Since the COVID-19 pandemic, healthcare organizations have experienced a drastic shift in the way they serve their patients. A significant proportion of care has migrated to virtual models, offering clinicians and patients a convenient, efficient and costeffective way to deliver and receive care.
Department of Health and Human Services data show that Medicare visits conducted through telehealth increased about 63-fold in the pandemic’s first year, from approximately 840,000 visits in 2019 to more than 52 million in 2020. Telehealth services quickly became a popular and safe alternative to in-person appointments, with 46% of consumers using telehealth by May 2020 to replace canceled healthcare visits—up from 11% in 2019—according to McKinsey & Co.
In the coming years, telehealth is primed to remain an integral component of care delivery. An estimated $250 billion, or 20%, of all outpatient, clinic and home health spending by Medicare, Medicaid and commercial payers could be shifted to virtual care, McKinsey forecasts.
One clinician leader who has experienced the meteoric rise of telehealth utilization first-hand is Lee H. Schwamm, MD, an American Heart Association volunteer, chief digital advisor at Mass General Brigham (MGB) and director of the MGH Center for TeleHealth. The MGB organization conducted approximately 10,000 virtual visits in the year preceding March 2019, according to Dr. Schwamm. By the end of September 2020, that number rose to 1.8 million visits.
“You’d be surprised how you can modify the exam to conduct it remotely,” he said, explaining that contrary to what some might initially believe, even parts of a standard neurological exam can be readily accomplished via telehealth.
Advantages of telehealth
Flexible and widely available, telehealth is a promising catalyst for transformation in an industry bogged down by complexity and access barriers. It offers the potential to advance person-centered care, increase patient access and satisfaction, and therefore, improve clinical outcomes.
Along with driving benefits on the patient side, elevating care quality via telehealth can deliver greater satisfaction among care teams. By empowering clinicians to spend more time directly interacting with patients, virtual tools can help to address the pervasive burnout and dissatisfaction in the sector contributing to widespread labor shortages. For instance, virtual tools mitigate traditional barriers such as commuting and allow physicians to regain control over their scheduling.
“New clinicians coming into the field is what keeps medicine renewed, vital, exciting and engaging,” said Dr. Schwamm, who is also a professor of neurology at Harvard Medical School. “Focusing on our trainees, who are digital natives, is critical. They will bring knowledge of the changing world of technology with them, and this will bring tremendous insights.”
For healthcare organizations overall, the flexibility of telehealth services can aid with clinician recruitment and retention, while driving cost-saving efficiencies at scale. These advantages of telehealth utilization can have a profound impact on care quality and affordability.
To reap these benefits, however, a strong foundation is essential.
While February is American Heart Month, a time for putting a spotlight on cardiovascular health, regardless of specialty, “there are core principles that need to be applied when I’m talking to (patients through telehealth) and sharing information with them about their diagnosis, prognosis, course of treatment, or complications,” Dr. Schwamm said.
Telehealth guidance and education
The American Heart Association is offering this kind of guidance through research and analysis, having published a scientific statement that lays out telehealth-specific definitions, evaluates how telehealth utilization affects disease care, and outlines obstacles to telehealth adoption. The Association has additionally developed a digital learning and continuing education platform, the Intelligo Professional Education Hub™, featuring quality courses and training designed to advance clinical skills in ways that translate to better patient outcomes.
The resources are laying important groundwork for telehealth optimization, since the early days of the pandemic necessitated the abrupt uptake of telehealth services as opposed to the usual careful, well-planned integration.
“Now, we’re beyond the adoption point,” Dr. Schwamm said. “We have to go back and firm things up, make sure there are really strong and robust support systems in place.”
To get the most out of telehealth services, clinicians must approach the modality with an open mind and a hunger to learn. Rather than viewing telehealth as an entirely different kind of care delivery, they should consider telehealth to be a modern vehicle for delivering care—like a new surgical device.
If a physician were trained to do a procedure with a big, rigid tube, for instance, and then that device could be replaced by a tiny, flexible tube with a camera, the decision to use the new tool would have to weigh several criteria. Vital questions would include: When is it clinically appropriate to use the new device, how variable is the outcome based on the provider’s proficiency level, and who is qualified to teach clinicians the proper usage?
