Becker's ASC Review

29 Executive Briefing Sponsored by: V arious reports indicate that physician adoption of telemedicine has boomed over the course of just the past few months, with virtual healthcare interactions set to surpass 1 billion by the end of the year. Similarly, in 2019 just 8% of patients surveyed had sought care via telemedicine, but as of April 2020, that number had increased to over 50%. (Source: Doctor.com CX Trends 2020 and Telemedicine Adoption in the Age of COVID 19 and Beyond) "Due to the COVID-19 crisis, what was a five- to ten-year organic technology adoption cycle got compressed down to five months — naturally creating a lot of chaos among healthcare organizations," said Andrei Zimiles, CEO and Founder of Doctor.com. "Prior to the pandemic, many providers regarded telemedicine as a novel technology that was not essential to their business, often serving as just one of a series of possible interventions to steer patients toward the right care. Then the coronavirus hit, and elective procedure departments were shut down, the ER was overflowing, and patients were either unable or unwilling to go to the hospital due to COVID-19. Health systems had to pivot." Physicians are quick to corroborate these trends. "If there's one thing our experience with COVID-19 has taught us, it's that telemedicine is no longer an option, but a necessity," said Howard D. Krein, MD PhD, Associate Professor, Thomas Jefferson University Hospital. "It is here to stay, and it's only going to become a larger part of medicine as we continue to innovate. And patients are hungry for this kind of innovation." Organizations that adopted telehealth under duress face challenges While the initial surge of COVID-19 has subsided, the pandemic is far from over. Healthcare organizations must continue to act with urgency to substantially scale telehealth offerings and prepare for what many predict will be a permanent shift in the care delivery model. Prior to the pandemic, most health systems didn't have a reliable, scalable telehealth platform in place, and most vendors weren't equipped to help them get up and running on their solutions quickly. Complex software with heavily customized integrations could take months — or even years — to deploy. When the pandemic hit, healthcare organizations didn't have time to implement a unified and comprehensive telehealth strategy, often leaving individual physicians to their own devices to choose disparate "quick fix" virtual care solutions. CMS waived HIPAA restrictions early on and broadened the scope of what could be treated through telemedicine. Medicare beneficiaries have been able to transition to telemedicine using Zoom, FaceTime, Google Duo/Meet, and other platforms that were hastily approved for temporary use. However, these general-purpose video-conferencing platforms pose significant issues within the healthcare industry, as they may not be sufficiently secure, robust, or HIPAA compliant outside of the pandemic. Time pressure combined with relaxed regulations led to widespread decentralized adoption — which created a mess that many hospitals are only now starting to address. "We are seeing a major second wave of reassessment where some health systems are discovering they have 20 to 30 different telemedicine services that have permeated their physician base," said Mr. Zimiles. "Obviously this presents a host of problems — security concerns, fragmented and siloed patient data, poor records keeping, increased overhead, and inconsistent patient experiences, to name a few. Staff will have to be retrained on a more secure, centralized, and durable system in the future. IT has to take control and make sure patient records are going to the right place and their platform stands up to regulatory requirements for healthcare use. Hospitals must now find a more robust and future-proof long-term solution. Most importantly, it has to be easy for the patients to adopt, and that's where many of the incumbent services have failed." Dr. Krein has firsthand experience watching this play out at his hospital. "When the pandemic hit, it was a bit of a free-for-all in terms of how various departments adopted telemedicine," Dr. Krein acknowledged. "The hospital did a great job of supporting us, but we still ended up rotating through different telemedicine solutions, including ones that require downloading an app. Unfortunately, a difficult installation process dampens the patient experience, and we have learned it should be simple: It should be click, verify, and join." Combining telemedicine and patient reviews to increase patient adoption and acquisition "Simplicity is so paramount when it comes to patient adoption," Mr. Zimiles said. "When you look at what has been successful with patients, it has been services that are generally much 'lighter weight' and easier to use. It's important that enterprises carefully balance user experience with the feature depth, security, and personalization necessary to meet their needs. Done right, telehealth presents a great opportunity for organizations to reinforce their brand by providing a delightful patient experience that is comfortable and reassuring." In a third-party survey of 1,800 patients funded by Doctor.com, 69% of patients said they'd be more likely to opt for a telemedicine appointment if the technology were easy to use. Any service that requires the patient to download and install an app can pose a significant barrier to adoption. This is especially true when telemedicine features are integrated as part of a larger patient portal application. In some cases, patients have signed up for the wrong hospital's app due to it having a similar name in the app store. Mr. Zimiles advises hospitals to choose a platform that can work on any device and does not require the patient to download anything or create a new account. Because much of healthcare research today is conducted online, telemedicine is set to become an integral fixture in the patient journey. "Healthcare providers have an incredible opportunity to engage patients at key moments in their research process — for example, the moment where they are typing keywords into Google or browsing a site like Healthgrades or WebMD. Providing a clear call to action for patients at this 'last mile' of their journey to schedule a virtual visit is a very effective way to drive acquisition, especially at a time when many people are still hesitant to visit medical facilities in person," said Mr. Zimiles. By integrating telemedicine capabilities with online patient feedback and reviews, hospitals have an opportunity to accelerate patient adoption and growth. For example, by prompting "early telehealth adopters" to share reviews and comments about their positive Hospitals rethink their strategy after haphazard adoption of telemedicine services during the COVID-19 crisis

• Cover