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Telehealth in the specialty world presents opportunities, challenges

Gabriel Perna | November 3, 2020

 Before the COVID-19 pandemic, telehealth was seen as a promising area for specialty docs, in particular in rural areas where there is a shortage of doctors. 

“The availability and access to qualified care is one of the biggest problems in the world. Qualified, accessible care is a human right. When you get to rural America, they don’t have access to some of these specialties. That’s a problem,” says Bret Larsen, CEO of eVisit, a telehealth provider. 

And telehealth had begun to make some inroads into specialty care before COVID. In fact, nearly 30 percent of doctors in radiology, psychiatry and cardiology had begun to use the technology already in 2019 and before, based on a research study from Health Affairs 

But that was a fairly small percentage overall. Like with everything else in regard to technology and health care, the promise of telehealth didn’t even come close to widescale adoption among sub-specialtiesReimbursement, licensure, and the usual array of problems thwarted it from becoming bigger, according to one American College of Physicians survey. Direct-to-consumer telehealth and other initiatives were often focused more on acute and primary care than specialties.  

That clearly changed as the pandemic has pushed the health care industry forward on telehealth adoption across the board, thanks in large part to the payer landscape adjusting reimbursement rules. According to data from Amwell, specialty care actually outpaced urgent care in telehealth use and helped drive larger adoption of the technology. The Boston-based company said that 42 percent of its consumers had a virtual visit had a scheduled appointment with a specialist they knew, while another 13 percent had a telehealth visit with a new specialist. 

Now specialties that never would have been associated with telehealth are becoming more familiar with the technology as well.  We had thought a little bit about telehealth prior to the pandemic and whether it could work, but we hadn’t gone as far as drawing up a full implementation planBut we started that process in April, where we thought we should just jump on it and make it happen,” says Rakhi Dimino, MD, an ob-gyn and Medical Director of Operations at OB Hospitalist Group.  

How does telehealth fit into ob-gyn? 

For ob-gyn doctors like Dimino, there were a lot of questions about telehealth that made it challenging to implement during the early days of the pandemic. She says many physicians who have spent years in the field of obstetrics and gynecology associate the specialty with in-person care. For instance, how can you tell how a pregnant patient is doing without feeling her belly? 

“The biggest challenge was trying to create the clinical protocol. Who can we see? Who should we not see? What do we do if there is truly an emergency? We wanted to help our clinicians understand that not everything has to be done in person. A lot of what we do as specialists is hearing what a patient has to say. The clues to her diagnosis are often in her history,” says Dimino. “It’s a different way of thinking about things.”  

During the pandemic, Dimino says OB Hospitalist’s doctors have been learning the techniques from other physicians more familiar with telehealth. This includes listening to the patients describe their symptoms and relying on a patient’s history rather than in-office monitoring devices. One thing that’s clear, she says, is that patients are ready for this change, especially those in underserved areas. 

“Having them always travel to us in low resource areas, whether they’re rural or just underserved, inner city areas, isn’t ideal,” says Dimino. “For those areas, telehealth is a great way to check in with those patients. I can’t imagine being a mom and wondering how they were going to get to the doctor. ‘Am I going to take a bus? Am I going to wait until tomorrow when I have a car?’ Now they have a way to assess what’s happening to them and determine if they have to go to the hospital, or if they can stay at home and monitor.”  

The next phase for the organization’s telehealth adoption is to integrate the technology into the patient’s continuum of care. Dimino says the telehealth attending doctor should be able to leave a note in the patient’s medical record – which is a type of communication that is currently lacking, and that does a disservice to the patient, Dimino says.  

“Use clinicians who are willing to be innovators, the ones who ask, ‘why can’t we?’ rather than ‘we can’t.’ With telehealth specialty care, you can’t think in terms of constraints,” Dimino advises health care CEOs. “You also should start by showing [doctors] the technology that’s out there. There are telehealth platforms that can listen to someone’s heartbeats or assess a patient’s lesions. These aren’t the things doctors think about, so being able to visualize what technology can do is important.”  

Behavioral telehealth builds on the patient-provider relationship 

Behavioral health has frequently been pointed to as a sizable opportunity for telehealth. The Health Affairs study listed psychiatry only behind radiology in terms of specialties that used the technology.  

But even though it had higher rates of telehealth adoption prior to the pandemic than other specialties, it faced its own set of challenges, says Paul Castaldo, chief development officer, Tridiuum, a telehealth platform for behavioral health providers.  

“Very few providers were trained to do telehealth. When you consider that mental health care, while a lot of it doesn’t require a face-to-face interaction, it’s completely dependent on the quality of the relationship between the provider and patient. Very often providers have had concerns that it would be harder for them to maintain the quality of that relationship outside a face-to-face environment,” says Castaldo.  

The pandemic, however, has flipped those preconceived notions upside down. In a recent survey Triduum82 percent of behavioral health clinicians said that video sessions led to an improvement in overall outcomes. The survey also found that 36 percent of providers saw an improvement in the therapeutic alliance they have with patients after using video visits. A majority of providers intend to leverage video visits for at least 50 percent of their patients even once social distancing requirements end. 

The biggest challenges for behavioral health providers in adopting telehealth include maintaining privacy and patient access to the technology. With regards to the latter, he says the savings from virtual care compared to conducting visits in a physical location could free up costs that could be invested elsewhere and advises CEOs to take lessons from the pandemic to heart.  

“This experience we’ve all had the past eight months should remove the overriding precautions that [telehealth] isn’t a way to deliver care broadly. We’re seeing the expectation that this can be a large portion of the way in which health care is provided,” says Castaldo.  

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email or on Twitter at @GabrielSPerna