How to make telehealth services easier and more accessible to all

But the ultimate success of telemedicine will depend largely on technology—how comfortable patients will find the process, and the digital divide that now prevents many physicians from accessing telehealth services and patients—and their resistance to doctors not being able to. will remove To lay hands on patients during examination.

This is how some healthcare providers are making telemedicine easier to use, and here’s a look at the challenges that remain.

before the trip

Doctors and hospitals have come a long way since the start of the pandemic, when patients and providers struggled to set up appointments using Zoom and other videoconferencing services. In a recent survey by consultant McKinsey & Company, only 9% of patients reporting on the negative aspects of online doctor visits cited technical difficulties as a reason.

Doctors at Texas Children’s Hospital in Houston do more than 14,000 video visits a month, and fewer than 300 fail due to technical glitches. Families with telehealth appointments receive visit reminders by email and text ahead of time that include video and written instructions in English and Spanish, and the help desk’s phone number. There is also an option to test audio and video connections. If the connection is substandard, the family is directed to call the help desk of the hospital.

Johns Hopkins Medicine also sees preparation as the key to ensuring a successful appointment. Because so many patients wait until minutes before an appointment to log in, “there’s little time to identify and resolve technical issues, which reinforces the need to try to find a way to be a little predictable.” does,” says Brian Haasfeld, medical director of digital health and telemedicine at Johns Hopkins Medicine in Baltimore.

In response, Johns Hopkins researchers developed a tool that tries to identify patients who are at risk of being unable to complete a video visit. The tool checks whether they have an active account in the portal, have completed the online check-in process, and have made recent video visits or only telephone visits. When warning signs are found, employees can be contacted by text, email, or telephone to offer assistance prior to placement.

inside the portal

Making portals easy to navigate is another big focus of telemedicine. At the start of the pandemic, many portals required patients to use a unique link and password for each virtual visit, and some required downloading new software. Now many use a much simpler interface. You use the same login information each time, after which you can view a list of your doctors and appointments. Click on your appointment, and start your journey.

“We realized there’s a lot of cognitive overload for patients,” says Lee Schwam, vice president of digital patient experience and virtual care at Boston-based Mass General Brigham. “It’s stressful to find an email, a link, and a password when you’re getting ready to visit your doctor.”

Some portals are also trying to make their virtual waiting rooms more patient-friendly. Texas Children’s chief innovation officer Myra Davis says its patients are greeted by a live staff member upon entering the virtual waiting room. The hospital system is trying to make it easier for a staff member to chat with patients and offer them a callback if the doctor is running late.

Robert H., medical director of e-Health at Texas Children’s Hospital. “Patients have a lower tolerance for waiting at home,” says Ball.

digital divide

While well-capitalized academic medical centers have invested heavily in hardware, software, help-desk staff and social-equity initiatives, smaller practices with fewer resources are falling behind when it comes to providing telemedicine. In the 2021 McKinsey Physicians Survey, 45% of doctors surveyed said they invested in telehealth during the pandemic, and 41% said they have the technology to seamlessly deliver telehealth.

“The lift is too large for this technology to be implemented,” says Dr. Ball.

The health system wants to increase access to telemedicine for disadvantaged groups such as non-white, poor and rural patients. Mass General Brigham’s Patient Portal is now available in six languages. At clinics in areas around Boston, a bilingual coordinator encourages patients to register for the portal and teaches them how to navigate the portal and participate in virtual therapy visits. For those without a device, the Navigator has 2,000 cellular-capable iPads to lend. And for those who have a device but a poor Internet connection, coordinators eventually plan to lend mobile hot spots, devices that will provide cellular-based Internet service to a patient’s home.

The University of Kansas Health System offers some tablets and hot spots for patients with limited income. It also partners with rural hospitals to provide rooms with equipment and Internet access that patients can use to connect with medical specialists in Kansas City. Jason Grundstrom, executive director of Continuity of Care in the Health System, says that although some patients may have personal electronic devices, the data they use to make virtual appointments can hit their budget.

Another issue holding some patients back is a lack of trust in the procedure, especially those patients who don’t have a telehealth appointment, says Kristin Rising, MD, director of the Center for Connected Care at Jefferson Health in Philadelphia.

Dr. Rising says he and his team are working on an effort targeting patients who would benefit from education and outreach related to telemedicine. “Telemedicine is more accessible to patients, and it’s quicker to provide care,” she says. “But the point is in getting people to understand this.”

doctor doubt

Physicians themselves have some concerns about telemedicine. Roughly two-thirds of doctors in a survey released by McKinsey & Company earlier this year identified deficiencies in telemedicine as making it difficult for them to do their jobs effectively.

His biggest criticism: The lack of a physical exam. “There are some situations where I need a physical exam to make decisions about patient care,” says Keith Sell, vice president of ambulatory services at the University of Kansas Health System.

Collecting laboratory samples can also be a challenge. Asking a patient to go to a nearby laboratory for testing in a virtual tour is far less certain to provide quick, satisfactory results than collecting a sample during an office visit.

Doctors also worry about the future of reimbursement for telemedicine. According to research from the Center for Connected Health Policy, only 21 states require commercial insurers to cover telemedicine visits at the same rate as in-person.

During the pandemic, the Centers for Medicare and Medicaid Services loosened coverage requirements for telemedicine visits and established payment parity for personal, video and telephone visits. Most commercial insurance companies do the same. Some CMS exceptions related to the pandemic are due to expire on October 13, but Congress extended most exceptions to March.

At that point, unless further expanded by Congress, CMS coverage of telemedicine for traditional Medicare recipients will revert to pre-pandemic rules, with a few exceptions. Coverage will once again be primarily limited to patients in rural areas, and providers such as physical therapists and audiologists will be excluded. CMS will no longer cover telephone visits except for mental and behavioral health, and its reimbursement rates for telemedicine may be lower than for in-person visits. Commercial insurers will make their own coverage decisions, and states will do the same for Medicaid.

On the plus side for doctors, cancellation rates are lower for virtual visits, and a doctor can see more patients at the same time.

Dr. Schwam says, “In my view, 20% to 25% of visits will be a core part of what really doesn’t need to be done in person and probably shouldn’t…and will be patiently sought for. ” “Covid has taught me that we can never be without this capability again.”

This story has been published without modification to the text from a wire agency feed

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