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Telehealth's evolution in 2020 will continue in the new year with more streamlined technologies

While 2020 has been a taxing year for society and the larger healthcare system, it will also mark the evolution of telehealth from fringe offering to mainstream treatment model. And with usage and patient satisfaction at an all-time high, trend lines are starting to emerge: Patients like it, providers like it, the reimbursement picture is clearer on where action is needed and the technology will play a larger role in patient care in 2021 than at any point in history.

One of the biggest takeaways from the past year is how dependent telehealth's evolution has been on the human component. Virtual health legislation was first passed back in 1996, so the concept isn't new; it's been around in some form for the past 25 or 30 years. But there were barriers to adoption, and the biggest one, in hindsight, was that human systems didn't want to change. Now everybody is on board.

"It's a testament to how challenging it is to change things without some bigger impetus," said Dr. David Nickelson, vice president of client growth at digital consultancy Nerdery.

"I think people have to stop and look at the data," he said. "Pre-COVID, we had all of these healthcare systems dabbling with the virtual care platform for chat, which was different than the platform for email. None of that was integrated, and it was one-off, and that was Phase 0, pre-COVID. In Phase 1 they've put together systems that work, and now they can see a volume of patients. The challenge they've got is that most of those are Rube Goldberg experiments. It was cobbled together to create some kind of experience."


In 2021, Nickelson finds it likely that the industry at large will have a different take on what the patient experience means in the context of virtual care. Gone will be the Rube Goldberg approach and in its place will be a more cohesive and integrated strategy that will allow patients to more seamlessly transition between modalities such as talk, chat and full-blown telemedicine.

That's something that has yet to take shape in any large-scale or meaningful way. In Nickelson's experience, patients are tolerating telehealth but are finding aspects of the experience to be lacking. Providers should be paying attention to the "soft components," the things patients need in order to foster a sense of healing and the kinds of relationships they want with their providers.

"Doctors' experience with this tool is also less than ideal, because they're not able to pull info from their electronic medical record and integrate it into the conversation," said Nickelson. "That piece is really frustrating to the physician. Adoption is better when they have confidence in the technology and can integrate it into the workflow.

"(But) the consumer needs to come first," he said. "The magic behind the scenes with telemedicine -- the patient doesn't care. They just want this good experience."

One trend that's been made clear by the pandemic is that patients were ready for telehealth to be a part of their care delivery journeys well before providers were -- especially Millennials and those who were savvy about their devices, and less concerned with the prestige of a healthcare brand.

Already, they've gravitated toward tools that allow them more flexibility within virtual care, indicating the technology already had a pre-built audience. What the COVID-19 pandemic did was prompt many people to recognize that it actually does work, and Nickelson expects the industry will continue to see at least a 15% shift from in-person care to virtual care.

"If you can create a better experience than the one you have now, why can't you raise that to a higher number, say 30% of patients being covered by these modalities? The presence of the provider is as good as it would be as if they're in the office," he said. "They're all looking to reduce costs of care, and they're learning, 'Wow, what if you could decrease the total amount of real estate you have to invest in?' That's a huge efficiency gain by making that shift. You can reduce the time that doctors are in offices and the real estate you have to maintain, and that's a tremendous double-whammy."


Building an approach and a patient experience that puts them back at the forefront of their care has been shown this year to improve retention rates, with more patients coming back as loyal customers, which has been critical for hospitals and health systems as they look to recover financially from the lost revenue that marked the worst of the pandemic.

Specialties that lend themselves to telehealth, such as dermatology, have seen a huge boom in specific platforms and tools that support them. More specialties will likely join the fray in 2021, and that will require agile software development and design, requiring support for software developers. Systems need to be faster and higher-quality, and document for compliance if virtual care is to expand beyond its current base.

Some of that is changing already. Remote technologies that measure vitals and other important data are more plentiful and easier to use; clunky interfaces that make things cumbersome for the patient are beginning to erode, as devices are now better at understanding the kinds of metrics they're monitoring and can communicate with the patient about their health.

"The bar has been raised," said Nickelson. "Having that designed in the right way is important, because physicians are expected to integrate it faster into their treatment. That needs to be something that's easier to understand."

One of the big developments in 2021 will be the continued evolution of the internet of medical things, which is expanding telehealth's capabilities and allowing for more specialties to join the fold. Interactive devices that can capture and communicate health data are slicker and more streamlined, and this is benefiting providers: Alerts can inform nurse practitioners, for example, that they may need to intervene in a health event, and remote care technicians can more easily parse the data and determine whether they need to investigate further, allowing for quicker intervention.

Such developments will usher telehealth into the future.

"It relates to virtual care because you want to have these remote sensors out there, recognizing and alerting people to any issues that may come up, and then be able to intervene remotely without bringing the patient in, or at least doing an initial diagnostic," said Nickelson. "This will drive virtual care in the years ahead."

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