Becker's Hospital Review

22 Executive Briefing Sponsored by: T he COVID-19 pandemic has catapulted telehealth from reluctant adoption to rapid rollouts at healthcare organizations across the globe. Previously viewed as a concept of the future, telehealth is now a tool that most providers and patients have jumped on amid social distancing and infection control protocols. In February and March, providers began rapidly implementing telehealth programs to mitigate potential infection spread as federal and state governments relaxed guidelines that previously barred widespread telehealth adoption. After President Donald Trump announced March 17 that his administration would not enforce HIPAA penalties throughout the duration of the public health emergency, providers and patients gained access to platforms such as FaceTime, Zoom and Facebook Messenger for virtual visits. The expanded availability of platforms coupled with state licensing relaxations and increased telehealth services covered by Medicare, Medicaid and big payers sparked widespread adoption, with many providers rolling out telehealth programs in a matter of days or weeks. Becker's Hospital Review recently spoke with Roy Schoenberg, MD, president and CEO of Amwell, and Peter Antall, MD, chief medical officer of Amwell, about the explosion of telehealth during the pandemic and how providers can make the most of their virtual care platforms to improve workflows and create a clinically excellent experience for clinicians and patients. The motivation for telehealth has changed Before the pandemic, telehealth was considered more of a modernization effort or something that was understood and embraced as the way of the future, according to Dr. Schoenberg. But once COVID-19 hit, the large volume of patient interactions — not just for COVID-19 patients but also for patients with diabetes, heart failure, cancer and other conditions — shifted to telehealth to reduce spread of the disease. "The motivation for using telehealth was no longer about modernizing and looking into the future of how we're going to interact with patients," Dr. Schoenberg said. "It became the only way by which we can practice the art and carry out our responsibility toward patients; to be there, follow up and take necessary actions on a regular daily, weekly, monthly basis to ensure their health progresses the right way." By early March, telehealth suddenly became a normal part of healthcare and was being fully embraced by providers as the ambulatory healthcare system began to shut down. Patients no longer felt safe going into the doctor's office and clinicians didn't necessarily feel safe themselves due to personal protective equipment shortages and the health risk for staff, according to Dr. Antall. The pandemic created a compelling need for healthcare providers to adjust their models of practice. Pre-COVID-19, most healthcare organizations were focused on how to fully integrate telehealth into their underlying systems and workflows, such as the EHR and practice management system. Providers wanted to ensure their clinicians' workflows could be easily interchangeable between telehealth and in- person care. Providers want easy-to-use telehealth platforms for themselves and patients While accessibility and usability were always important requirements for telehealth, they became vital for providers conducting virtual visits with patients during the pandemic. After in-person visits closed down, telehealth began to cater to all the different circumstances clinicians want to get in front of patients for. Dr. Schoenberg said most providers began looking to Amwell for a quick way to send an electronic invite to the patient, which allowed them to click on a link and enter the telehealth visit with their clinician, similar to FaceTime. "These are telehealth interactions that prior to COVID-19 were unthinkable — not only because HIPAA regulations were in place but also because nobody would expect healthcare to be done through FaceTime," Dr. Schoenberg said. As telehealth interactions morphed toward simplicity, the rules of clinician availability and engagement also changed across several states. In New York, at the peak of the pandemic's devastation in March, Gov. Andrew Cuomo opened up licensure rules to allow clinicians from other states to provide care as in-state providers were overwhelmed by patient surges and PPE shortages. This further opened the door for telehealth and prompted providers to consider how healthcare services can travel if made available through technology. "The span of telehealth types has dramatically increased in both directions: toward simplicity and as a very quick way of interacting with the patient significantly in a way that is less complex than what happens inside EHRs and all the way to the other side of the spectrum of transitioning medical services from available areas to areas where they're desperately needed," Dr. Schoenberg said. How telehealth is expanding provider workflows, transforming clinical experience

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