Telehealth Is Working for Patients. But What About Doctors?
As the healthcare industry embraces telehealth, we must ensuring providers are not only on-board with digital transformation but also see their experience of care enhanced in the process. Doing so involves a number of key considerations and requirements: Providers must 1) take change management seriously; 2) Employ human-centered design; and 3) Enhance care team connection and coordination.
It has become almost cliché by now to note how Covid-19 has accelerated digital transformation in healthcare, with the number of Americans trying virtual care roughly doubling since the start of the pandemic. Although the pendulum has swung back in recent months – with in-person outpatient visits returning to pre-pandemic levels and some insurers pulling back on reimbursement – all indications are, as Seema Verma, the administrator of The Centers for Medicare and Medicaid Services (CMS), stated, that “the genie is out of the bottle on this one” and there’s no going back on telehealth.
Studies have consistently shown that consumer preference is behind much of this movement. In one recent consumer survey, 94% of people who sampled telehealth, in the form of synchronous virtual visits, for the first time during Covid reported satisfaction with the ease and convenience and expressed interest in other modes of virtual care, such as digital monitoring and at-home lab testing. In healthcare, however, it bears reminding that digital adoption is a two-way street, requiring the satisfaction and buy-in of providers as well as patients.
Well before the pandemic moved most of healthcare online — along with much of our social and work lives — many providers were already experiencing what neuroscientist Adam Gazzaley has called a “cognition crisis,” with excess screen time and corresponding information overload leading to digital fatigue and stress. In surveys fielded over the past few years, a third or more of physicians regularly report symptoms of burnout, while more than half say those symptoms have increased since the onset of the current public health crisis.
Although provider comfort and ease with telehealth has increased over the pandemic, many remain wary of virtual care and the potential for adding to their already weighty technological and administrative burdens. Note that that the last time we saw a massive digital acceleration in healthcare was the national drive for physician adoption of electronic health records (EHR), fueled by the HITECH Act’s $35 billion in incentives. While much good ultimately came from this push, the same EHRs that were meant to liberate doctors from the tyranny of paper instead emerged as the top cause of physician burnout.
As the healthcare industry looks to harness the current moment to advance digital innovation, we must tread carefully to avoid any replay of this scenario, ensuring providers are not only on-board with digital transformation but also see their experience of care enhanced in the process. Doing so involves a number of key considerations and requirements.
A recent review of research into telehealth adoption found that providers’ satisfaction was directly proportional to the degree of input they had in program design and rollout within their institutions. In my prior role overseeing the EHR Modernization Program at the Veterans Administration (VA), I learned first-hand the importance of investing in change management and engaging stakeholders as co-designers and champions of technology change. At an organization like the VA with approximately 400,000 employees, it was especially important to engage early and often and over-communicate with maximum transparency. Telehealth adoption will require a comparable level of engagement and will be more likely to succeed if it is “pulled” into organizations and workflows by providers rather than “pushed” on them by leadership.
Providers also need ongoing support and digital immersion training not only to seamlessly integrate new tools and modalities into their practice but to recognize and mitigate digital fatigue and burnout in the process. While basic two-way video consults, for example, may on the surface appear to be simple and straightforward to master, they are in other respects like a new language demanding different clinical and communication skills. As one new-to-digital pediatrician conveyed, “I am learning to listen for when it is my turn to speak, to diagnose rashes on a phone screen, to identify emotions from words and tone as much as from facial expressions.”
The EHR technology that’s still standard in many hospitals and practices was rarely designed with the provider in mind, let alone the patient. When providers use these EHRs, more often than not their attention is directed less at the patient in front of them than at the screens and form fields they must click through. In one study using eye pupil data to register digital fatigue, over a third of physicians in an ICU experienced fatigue in just the first minute of EHR use. While most telehealth takes place over newer cloud-based platforms designed with more modern, human-centered experience standards, the potential to add to fatigue and digital overload remains.
As the flow of data from virtual visits, remote monitoring devices, and wearables increases, we must be sure providers don’t shoulder the cognitive burden of swiveling among even more screens and data feeds to manage patient care. It’s critical for data to be brought together on a unifying platform, where providers and staff have a “single pane” view of the patient journey. (My company, Salesforce, has developed and implemented such platforms to provider organizations.) Artificial intelligence, machine learning, and voice technologies play crucial roles in reducing documentation burden by quickly filtering and surfacing the most useful and relevant data for understanding the patient story and delivering the right care.
Healthcare is increasingly team-based, especially with the shift toward value-based care. Care coordination, enabled by seamless data sharing, is therefore as important to the provider experience as it is to care quality and outcomes. Virtual care platforms tend to be purpose-built for team-based care, reducing the burden on the provider by making it easier to distribute and coordinate care among nurses, care managers, and other clinical staff.
These platforms also open up the potential for greater collaboration with specialists across geographies. For example, Dartmouth-Hitchcock Medical Center’s telemedicine platform allows their providers in rural regional hospitals to do virtual consults with specialists such as neurologists available only at the main medical center without having to transfer critically injured patients. This is not only better for patients but helps relieve stress on the referring provider by giving them a sense of control and connection to a broader team.
While most of the recent growth in telehealth has been around virtual visits, its potential lies in connecting longitudinal data across the entire consumer journey — from wearables and remote monitoring devices and self-care apps to the EHR as the record of care. Through platforms like Livongo and Omada Health, which offer digital health management of chronic conditions, patients digitally monitor and manage diabetes and other conditions from the comfort — and, in the age of Covid, safety – of their homes. When a provider does need to see their patient, virtually or in-person, they now have access to a wealth of longitudinal information, from biometric data to blood pressure readings and diet regime, giving them a much richer picture of what happened since the last visit to inform and personalize ongoing care.
The recent acceleration of telehealth is a welcome kick in the pants to an industry notoriously resistant to change. The benefits to consumers are already evident: greater access and convenience, and more control and empowerment through self-care. Through thoughtful engagement and co-design of programs – and by learning lessons from past failures – health systems and their telehealth partners can work together to ensure providers benefit equally and see their quality and experience of care elevated as a result.
Telehealth Is Working for Patients. But What About Doctors?
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