Telehealth, telemedicine, and virtual care are often used interchangeably to describe remote healthcare visits. But virtual care means something much more than just telehealth or telemedicine. In fact, virtual care is in a category all its own. It is the logical, necessary next step in providing access to healthcare for all.
Telemedicine is Evolving
Remote monitoring and telehealth are nothing new. For decades, doctors have been able to monitor patients remotely or provide medical consults over the phone. Anxious parents have called in to 24-7 nurse hotlines to get advice about childhood illnesses and accidents. More recently, with the advancement of smart phones and web cams, new business models were created to connect patients with doctors over the internet.
However, most people still preferred to visit their doctors in person, and most doctors and healthcare centers weren’t considering a major shift to video any time soon.
Then COVID hit. It accelerated peoples’ desire for virtual healthcare visits and helped them feel more comfortable using video conferencing technology. Zoom, FaceTime, Google Meet and Skype became the go-to solutions for clinics large and small that didn’t yet have telehealth in place.
Video conferencing did good things for healthcare:
• Prevented even higher rates of delayed care
• Enabled providers to triage patients from a distance
• Gave quarantined providers a way to treat patients remotely
• Kept more clinics open and providers working
• Improved access to care for more patients
And while these video conference technologies solved an immediate problem, they quickly showed their limitations. These bandage solutions solved one issue while encountering (and even creating) many more problems.
Rapid expansion of video conferencing for healthcare exposed its weaknesses from HIPAA compliance issues, non-secure connections, the inability to bring a third party onto the call, wasted time as patients and/or doctors wait for the other party to join, limited number of users, concurrent calls, and call minutes and even the limited length of calls. The pandemic accelerated everything, even the “bad habits” of telemedicine.
An increasing number of entrepreneurs and innovators are tackling challenges in healthcare, but many of these solutions will never make it to market. It is critical to lay the right foundation by applying the principles of discovery and validation early in the process of innovation in healthcare technology.
Understanding the Basics of Discovery and Validation
Innovation thought leaders like Steve Blank have lauded the importance of discovery and validation. During the discovery phase, innovators gather data to substantiate market needs by talking to potential customers and other stakeholders. This data forms the first iteration of a business model.
Despite being informed by data, the business model also contains numerous assumptions. During validation, experiments are designed to test assumptions and reduce uncertainty. Often, experiments yield new insights and inform business model pivots while requiring innovators to conduct additional discovery. Innovators must collect enough data to feel confident about their assumptions without getting caught in an endless loop of testing.
This constant churn of trying to make sense of data helps get early stage healthcare innovations off the ground. For those in the healthcare field, the experience can be taxing. So-called “innovation fatigue” can set in fast, particularly for team members who don’t realize they’re embarking on a marathon instead of a sprint.
The pressures on healthcare organizations and employees make them even more susceptible to fatigue. Is it any wonder so many of them skip validation altogether? It might be tempting to make definitive decisions after an involved discovery excursion, but that won’t help stakeholders in the long run. Not testing after gathering insights can lead teams down an expensive road by building a solution and going to market prematurely.
Still, plenty of well-meaning healthcare innovators believe validation is not essential. Sometimes, it’s because they believe in the mythos of overnight success; they underestimate the time and resources required to explore and de-risk early stage opportunities, ultimately failing to anticipate the iterative nature of discovery and validation. Other times, they become overly confident in what they’ve seen and achieved during discovery and think no further iteration or learning is necessary.
To be sure, discovery gives healthcare innovation teams the knowledge to extract and shape a preliminary idea and begin to identify underlying risk quickly. Nevertheless, discovery alone means very little in practice. Validation is required if healthcare technology innovators really want to design experiments that will help resolve uncertainties, reduce risks, and pinpoint whether a hypothesized solution should persist, pivot, or perish.
Ultimately, organizations that lack a clear bridge from discovery to validation will see high-potential opportunities linger in their innovation pipelines. They never move because no one’s sure what to do with them. Eventually, these opportunities may fade away — meaning the healthcare system (and the people it serves) suffers.
The challenges and tragedies of the past year are well-known, but amidst the hardships of 2020 some hopeful signals have emerged in healthcare. Patients and the people and systems who care for them have been forced to do things differently this year, and many of these experiments will be with us to stay. These are some trends that will strengthen and take shape in 2021.
