ATA2022: What Does the Future Hold for Virtual Care?

The Virtual Care Concerns ‘Keeping Physician Executives Up at Night’

In the panel discussion “What’s Keeping Physician Executives Up at Night: Powering the Future of Care Delivery and Ensuring Policy Doesn’t Stifle Innovation,” healthcare leaders explained their biggest virtual care concerns and overall healthcare issues and outlined needed change.

Denise Gonzales, medical director at Presbyterian Healthcare Services, said that while her organization is still conducting telemedicine visits, there are parts of New Mexico, where the health system is based, that don’t have a reliable broadband connection. Her major concern was how the industry can tackle the connectivity disparity to provide equitable care to communities that are underserved and lack access.

For Christina Chen, medical director at Bright.md, the rise in healthcare consumerism is a challenge the industry needs to be prepared to address.

LEARN MORE: ATA's Dr. Joseph Kvedar on the current telehealth landscape.

“It’s affecting the ability to retain patients. They’re not just patients anymore — they’re consumers. They want easy, accessible and timely care similar to what they receive in other aspects of their life,” she said. “Patient are going to direct-to-consumer offerings online. They don’t want to be on hold for 30 minutes, then on the phone with a person for 20 minutes to schedule an appointment that will take place two to three weeks from now. A typical in-person visit takes 121 minutes. Physicians had to think about how to compete with direct-to-consumer options first with low-acuity conditions, but now that includes complex and chronic conditions.”

Physician burnout and a shortage of providers are additional points of concern affecting all segments of healthcare. Chen said that it’s only getting worse. 

“How do we solve this problem? A lot of physicians will tell you technology and tools make their jobs harder, and that it takes longer,” she said. “We need to find ways to deploy technology to combat burnout and focus on things that don’t require a physician to do. We need them to focus on the hard stuff like clinician decision-making.”

She said if implemented correctly, digital tools can decrease physician anxiety. Finding ways to integrate the patchwork of tools implemented during the pandemic is key to mitigating burnout. 

Christina Chen, Medical Director at Bright.md; Lee Schwamm, Vice President of Digital Patient Experience and Virtual Care at Mass General Brigham; Denise Gonzales, Medical Director at Presbyterian Healthcare Services; and Timothy Andrews, Vice President at Booz Allen Hamilton, discuss their biggest concerns about the future of virtual care.

Lee Schwamm, vice president of digital patient experience and virtual care at Mass General Brigham and a professor of neurology at Harvard Medical School, said there’s tremendous pressure to get the most out of a singular platform, but that one overarching platform will never be as good as a platform designed for a specific need.

“We’re constantly trying to figure out what we can consolidate while still doing a good job,” he said.

WATCH NOW: Get the most out of virtual care technology.

What Schwamm said worries him most is that many people have a narrow definition of virtual care, defining it as a virtual visit when solutions such as remote patient monitoring are also encompassed within virtual care. He also said he fears healthcare isn’t pushing the boundaries. “We need to ask the bigger question: What do patients need and are there better ways to provide that?” he said. 

Schwamm used the example of a smoking car with a check engine light on to make the point that it doesn’t help just to tell someone what’s already happening — prevention is also important. 

“We need to tell patients in advance, and we don’t do a good job of that. Smartphones are ubiquitous. I think we have the infrastructure necessary to create this passive environment,” he said. “We can do with healthcare what we see with companies like Netflix and Uber: There’s a reason why when someone finishes the first episode the next one starts immediately. We need to do that with checking blood pressure, taking pills and scheduling visits. It makes me worry that we’re not being bold enough.”

Many people end up paying out of pocket at urgent care clinics because they can’t access their physicians in person when they need them. Having continuous digital access could help solve that problem, according to Schwamm.

READ MORE: Why health leaders still advocate for hospital-at-home care delivery.

However, Gonzales pointed out that healthcare is faced with the infrastructure and legislation of today, which prevents such bold moves. 

“The structure we work in, take CMS for example, needs to catch up. We need to document certain things a certain way for the transaction to go through, to be compensated and to continue to have a business,” she said.

Uncertainties around reimbursement are a major cause for concern across healthcare, Schwamm said. Healthcare organizations need to know they’ll be paid for telehealth services going forward. 

How to Create a More Integrated Healthcare System

Interoperability and integration have been goals of the healthcare system for years, but more needs to be done to improve efficiency for clinicians and healthcare organizations. That was the topic of discussion in the panel session “Telehealth’s Next Chapter: What Must We Do to Ensure an Integrated Future of Healthcare?”

Scott Simmons, healthcare lead at Poly Americas, emphasized that a single organization isn’t going to be able to develop technology that encompasses everything a healthcare organization needs in a way that works. He pointed to RESTful API web services to build together while having companies focus on what they do best.

Milton Chen, CEO of VSee, the telemedicine videoconferencing platform used by NASA, described his company as a “building-block company” that allows customization and flexibility. He envisions a future where virtual care systems are fully integrated and provide an elegant patient experience, from notifications prior to a telehealth visit to the back-end claims process.

“Every organization is its own organism,” Simmons said. “Every clinic or ward in an organization has its own unique situations. It’s so complex. That complexity needs to be communicated in partnership with the vendor community.”

Another way to ensure virtual care success and improve access is to invite clinicians, interpreters, care teams and patients to the table when designing a telehealth solution, according to Oren Mechanic, director of telehealth at Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center. 

Sarah Sossong, Senior Vice President of Digital Health and Informatics at Commonwealth Care Alliance; Scott Simmons, Healthcare Lead at Poly Americas; Marcia Murphy, Vice President of Clinical Operations and Nursing at Hicuity Health; Oren Mechanic, Director of Telehealth at Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center; and Milton Chen, CEO of VSee, discuss how to create more integrated virtual care solutions to increase access and efficiency.

Chen pointed out that many physicians don’t want to use telehealth because they are less productive when using it. He said improving efficiency and integration is key to increasing telehealth use and access to care, especially because consumer demand has always been there.

To practically address these issues, Marcia Murphy, vice president of clinical operations and nursing at Hicuity Health, said to being by identifying problems and then approaching solutions in a systematic way. 

“Identify your biggest problem and start there. Investments in technology are going to happen, but the technology vendors should come together with the clinicians to come up with solutions that work,” she said. “Some of the process may include trial and error, but there are also people who have been doing this for years.”

DISCOVER: Learn what's on the horizon for virtual care in 2022.

Chen used Apple as an example to describe where healthcare is in its virtual care journey: “We’re at the Newton phase. We’re not at the iPhone phase yet.” 

“The pandemic was the first exposure to telehealth for a lot of people,” added Simmons.

Mechanic said that to make virtual care sustainable, payment parity needs to exist. He described that as the biggest obstacle. Interoperability is also important for success, but healthcare is still early in its journey to achieve true integration. 

The electronic health record is often the main focus of interoperability discussions, but Chen said EHR integration is not an engineering challenge.

“There are a lot of smart engineers who can give you everything you want, but there’s no financial incentive for the hospitals to force EHR companies to give those APIs,” he said.

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