Ask anybody in the healthcare industry to give it some serious thought and the conclusion is inevitable: Telehealth is here to stay. At Ingenium Digital Health, we define telehealth as “delivering healthcare at a distance” and if we look at how iPhones and SmartPhones have changed the way many of us are communicating in just 10 short years, it’s becoming clear that the changed expectations of consumers like us is already spilling over into healthcare.

Hospital executives’ predictions documented in the 2017 edition of FutureScan are very clear: Virtually all hospital executives agree that telemedicine will produce measurable improvements in care (94%), that demand for telehealth will grow by at least a quarter (89%) and that telemedicine will become a competitively-important strategic priority (95%).

Like it or not, but all of us will eventually, at one time or another, become a patient, and we will expect healthcare to be delivered as a service, just like we are used to in the way we shop, bank, or go about many other aspects in our lives. We have grown accustomed to have access to services when we want, where we want and how we want, and we want healthcare to be no different. And telehealth can fulfill that expectation.

Now, I’m not predicting that telehealth will replace traditional care delivery of personal, in-person visits with your trusted care provider either in an impressively intimidating office or a clinically clean exam room. Rather, telehealth is best leveraged to augment healthcare delivery, where it is meaningful and clinically justified.

But to “see” our physicians online, to have a neurologist assess your stroke symptoms over camera, or to have our specialty providers remotely monitor our vital signs to manage chronic disease — those encounters are no longer Jetsons-like futuristic scenarios, they are reality. “The future is already here — it is just not evenly distributed” is a particularly fitting quote (by American-Canadian writer William Gibson), especially when it comes to looking at the future of telehealth. When I was describing the state of telehealth in the US to a digital health audience in Switzerland, I quipped that “if you can think about it, somebody is doing it in the US”. And it’s true: Healthcare Innovation is happening all over the country and it will soon come “to (or from) a clinic near you”.

Thus healthcare leaders (and that includes politicians, though for the purpose of this article I am specifically addressing the C-suite of health systems, hospitals, and other healthcare delivery organizations) can no longer stick their head in the sand and hope that telehealth is a fad that will pass (“hey, we are not legally required to do anything”, (yet), so they argue). Telehealth is here to stay, and — to paraphrase a Chinese proverb — the best time to do something about telehealth for your organization and for your patients, was 10 years ago; the second best time is now.

But before you get started implementing telehealth, I’d like to share with you the three powerful forces at play that are preventing progress at many health systems, hospitals, and clinics around the US, that healthcare leaders need to be aware of.

They are: Ignorance, Inertia, and Internal IT.


Ignorance, or willful neglect to educate oneself, stands in the way of success at most organizations and is actually the underlying root cause for the other two causes: If you don’t know ‘why?’, you won’t move; and if you don’t know better, you’ll assign responsibility for telehealth to IT (see below).

Just a few years ago, being ignorant about telehealth was fine, tolerable, even acceptable. Healthcare organizations were busy implementing HIEs and Meaningful Use, and many organizations, still to this date, are still introducing and changing out their electronic medical record management system.

But now telehealth has come of age and is technically available in patients’ kitchens, living rooms, and bedrooms. And multiple non-traditional telehealth service providers (like AmericanWell, Teladoc, MDLive) are now operating nationally, providing very convenient ways for your patients to access and receive pretty good healthcare.

Also widely available now is information about telehealth (as is misinformation). Peer-reviewed guidelines have been developed to assist in the development of telehealth services, a plethora of affordable technologies are available to get started, and more and more experts, like our consortium of experienced telehealth experts, are sharing expertise through their services.


The second and probably biggest force standing in the way of telehealth adoption at many organizations is Inertia, or the unwillingness to determinedly develop ways to overcome resistance to change — including one’s own resistance. As I have found over many projects that required changing the way people work, Inertia is often caused by a lack of clarity, a lack of knowledge. Launching telehealth is first and foremost and undertaking in change management and without a conscious focus on that, the inertia, especially in healthcare, is just simply too high.

Another reason for high inertia is the lack of leadership, a lack of a compelling vision by the C-Suite to motivate people to change their ways, which often is rooted in the fact that today’s healthcare leaders only know that they need to do something about telehealth, but don’t know where to start.

Internal IT

A third force standing in the way of progress is the cardinal mistake of pawning the responsibility to implement telehealth off to the CIO and the Internal IT department. While on the surface it might make sense (telehealth, after all, is about technology, right?) this approach will inevitably lead to failure.

Now I’m not bashing IT here – many seasoned CIOs are vigorously implementing the many lessons learned over the past decades in what one can do wrong in rolling out new technology in healthcare. And IT is definitely essential in a successful rollout of telehealth.

Yet I’ve found that even the most enlightened CIOs are still today falling into the same old habits and traditional “power grabs”. But telehealth is different. It’s not a technology that is simply deployed to augment existing services: Telehealth requires the design of new workflows, and IT is definitely not the best team to redesign clinical workflows.

As I laid out in the introduction, the future of Telehealth lies in augmenting the delivery of healthcare. Telehealth is not about the technology, but telehealth is about delivering care at a distance. To work effectively, Telehealth must be fully integrated into the processes that make up the delivery of healthcare. Telehealth, therefore, is not a technology, but rather Telehealth is a clinical service and as such needs to be designed, implemented and led by physicians and nurses.

There is a better way

Given the many mandated healthcare changes in the past decade, clinical staff are very change fatigued. So in our engagements of launching telehealth programs, we use Telehealth as a unique opportunity for healthcare practitioners and healthcare leaders to proactively take the future of healthcare delivery into their own hands, rather than reactively implementing federal mandates (which are sure to come in a few years).

When telehealth is implemented with physicians at the helm of charting the future course of healthcare, using technology as a tool, not as the raison d’être, the mistakes of botched EMR and HIE and Meaningful Use implementations can be avoided. But putting IT in charge of telehealth is to do the same thing over again and expect different outcomes. Telehealth is about care delivery and as such needs clinical leadership.

The good news is, if the reasons you haven’t implemented telehealth are Ignorance and/or Inertia, you can now leapfrog organizations that started telehealth years or even decades ago. With a strategic approach to telehealth, you can rapidly ramp up your telehealth services, because the technology is quite mature and affordable, and implementation help from experienced consultants is readily available.

If, however, you have a telehealth program that is rather just limping along, maybe because it has been implemented without strong clinical leadership, the “treatment” is going to hurt a little, because you’ve blown your chance to make a good first impression. But that is the topic of a conversation we should have another day.

To receive articles like these in your Inbox every week, you can subscribe to Christian’s Telehealth Tuesday Newsletter.

Subscribe to Telehealth Tuesday

Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.

Contact Christian by phone or text at 657-464-3648, via email, or video chat.