#1 Stakeholders embrace asynchronous
Payors, providers and other industry stakeholders who may have been reluctant to engage with async models in the past have been won over in 2020. The pandemic accelerated the understanding that async can safely and efficiently care for patients at scale. Providers who waded into async out of necessity during Covid have found that it allows for less rushed, more direct communication with patients that in many cases results in better care, while increasing provider flexibility and quality of life. Payors are realizing telehealth offers smart savings compared to legacy systems. State laws are coming along too — in May Maryland changed legislation allowing for asynchronous telemedicine to be accepted, and we expect more states to modernize in this way.
#2 Decrease of PCP as gatekeeper
Today’s young adults were already less likely than those of previous generations to have a primary care provider, and this trend will grow as PCPs close practices and people grow accustomed to a la carte care. Circumstances of 2020 have led people to get care formerly channeled through a primary provider directly, in a diverse array of settings. Covid swabs at drive-through clinics, flu shots at supermarket pharmacies, and prescription medications through telehealth, combined with increased utilization of home monitoring devices and wearables, have transformed patients (for better or worse) into their own care coordinators.
By John Danaher, MD, president, global clinical solutions, Elsevier.
John Danaher, MD
At the beginning of last year, we all had our own thoughts on how the year would unfold. However, a few months into 2020, we realized that the year would be quite different than we previously imagined because of the COVID-19 pandemic. With 2021 underway, we will continue to witness the digital transformation of the healthcare industry that was accelerated by the COVID-19 pandemic.
Clinicians were quick to embrace different types of innovative technology, such as telemedicine platforms and non-contact solutions to track patient vitals, that allowed them to provide patient care remotely. I believe that in 2021, we will continue to see an evolution of technology to assist clinicians and widespread adoption of digital health services. I also expect the industry will take key learnings with them as we move towards the future, such as the importance of building more trust in science and data.
Investments in AI are paying off
We have seen the impact of AI in the fight against COVID-19, specifically in the diagnosis and tracking of cases, predicting future outbreaks and assisting in selecting treatment plans.
I hope to see more infections decline as populations receive access to the COVID-19 vaccines and I see a renewed focus in how AI can help healthcare systems recover from the pandemic. Artificial Intelligence will be paramount in aiding many healthcare systems’ return to their regular operations as they were pre-pandemic. Artificial intelligence helps systems work faster to address the backlog of patient cases across other diseases and conditions that were postponed due to the pandemic, and deal with the financial strains caused by the virus. These tools can be used in revenue cycle management to assist with staffing, bed and device management, and provide a better understanding of patient utilization.
Artificial intelligence will continue to play a larger role as telemedicine tools and solutions rise in popularity.
Widespread use of telemedicine
One of the longest lasting effects of this pandemic is how clinicians have adjusted their delivery of care. The use of telemedicine applications is now a widely used practice, with the U.S. seeing an increase of 154% in telehealth visits in March 2020, compared to the same time period in 2019. There’s no doubt that the rise in the usage of telehealth services have benefited both healthcare providers and patients.
Mainly, the adoption of services has decreased the number of patients in medical offices seeking non-emergency care and ultimately minimizing the risk of exposure to COVID-19. While telemedicine will not replace in-person care, it will remain a necessity in 2021 and beyond. As patients are now more accustomed to the convenient delivery of care services, they will be more inclined to expect these remote services, along with other services, such as drive through testing sites and at-home delivery of prescription medications that do not require in-person visits.
Across the country, well over 100,000 Americans are currently hospitalized with COVID-19, and these numbers continue to climb along with rising positivity rates. Similar to the earliest days of the pandemic, this surge in patients is filling hospitals to capacity and beyond.
The resulting shortage of beds and clinicians threatens to compromise quality of patient care and even raise the specter of rationing care in some hard-hit communities.
Increasingly, hospitals are recognizing that telemedicine provides a powerful tool for stretching limited resources by preventing and better managing overcrowding.
Telemedicine can make a critical difference in three key ways:
Telemedicine enables rural hospitals to treat patients with complex needs, reducing or eliminating the need for transfers. For critical access hospitals without specialists such as cardiologists or pulmonologists on staff, managing patients with complex or high-risk medical needs – whether COVID-19 related or not – typically requires transferring them to a tertiary facility. By providing virtual access to experienced board-certified specialists as needed, telemedicine allows rural hospitals to diagnose and treat many of these patients right in their own facility.
For example, consider a patient admitted to a rural hospital presenting with elevated biomarker levels. Through telemedicine, a cardiologist can remotely evaluate whether the patient is having a heart attack or displaying COVID-related organ stress. The specialist can then collaborate with on-site care providers to determine if the patient can successfully be cared for internally.
