By David Nickelson, PsyD, JD
No sector has been more affected by COVID-19 than healthcare. Patients, providers and those who create telehealth platforms are scrambling to find ways to help and protect one another that respect the revised Centers for Disease Control and Prevention (CDC) guidelines for testing, treatment and social distancing. In only a few short weeks, telehealth adoption has reached, and moved well past, a tipping point. Many predict we are not going back to the way things “used to be.” At Nerdery, the health systems and health insurers that we support are reaching out almost daily to ask, “How can I quickly provide patients and providers high quality telemedicine visits that seamlessly connect with my clinical, financial and administrative platforms?”
Prior to COVID-19, telehealth use by patients, providers and health systems was steadily increasing; now, as the nation works to “flatten the curve” of infection through social distancing, demand by both patients and providers is reaching unprecedented levels, both here and abroad. Doxy.me, an online telehealth platform provider offering a free, secure telehealth platform for individual clinicians, saw registrations skyrocket from 2,500 per month to 2,500 per hour this week, leading to scattered connectivity problems and decreased video quality. An IT leader at a major health system that is partnered with one of the largest commercial telehealth platforms reports that they are asking their vendor to double their capacity in the next 30 days. Two public health experts, writing in the New England Journal of Medicine last week, noted that telemedicine is “virtually perfect” for both patients and providers dealing with COVID and should lead to broader integration of telehealth into general practice, public health and disaster response. The federal government, in response to CDC recommendations, dramatically expanded the range of services and providers eligible for Medicare telehealth reimbursement, and if the past predicts the future, nearly all commercial insurance providers will quickly follow.
Nerdery predicts these factors will lead to widespread lasting health system adoption and deep integration of telemedicine into both primary and specialty care workflows. The time for health systems and health insurers to act is now. And it’s not just telemedicine or telehealth platforms; we believe this demand for better integrated telehealth services signals a real, concrete start to the much needed digital transformation of healthcare overall. This brave new world creates opportunities for both more and less experienced organizations to use the current momentum to leapfrog forward. To be successful with telemedicine, we suggest focusing on three key areas:
Current leading telehealth platform providers vary widely in their technologies, business models and level of integration with existing health system technology stacks. Less mature health systems have an advantage here, as they are not yet tied to a specific vendor, leaving them open to evaluating which platform will best integrate into their long-term strategy, brand experience, data capabilities and technology stack. Most leading platforms are still privately held, and may not have access to the capital required to scale quickly. This creates promising partnership and investment opportunities for health systems with venture arms or immediate access to capital to co-create and go-to-market together.
In contrast to nearly every other industry, the health sector continues to lag in the adoption of cloud strategies and technologies. The telehealth sector is an exception, and in this case, the exception that may prove the rule. The telehealth platform providers who are successfully managing current demand are the ones that have strong cloud hosting partners who ensure they can quickly scale to meet demand without compromising safety, security and the patient-provider relationship. The way this sector has mastered the technological, legal and regulatory challenges inherent in providing direct services via digital should encourage every health system to develop their own long-term cloud adoption roadmap and strategy.
Patient and Provider Experience
The “consumerization” of healthcare is no longer a trend; it’s a fact. Patients now expect to have the same kind of experience with selecting, scheduling and seeing a healthcare provider as they do with ordering a ride-share or takeout food delivery. While they need to move quickly to meet demand and support their patients, providers and communities during this time, health system leaders should consider how and where telehealth services can deliver on their brand promise at key touch points along both the outpatient and inpatient journeys. Example touchpoints include disease-specific content search, check-in, admissions, discharge and remote/home care.
For example, patients with COVID-19-related concerns who want to avoid potential exposure at or overburdening a clinic or emergency room should be able to easily find your telehealth services, schedule a visit, pay for the visit and access test results seamlessly. Providers should have a mirror-image experience: low-friction access to the platform, easy-to-use technology and tools, seamless integration with relevant Electronic Medical Records (EMR) and support services to ensure care coordination (e.g., teleradiology, telemental health, telepathology, etc.). Health systems that can deliver this kind of experience via telehealth — and across their physical and digital channels — will be most likely to succeed.
Data-Integration and Interoperability
The leading platforms also differ in their ability to read, write, collect and analyze patient data before, during and after a telehealth visit, and have made telehealth interoperability a key issue for the American Telemedicine Association. Telehealth systems that are stand-alone, or that can only write into an EMR, are unable to provide the level of personalization that patients need and demand. For example, in a time of scarce resources, knowing that a patient has a chronic condition like diabetes or COPD — or has a history of pneumonia or other respiratory disease — can help with deciding who is the best provider for them to see, and whether testing may be required or discretionary. This can do more than increase convenience; it can literally save lives.
Thankfully, one of the key barriers to health data interoperability was recently addressed by the Centers for Medicare & Medicaid Services (CMS). The Interoperability and Patient Access final rule (CMS-9115-F) is a significant step forward for patients who are demanding the safe, secure and appropriate exchange of their health data between payers, providers and the many mostly proprietary Electronic Health Record (EHR) vendors. It requires all CMS-regulated payers (Medicare, Medicaid, etc.) to implement, maintain and make freely available a series of secure, standards-based (HL7 FHIR Release 4.0.1) Patient, Provider Directory and Payer-to-Payer APIs that will greatly enhance the ability of third-party application developers — including telehealth platform providers — to connect with previously proprietary data sets and develop personalized, innovative solutions that can better integrate with current and future health system digital ecosystems. While still too early to predict the full impact of this important rule, it clearly paves a way for the existing telehealth platforms to improve data exchange and the patient experience on behalf of patients, health systems and payers.
The immediate focus for any health system must remain the same as it has always been: care for patients, provide a safe place for providers to practice their craft, and improve the quality of life in the communities they serve. Luckily, some things really never do change; in just the past few weeks, the examples of individual physicians, nurses, clinics and hospitals doing just these things to combat this pandemic has been nothing short of astonishing (and frankly, inspiring). What’s become clear, however -- also in only a few short weeks -- is that going forward, the lens that both consumers and providers will look through when evaluating care options will have a distinctly digital filter, and will be expecting to find an even more highly integrated and connected picture of care.
Published on 03.20.20