“I view telehealth in much the same way,” Dr. Schwamm explained. “Because it touches so many aspects of how we deliver care, it is complex to learn and master this new way of delivering care, and that requires a curriculum be built around it. We need common standards around competency and quality and a framework for evaluating the quality of care when delivered through digital means.”
Specifically, providers and health systems must understand how to define appropriateness and determine when care should be delivered in person. Just as hospitals require yearly health and safety training, they should ensure that providers are regularly reminded of the standards for telehealth.
The American Heart Association is working toward this aim with a certification for telehealth professionals slated to launch later this year.
“Having a certification benefits patients because it creates a set of uniform expectations around the safe practices of telehealth,” Dr. Schwamm said.
It can also help address concerns such as ensuring a patient’s identity is verified, that there’s no exchange of information that is violating privacy, and that encounters are structured so that physicians still have control of the environment.
Education and training will not only support the continued growth of telehealth, but also contribute to ongoing quality improvement using these services. Further, standardized training can garner trust among payers, establishing the buy-in necessary to appropriately reimburse telehealth services.
“When we have those systems in place, we have a much better dialogue with commercial and government payers, and we can start to build a framework around reimbursement,” Dr. Schwamm said. “That means that these services will be available long-term for patients and won't just disappear when the pandemic is over.”
A deliberate, science-driven approach
As a member of the physician advisory panel helping to design a telehealth certification for individual providers and professionals, Dr. Schwamm believes the American Heart Association is well-positioned to advance telehealth quality. This is because of the organization’s “secret sauce”—a mixture of patient centric focus, scientific approach, emphasis on equity, and inclusion of stakeholder input.
“They’re a convener that really understands the importance of process and knows how to build out programs and certifications,” Dr. Schwamm added. “A trusted third party like the American Heart Association that is not trying to drive the agenda in a specific direction is a very powerful stimulus for cooperation and collaboration.”
The Association has created a formula for facilitating constructive dialogue among various groups, gathering evidence, translating it into practice, and then helping hospitals benchmark against their peers and high performers. It takes an iterative approach to improving quality, which is well-suited for relatively new methods of care delivery like telehealth.
The feedback loop involves providing education, engaging with stakeholders, and then incorporating any learnings back into education— a process of ongoing refinement. Considering broadband access issues and threats to reimbursement for structured, audio-only visits, the American Heart Association’s emphasis on eradicating disparities is also essential as telehealth continues developing.
While specialty groups will ultimately take the lead on procedure-specific guidance, the American Heart Association’s creation of training, guidance, and eventually, certification will help providers confidently provide quality telehealth-enabled care.
Foundation for the future
“We're at the edge of a digital revolution in healthcare,” Dr. Schwamm said. “Artificial intelligence, machine learning algorithms, automation, remote patient monitoring, hospitalizations at home—these are no longer fantasies. These will be the reality for the next generation of doctors; they will practice in completely new and unimagined ways.”
Before these larger innovations can move healthcare forward, providers must master the technology already at play. Telehealth must be strategically integrated into care delivery rather than tacked on. Leveraging telehealth to make a positive impact starts with ongoing education, which the American Heart Association has demonstrated its expertise in providing.
“I’ve always been impressed with the American Heart Association for its leadership’s ability to understand where the puck will be and skate there,” Dr. Schwamm said, referring to the Intelligo Professional Education Hub™ and the new certification being refined for launch. “(Telehealth) is where the puck is headed.”
While the American Heart Association continues to create and share essential resources, it is imperative that healthcare providers commit to understanding and following best practices. They must also stay abreast of evolving standards to ensure that telehealth services only become more appropriate, relevant and equitable in practice.
This is no time to sit back. Once telehealth becomes fully ingrained in care delivery, those that haven’t mastered it might be at a significant competitive disadvantage.
“If you miss the digital bandwagon, you may never catch up,” Dr. Schwamm said. “This will be a really important new way that medicine is delivered. Healthcare executives need to start thinking about where the clinical care delivery puck is going, to make sure their clinicians fully understand this new care modality.”
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