I think technology’s always a barrier for both sides. Where I work at Mass General Brigham in Boston, we’ve just spent quite a bit of money to integrate Zoom into our electronic records so that, as a patient, you can request a virtual visit from our patient portal. As a doctor, you can pull up the patient’s chart and connect right into a virtual visit from the context of the electronic record. So that is very helpful to accelerate adoption, because having different apps, screens and software makes it harder for people to get their work done.
On the patient side, there’s going to be a small cohort of individuals who aren’t comfortable doing this. Often, they skew toward people who are quite old, around 80 or 90 years old, that age range. I mean, I’m 64, right? I’m not a digital native, but I’m quite comfortable using technology, as are most of the people in my demographic. So that’s less and less, but it’s there.
The bigger issue with patients and technology is affordability and inequity. Broadband is not universally available. We’re very keen to try to change that. And people sometimes can’t afford a data plan, even if they have access. They may or may not be able to afford a phone. Although most people do have a phone, that brings up another thing that we’re very proactive on, reimbursement for audio telehealth as a tool to bridge the digital divide.
HEALTHTECH: With many more people having experienced telehealth over the past year, do you think the perception that people don’t get the same quality of care through telehealth is fading?
KVEDAR: I do. During the lockdown phase from March through June 2020, the downside of that experience is that we kind of did everything that way. There were so many awkward moments where you really felt like the person should be in front of you in the office, but you couldn't bring them in. That didn’t help the phenomenon you’re speaking of. But I think now that people have experienced hybrid and healthcare organizations are getting more thoughtful about what they use telehealth for, clinicians are starting to steer patients in one direction or another more proactively. We’re starting to get a much better sense of using this tool for quality care.
HEALTHTECH: How can clinicians and healthcare organizations create more value for their organizations through telehealth?
KVEDAR: I think the watchword is integration — integration with the electronic record, but also integration with your general service delivery mode. Every other service you and I consume has a digital-first component, whether it’s telephone banking or setting up a reservation on OpenTable — the list goes on. We really must get ourselves to the point that when a consumer approaches us, they’re comfortable doing it first through a digital interface, and it’s not just an experiment or a new thing.
MORE FROM HEALTHTECH: How healthcare organizations can break down barriers to care.
We have to invest more in things like chatbots, symptom checkers and wayfinders. And then there’s remote monitoring, which is probably the next thing to pop now that we’ve learned the power and the limits of video visits. But for chronic illness management, you can have people use a device or two, and then collect data, look at their health and have that flow into an electronic record environment, or use it for them to motivate themselves to do better, the way people now measure their steps and their step counts. Things like this are really important and starting to catch on. There are reimbursement codes now to support remote patient monitoring. So that’s an important one as well.
HEALTHTECH: Is there anything else you would want to add about the future of telehealth or anything that ATA is doing to further adoption?
KVEDAR: Well, our priorities are certainly to use telehealth as a tool to bridge that digital divide, not create it or exacerbate it. And then the other big priority is regarding some of this policy activity. We want to simplify reimbursement and make sure there’s clear and consistent reimbursement. We didn’t really talk too much about state licensure, but that’s another barrier. And ATA’s view on that is that we should support regional compacts, that the national licensure is unrealistic, loosely, and probably not the right solution. I’m in Eastern Massachusetts. I see patients in person all the time from Rhode Island and New Hampshire, and the idea that they go home and I can’t do a telehealth call with them is absurd.
The slowest change is going to be licensure. The state medical boards are geographically based. They want to make sure the doctors in their state are high quality, and the only way they feel they can do that is to be geographically based. It’s a very long and difficult climb to get to the point where we’d have something that’s either regional or national.
Keep this page bookmarked for articles from the event. Follow us on Twitter @HealthTechMag as well as the official organization account, @AmericanTelemed, and join the conversation using the hashtags #ATA2021 and #GoTelehealth.