Telehealth: Alive & Kicking

Quite a few clinicians and healthcare leaders in organizations that were not engaged in telehealth prior to the Covid-19 health crisis still hold on to the notion that telehealth was simply a “best we can do” stop-gap measure during a time where physically coming into the clinic would have posed too much of a risk for patients and staff alike.

The Quiet Growth of Telehealth

Yet, telehealth has been steadily and quietly growing in many different corners of the healthcare universe:

• since the mid 1990s (and earlier) at academic medical centers — e.g., the University of Virginia started their telehealth program in the mid-1990s and is now offering telehealth access to over 40 different specialties, oftentimes within days or weeks, vs. months-long waiting times for in-person appointments.

• for the last 10-15 years national and regional health systems — e.g., 10 years ago, in 2012, we launched eight different telehealth services at Olmsted Medical Center, a small health system in rural Minnesota; other health systems we worked with include Maine General, Lifebridge Health, TidalHealth, and Wise Health

• over the past 5-10 years at employee care clinics — such as Amazon Care, Walmart Health, or outsourced providers such as First Stop Health or Marathon Health

• and for the last 20 years at telemedicine-only providers — with household names such as AmWell, Doctor on Demand, MD Live, etc.

A Cornucopia of Telehealth Services

In 2014 the Arizona Telemedicine Program and the Southwest Telehealth Resource Center established a Telemedicine and Telehealth Service Provider Directory “to help healthcare organizations find medical specialty service providers offering telemedicine and telehealth services”.

This database contains the self-submitted information about companies and organizations that have clinicians offering their services in various states via telehealth.

Over the years this database has grown to almost 200 companies covering over 70 different specialties from Obstetrics to Hospice, from Pediatrics to Geriatrics, and from Audiology to Ophthalmology.

While some companies only have clinicians licensed in a single state (e.g., Astia Health in Wisconsin or East Carolina University Telemedicine Center in North Carolina), many provide their services in multiple states or even in virtually all states (e.g., Alina Telehealth in 47 states and DC).

Contrary to some perceptions, the specialty services are not exclusively focused on behavioral health, but include many medical specialties:

• 41 providers in Infectious Disease
• 40 providers in Dermatology
• 37 providers in Endocrinology
• 35 providers in Pulmonary Medicine
• 19 providers in Cardiology
• 19 providers in Urology
• 16 providers in Otorhinolaryngology (ENT)
• 12 providers in Rheumatology

Of course, the largest specialties are the usual suspects. Out of the 192 providers there were

• 82 providers in Psychiatry
• 46 providers in Psychology
• 56 providers in Primary Care
• 56 providers in Chronic Disease Management
• 45 providers in Urgent Care

But even specialty services that are often not thought of as telehealth ready can be found in this directory, e.g., Orthopedic Surgery (22), Dentistry (11), Sleep Medicine (25) — just to name a few.

The Implications

Here are the three key insights:

1. Informed patients (“modern healthcare consumers”) now have more telehealth options than ever. Eventually clever marketers will make it very easy for patients to quickly choose between 5 or more companies that serve their state to access to any clinical care they need. Urgent Care in Virginia? 28 companies. Pediatrics in Colorado? 24 companies. Substance Use in Vermont? 10 companies. Etc.

2. More and more clinicians are discovering and mastering the flexibility and joy of working as a telehealth clinician, as demonstrated by the availability of these services. For many, it’s an escape from the 10-hour a day burnout and the ability to establish, over time, a multi-state or national specialty practice focused on the subspecialty aspects they feel most passionate about.

3. The breadth of services in the directory clearly demonstrates that virtually every medical specialty (pun intended) can effectively leverage telehealth. And the 100s if not 1,000s of telehealth services provided to patients every day in every specialty is advancing medicine and its ability to provide diagnosis, care and treatment “at a distance”.

If your healthcare organization is not on top of its telehealth game to offer in-person and virtual care services equally, here’s the marching order for your leadership team:

1. Create a telehealth business plan that includes an updated environmental analysis (including regional telehealth competition and patient acceptance), a telehealth strategy, and your prioritized telehealth services roadmap.

2. Establish a cross-functional telehealth governance team with clinical, executive, and operational leadership and representatives from finance, IT, and operations.

3. Hire and train a designated (though not necessarily full-time) telehealth coordinator to provide optimization, launch, and growth support and to liaise with named technical, operational, and billing support staff.

4. Systematically optimize your telehealth services – technically, operationally, clinically, and strategically.

Following this plan will improve your organization’s ability to offer telehealth services in parallel to your in-person care; and if you’d like some more guidance on how best get started, then reach out to me to set up a brief video chat.