A Brief History
The application of telecommunications technology to the practice of medicine has long been driven by our medical community’s collective innovation, imagination, and relentless pursuit. As early as 1924, we were envisioning a future where the traditional house call might take place via radio — the original vision of “doctors on demand”. After many cycles of political, economic, and technological change, today’s unprecedented circumstances have brought us to telelmedicine’s breakout moment. But this is just the beginning.
The cover of Radio News magazine, April, 1924. These days, telemedicine is no longer a sci-fi “maybe.” In rural America, more and more doctors and patients are connecting via live video. NIH.GOV
The ever-increasing complexity of our healthcare system and its convoluted effect on stakeholder incentives resulted in years of increasing friction against the original, simple pursuit of a pure, remote, on-demand, patient-provider interaction experience. Now, in response to the global pandemic, we have come together in a matter of weeks as an entire ecosystem (health systems, vendors, government agencies, and patients) to swiftly lift crushing restrictions across regulation, reimbursement, technology, and even cultural/behavioral norms to re-invigorate the purity of that original intent of the radio doctor — a simple, effective patient-physician/care team member interaction across physical distance.
Observations, Lessons Learned from the COVID-Response Period
The COVID-catalyzed explosion of demand for video-enabled interactions, coupled with softening regulations, has resulted in a wide range of unintended consequences:
- An over-proliferation of communication tools. One of our provider’s phones is now “fully loaded” with Slack, Zoom, MicroSoft Teams, and two HIPAA-compliant, but single-purpose-only secure messaging apps
- iPads have become the predominant device of choice for patient interaction in hospitals. However, the primary utility on these powerful devices is to provide a video link-out that is designed for consumer-grade interactions and lack healthcare enterprise controls, provisions, care team context, and workflow capabilities
- Provider groups within the same health system must switch between telehealth platforms intended for on-demand urgent care visits and FaceTime just to connect with patients and other providers who may not have the appropriate, networked access to the same telehealth applications
- Appropriate context and data capture, effective EHR and workflow integrations are mainly after-thoughts for now
While health system IT teams rapidly, valiantly responded and scaled existing infrastructure to support the COVID-induced telehealth pivot, a more complete consideration of the full range of use cases and a longer-term strategy to sustainably implement, support, and scale telehealth experiences are only now being examined in earnest. Understandably, health systems are focused on working towards safe and effective recovery while anticipating the increasing risk of a second wave of the pandemic. Under the anticipated dual system of care, health systems need to figure out the right staffing models, procedures, processes, coordination mechanisms, and supporting technologies to treat two distinct patient cohorts while operating at maximum capacity.
How we choose to support the clinical “new normal” with the right blend of technologies is both a significant challenge and an immense opportunity.
The Vision for Virtual, Team-Based Care
Witnessing our frontline care teams using all available tools across EHR configurations, remote patient monitoring, secured messaging, voice-enabled interactions, video conferencing, and even AI-enabled patient and clinician assistance tools, reminded me that in some ways, we have already moved past the “tele” part of “tele-medicine”. We have accelerated toward a virtual, team-based care delivery future.
Virtual, team-based care is a paradigm in which we are no longer limited by the capabilities and resources available at a given location, within just a single health system. A fundamental re-imagining and retooling of staff and patient experiences, underlying operational processes, and even corresponding business models is now required to adapt to the strategic necessity of the dynamic, dual-systems of care needed to prevail over the current pandemic, successfully deal with its aftermath, and invest in the preparedness needed to respond to future epidemics.
Key to this period is thinking beyond the initial use case of video consults. There are many well-established telehealth platforms in place. We believe health systems will start to consolidate vendor choices as they define sustainable, scalable strategies to enable virtual, team-based care delivery. Those strategies start by asking the right questions for the specific types of outcomes they want to achieve, then translate each target outcome into a set of staff and patient experiences with reliable workflows and a supporting mix of technologies. Under this framework, they will systematically identify the multiple new use cases to support and deeply understand what’s addressable via EHR configuration and what requirements to set for their clinical communication platform partners. In addition, they will determine the level of integration needed between patient engagement tools, mobile communications tools, the EHR, and telehealth solutions to enable an end-to-end care delivery experience.
At PatientSafe, we are excited by our customers’ and partners’ momentum towards this future. We have been working in close collaboration to integrate with health systems’ telehealth solution of choice, add workflow-triggered video sessions to address key in-patient hand-off and coordination gaps, enable cloud-based delivery mechanisms to transform speed and ease of deployment, and deliver enhanced integrations with EHR platforms to drive closed-loop workflows. We are grateful for the opportunity to support our customers as they adapt to the new normal and stand ready with them to meet the challenge.
- Naylor MD, Coburn KD, Kurtzman ET, et al. Inter-professional team-based primary care for chronically ill adults: state of the science. Unpublished white paper presented at the ABIM Foundation meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings. 2010 March 24-25; Philadelphia, PA.
- Mitchell P, Wynia R, Golden B, et al. Core principles and values of effective team-based health care. Discussion Paper. Washington, DC: Institute of Medicine; 2012. https://www.nationalahec.org/pdfs/VSRT-Team-Based-Care-Principles-Values.pdf.
- Okun, S, Schoenbaum S, Andrews D, et al. Patients and health care teams forging effective partnerships. Discussion Paper. Washington, DC: Institute of Medicine; 2014. https://www.accp.com/docs/positions/misc/PatientsForgingEffectivePartnerships%20-%20IOM%20discussion%20paper%202014.pdf.