Health

HE A LTH • Summer 2020 11 H Patient telehealth experience survey A bad digital experience with a healthcare provider ruins the entire experience with that provider. Strongly agree and agree ........................50% Neutral ................................................. 25% Strongly disagree and disagree ................ 25% A good digital experience has a major influence on my experience with a healthcare provider. Strongly agree and agree ........................39% Neutral ................................................38% Strongly disagree and disagree ................23% I am comfortable using a range of health and wellness services, including digital and virtual, to manage my health. Strongly agree and agree .........................38% Neutral .................................................35% Strongly disagree and disagree ................ 27% Half of U.S. patients said in a survey this year from Irish consulting firm Accenture a bad digital experience would ruin an entire medical encounter for them. To what extent do you agree with the following statements? Telehealth comfortability U.S. patients said in a survey this year from Irish consulting firm Accenture they are more willing to receive virtual care in some areas of service than others. Which of the following would you do virtually if given the choice? Health and wellness advisories Remote monitoring of ongoing health issues through at-home devices Routine appointments Mental health appointments Appointmens with medical specialists from chronic conditions Appointmens with medical specialists for diagnosis or acute care Diagnoses for illnesses, diseases and disorders 62% 57% 52% 46% 45% 44% 42% Note: Included are responses of "definitely" and "probably would do virtually." Source: Accenture Safety of health information MY DOCTOR OR OTHER HEALTHCARE PROVIDER... Very much .............................................36% Some .................................................... 52% Not very much ....................................... 10% Not at all .................................................4% Very much .............................................36% Some .................................................... 52% Not very much ....................................... 10% Not at all .................................................4% Very much .............................................36% Some .................................................... 52% Not very much ....................................... 10% Not at all .................................................4% U.S. patients said in a survey this year from Irish consulting firm Accenture said they are increasingly untrustful of tech companies, and even their own healthcare providers, when keeping information safe. How much do you trust the following to keep your digital healthcare information secure? 201 7 201 9 2020 TECH COMPANIES... Very much ............................................. 14% Some ....................................................43% Not very much .......................................33% Not at all ............................................... 10% Very much ............................................. 12% Some ....................................................36% Not very much .......................................29% Not at all ............................................... 10% Very much ............................................. 13% Some ....................................................32% Not very much .......................................30% Not at all ............................................... 25% 201 7 201 9 2020 Source: Accenture careers, which in some cases span decades. Older patients were also less anxious to figure out technology needed to meet with a provider in a whole new way. Patients have been shown to be quick- ly deterred by bad telehealth visits and have a lack of trust in the safety of their information online. Half of patients in a survey this year by Accenture, a professional services company, said a bad digital experience with a healthcare provider would ruin the whole experience with that provider. But there is a more encouraging trend for those looking to adapt telehealth practices. While 14% of the Silent Generation and 20% of Baby Boomers said they trust tech companies' health services, those rates were 32% for Generation X and 43% for Millennials, younger gener- ations who have been using technology for a greater share of their lives. Younger generations showed more willingness to try virtual care from tech companies and retail brands. After the peak of the pandemic, healthcare providers haven't seen a lack of trust – at least for now – standing in the way of telehealth becoming a greater part of health services permanently. At Saint Vincent Hospital in Worcester, health leaders cite other challenges patients and practitioners have had to overcome. "A lot of it is a perception that 'A doc- tor needs to see me,'" said Dr. Sowmya Viswanathan, the chief medical officer for Saint Vincent and sibling hospital MetroWest Medical Center. "Meaning, he or she needs to see me in person in order to diagnose me properly." Among practitioners, some had con- cerns about missing physical cues like an unsteady gait or that the appoint- ment would feel less personal, said Dr. Melissa Buchner-Mehling, the medical director for advisory services for Saint Vincent. But providers have also discov- ered telehealth can increase efficiency, she said. Patients who before might have difficulty scheduling an appoint- ment around work or child care can now more easily be seen. Making telehealth work Dr. Joseph Kvedar, the president-elect of the American Telemedicine Association, said he's advised clinicians to stay mindful of what lends itself to online appointments and what doesn't. "If we stray into areas where a physi- cal exam is needed – where I have to touch you or use an instrument to get the information I need to make the diagnosis – and we don't do that, then quality will suffer," he said in a forum by the Betsy Lehman Center for Patient Safety, a state office in Boston. Another factor could dictate the lon- ger-term widespread use of telehealth: health insurance reimbursement rates. Today, insurers and Medicaid and Medicare are paying the same rates for telehealth as for in-person appoint- ments. That wasn't the case before. Healthcare systems faced a financial disincentive for switching to telehealth. "That was one of the larger reasons why adoption lagged where the tech- nology was," said Dr. Mark Manning, the medical director for ambulatory services at UMass Memorial. Telehealth isn't replacing services requiring in-person visits, like a CT scan, or MRI. But technology is already making some services available remotely, including a gadget acting like a stethoscope to analyze breathing. Telehealth has worked best in areas such as behavioral health, which doesn't require a physical touch, and dermatology, when a photo from a patient can often work just as well. "There's always going to be some limitation with technology," said Dr. Basava Vallabhaneni, the system medi- cal director for sound physicians and medical director of informatics at MetroWest Medical Center in Framingham and Natick. "Technology isn't going to replace the physician- patient relationship. It's going to com- plement it." At Reliant, Garber said telehealth is bound to be used at least slightly less once the pandemic passes. Garber, a practicing internist, predicted 10% to 20% of appointments will remain online. An annual physical, for exam- ple, could take place partly online with a briefer in-person visit for any needed hands-on exams. UMass Memorial found itself fortu- nate to have built a telehealth platform integrated into Epic, the electronic patient record system it launched in 2017. When it quickly switched to tele- health during the pandemic, every- thing ran relatively smoothly. "We were in a very good position when this hit to not have to work out those details in the midst of a crisis," Smith said.

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