Telemedicine can also play a valuable role in critical access facilities when patients admitted with COVID-19 begin to suffer increased respiratory stress. A pulmonologist can remotely evaluate whether intubation is required. If it is not, the specialist can also help continue to treat the patient safely in place, avoiding the need for transfer.
In addition, telemedicine can provide or supplement hospitalist services, including rounding and admission coverage, for rural hospitals. This capability stretches limited resources and supports local physicians’ ability to provide quality care for all patients in-house.
Remember Instagram’s “Ten Year Challenge”? When ‘grammars were posting pictures of themselves from a decade before, next to one from the present day? Now we’re seeing the “2020 Challenge” — and this time, it’s a picture from March next to a present day picture.
That said, it may seem like a gutsy move to make predictions for the healthcare industry after the year we’ve just had, but I’m a gutsy guy, so here goes:
Big tech, Big everything getting into healthcare. Or will they?
Telemedicine was the finger in the dyke at the beginning of pandemic panic, with healthcare providers grabbing whatever came to hand — encouraged by relaxed HIPAA regulations — to keep the dam from breaking. But as the dust settles, telemedicine is emerging as the commodity that it is, and value-add services are going to be the differentiating factors in an increasingly competitive marketplace. Offerings like remote patient monitoring and asynchronous communication, initially considered as “nice-to-haves,” are becoming standard offerings as healthcare providers see their value for continuous care beyond COVID.
By Dhaval Shah, senior vice president of medical technology, and Neha Vora, healthcare consultant of medical technology, CitiusTech
In the current COVID-19 disrupted world, telehealth has seen unprecedented growth in adoption, as it minimizes the risk of exposure and aligns with the concept of social distancing. This has made healthcare systems accelerate the adoption of these services and also rapidly scale their processes to address the growing need of virtual care, as opposed to in-person visits and services.
And the acceleration is anticipated to continue for the foreseeable future. According to a report by Global Market Insights, the telemedicine market is set to be valued at $175.5 billion by 2026.[1] Today, more than 50% of U.S. hospitals provide telehealth services in some form or other,[2] and to meet the anticipated market growth, many more hospitals will adopt telehealth in the coming years.
Increased demand for remote/virtual care combined with federal and state derestriction has provided the much-needed stimulus for health systems to fast track their digital transformation journey in this space. Studies predict that 30% of all care will be delivered virtually post-pandemic as people start to see telehealth as their first point of contact for urgent care needs.
This brings us to the real question that each healthcare system needs to ask: “Is the current telehealth strategy aligned for the post-COVID world – the new normal?”
By Adam Herbst, senior vice president, chief legal, compliance, planning and government relations officer for Blythedale Children’s Hospital and adjunct assistant professor, and Ira Bedzow, Ph.D., associate professor of medicine, New York Medical College.
We continue to see how states are responding to the multiple challenges that the COVID-19 pandemic presents – trying to ensure there is hospital capacity for patients, protective equipment for healthcare workers, money in the hands of the unemployed, and food in the mouths of those who are hungry. All these endeavors have been responsive, by which we mean that even when states are preparing for problems, state leaders are enacting temporary solutions with the hope to return to the status quo ante.
Yet there is one major area of healthcare that the pandemic is forcing state and health leaders to confront, which can fundamentally change healthcare delivery in the future – telemedicine. While telemedicine has begun to replace office visits to primary care physicians and in certain specialties, it can be a major disruptor for behavioral health, where changes made now could last long after the pandemic. That will be a good thing. It would allow healthcare to meet the increasing needs for behavioral health, both because of the pandemic and in general. It would also serve as a paradigm case for how healthcare can and should adapt to meet the economic, social, and technological needs and opportunities of the future.
Because of the pandemic, states have loosened regulatory requirements, such as HIPAA and other privacy protection measures, so that patients can access clinicians through Skype and Facetime. This has created access to conventional clinical care, such as diagnosis and monitoring, as well as patient education and wellness promotion, among other services.
Telehealth has also benefited from the easing of restrictions, but states can and should do more. For example, while states have suspended border restrictions for telehealth due to the pandemic, the suspension is temporary, like all other responses so far. But it shouldn’t be. Public officials and health leaders need to find ways to maintain the increased and flexible access to telehealth even after the pandemic, especially in behavioral health.
