Sometime in 2019, I was multi-tasking and racing between exam rooms amid a controlled chaos that defines an average day in my busy clinic. I was behind as usual, and I could sense the frustration in the air from my patients who had been waiting for a while. I knocked and entered a room to meet a patient for follow up on his MRI study.
The encounter was brief, as the patient was notably irritable from having to wait. At the end of the appointment, the patient’s final comment stuck with me for weeks to come: “How come you can’t call me with this result?”
Initially, I was insulted, to be honest. I thought to myself, I could literally call all my patients for follow ups, but then I wouldn’t really need to work in a clinic and what type of practice would that be?
Fast forward a year. The world has turned upside down and, ironically, I am one of the providers who utilizes telehealth the most in my large organization. I estimate about 90% of my visits were telehealth visits during the first four months of the pandemic.
Several studies have found over the years that patients are willing to engage with physicians via technology, and many patients have reported high satisfaction with their telehealth experience.
For years, however, thanks largely to reimbursement and regulatory challenges, and sometimes limited technology access, telehealth didn’t quite catch on as much as many hoped.
But since the start of the COVID-19 public health emergency, our organization has expanded its telehealth capabilities. In addition, our state workers compensation system has rolled out several temporary telehealth policies to allow injured workers to receive virtual medical treatment during this pandemic.
A brief background about myself and my practice: I am an occupational medicine physician working under a not-for-profit health care system. My clinic is situated in a suburb surrounded by many industries and in a densely populated community. My visit type is 95% work injury-related with the rest employment-related exams. My patient population is the working class, ages 14 and older.
My organization’s leaders assumed at first that face-to-face interaction was the preferred healthcare experience, and that telehealth visits dehumanized the medical encounter.
To test this assumption, I surveyed my patients.
Our telehealth visits are all pre-scheduled utilizing a web-based application. We use a HIPAA-compliant software that allows for two-way, high definition video and audio. We can also effortlessly share media online. There were no exclusions in this survey. I included patients who did not have a smart device or lived in a poorly networked area.
Over the course of three weeks, from the end of August through early September 2020, I collected a total of 115 surveys. About two-thirds of the patients I surveyed were follow-up patients. All new injury visits were done in-person. Each result was from a unique individual.
The survey consisted of one question: Considering the current COVID-19 pandemic, would you prefer a virtual visit (video or phone) or an in-person/in-clinic visit?
The survey question was given to the patient either on paper or read word-for-word in the case of virtual visits. The patient could only select one preference. Much to my surprise, 60% of in-person patients preferred a virtual encounter and 86% of virtual patients wanted their future visits to remain virtual.
Here are some comments from my patients:
“I like the first visit to be in-person but follow up visits can be virtual.”
“Virtual is good, but when I had that spasm last time, I actually preferred an in-person, so you can feel it.”
“Virtual visits are nice considering the pandemic, but I’d like to be looked at and examined every now and then.”
“I’m an essential worker, so virtual visits are convenient for me.”
“I don’t see anything you cannot do virtually that you have to do in-person.”
“I kinda like this, this is the collateral beauty of the pandemic.”
According to a similar survey in 2013, where healthcare consumers (1,547) were pooled from around the world, 74% of them were comfortable with virtual doctor visits. Here I highlight an example where modern patients, with modern technology, prefer a new way of medical experience – virtually.
I learned several lessons through this experience.
First, have robust and easy-to-use telehealth software and affirm that it is HIPAA-compliant. Next, targeting your patient population is critical. Younger generations (Gen X, Y and Z) are much more comfortable with adopting technology. Also, be flexible and have a threshold to convert the virtual visit to in-person when situations arise.
In addition, avoid telehealth visits during the acute infection and trauma phase. Advertise and offer telehealth visits to patients who live far and/or have limited transportation. Consider grouping the telehealth visits separate from the in-person visits for better workflow.
Finally, make plans to have in-person visits intermittently for the virtual patients, and remember, follow-ups and patients with chronic conditions are the best candidates for telehealth visits.
Today, 76% of hospitals use telehealth technology.5 Telehealth services save time and money for all parties involved. Its advantages and benefits are immeasurable. Timeliness of care is critical to better quality of care.
Through telehealth, one can access the healthcare system easily and more quickly than ever before simply at the touch of a button. Loss of productivity is hugely minimized since the patients do not have to take a half-day or a whole day off work just to attend a doctor’s appointment.
According to one survey, nine in 10 Americans stated that they would cancel or reschedule a preventative care appointment due to workplace pressures.6 Less transit to and from the doctor’s clinic reduces traffic congestion, traffic accidents and air pollution.
Over the years, a few of my patients have informed me that they were involved in motor vehicle accidents either coming to or leaving my clinic. I, too, find myself rushing to make it to my own medical appointments during or after work. The anxiety and stress related to being on time have caused a few near accidents of my own.
Telehealth helps reduce unnecessary visits to urgent care or the emergency room – before a worker goes to see a doctor, he/she can first consult with a healthcare provider via telehealth to determine whether such a visit is necessary or indicated.
A research study showed that telehealth visits for the most common health conditions save employers an average of $472 per visit. Telehealth allows a team-based approach and collaboration where other support members can join in on the virtual visit, e.g. dietician in a weight loss visit, prosthetist and/or orthotist in an amputee visit, vocational counselor in an occupational medicine appointment.
Telehealth is here to stay, and it will be a large platform in the future of medical delivery. We must learn to adopt and use it to our advantage instead of as a perceived hindrance.
Future challenges and opportunities include insurance recognition for proper reimbursement, establishing best practices, training and certification on utilizing the platform, tightening cyber security, and, finally, expanding into every aspect of medicine (e.g. ancillary telemedicine services like telepathology and telepharmacology).
To the patient I met last year, who wanted his MRI results given virtually, I want to say, thank you!
Dr. Archie Adams is a board-certified occupational medicine provider. He currently sees patients at MultiCare Centers of Occupational Medicine in Puyallup, Washington.