused on activity reimbursement rather than on efficiently solving patient care from start to finish. In other words, today, they are geared up to deliver transactional care.

To remain sustainable and competitive against new industry threats, healthcare institutions need to update their corporate “operating system” - the culture and processes they use to provide more context before, during, and after care episodes. This requires the automation, orchestration, and personalization of patient care journeys.

The recent leadership changes at Haven indicate how challenging it truly is to modernize healthcare. However, once-in-a-lifetime events like COVID-19 can be catalysts for radical new thinking and unprecedented change driven by technology.

The opportunity we have today is to not regress to old-fashioned analog care delivery models, but instead to leverage technology to deliver lean, contextual, and personalized care. If we embrace a “new, virtual normal,” we can design a more scalable, sustainable, and patient-centered care experience.

And hopefully one without a waiting room.

Robbie Hughes, founder and CEO of Lumeon.