October 2019

mHealth Update: What the FHI Says About Telehealth
By Lee DeOrio
For The Record
Vol. 31 No. 9 P. 26

In July, Philips released its 2019 Future Health Index, which revealed a number of new perspectives about digital health perceptions in the United States, including telehealth.

A peek inside the numbers reveals that digital health spending in the United States does not match adoption rates; while EMR use is high (84% of doctors), most other digital technologies are having trouble finding a niche (46% use telehealth, 33% use artificial intelligence [AI]). This is occurring despite industry spending that sits at one of the highest per capita rates. (The survey was conducted in 15 countries with a sample size of about 1,000 per market in the general population and about 200 per market for health care professionals.)

In other noteworthy findings, millennials hold onto their data as much as their parents—1 in 5 prefer not to share their data, a rate on par with Americans overall (18%) even though about two-thirds track health data with an app or device.

Fewer Americans would rather be healthy than rich, with 78% choosing the former option compared with 91% just two years ago. While still a majority, data indicate an increased importance of monetary issues, particularly among millennials, who are more likely to choose money over health (29%) than boomers (15%) and generation X (22%).

Many Americans don’t have high hopes for AI, with a sizeable portion (37%) associating the technology’s use in health care with less human interaction. Only 20% associate AI with more accurate diagnoses.

As for the wide-ranging report’s findings on telehealth, For The Record (FTR) poses a few questions to Joseph Frassica, MD, head of Philips Research, the Americas, and chief medical officer of Philips North America.

FTR: With regard to telehealth, were there any findings that surprised you?

JF: The 2019 Future Health Index report shows that, while American health care professionals are among the leaders in leveraging digital health records, the United States falls behind the 15-country average for most other digital technologies examined. Telehealth in particular is an area lacking adoption: 46% of those surveyed use telehealth in their practice compared with 61% across the 15-country average. These figures stand out, given the US is among the leaders in digital technology investment worldwide.

The public sector and organizations such as the VA have been very good at driving telehealth adoption here in the US, but, after several years, it is surprising to see that in the private sector, challenges such as reimbursement models that could help drive adoption have still not been fully addressed.

FTR: What are the leading barriers to more widespread adoption?

JF: While satisfaction levels for telehealth are high and can help address clinician burnout by helping to share the load across a health system and avoid missed appointments, it faces several challenges:

• Investment: Health systems need to account for how they can invest in new technologies such as telehealth, including the support that goes with them, such as working with a telecom provider and making sure they have the bandwidth to implement telehealth on a larger scale.

• Regulation: As mentioned, there’s a need for a new reimbursement model. Health care systems and insurers are not set up to understand or bill for virtual appointments vs traditional care, and there are many restrictions on reimbursement for most types of patient visits. Additionally, with a patchwork of state health care rules, in addition to federal, how do you address the need to see a specialist in a different state with this model? This is the question we must answer collectively.

• Education: The need to add to an already full plate and get health care professionals to learn and understand a new tool that will allow them to spend more time with patients, be more proactive in a patient’s health, and minimize missed appointments presents an additional challenge.

FTR: How can these hurdles be overcome?

JF: Since one of these barriers is the lack of education and training, telehealth technology providers must offer training, support, and the necessary change management to optimize the impact of these solutions. This includes educating them on how these technologies can improve patient outcomes, patient and staff experience, as well as financial metrics. Health care institutions need to work with health care technology providers to create a clear vision for telehealth within their organization and work together to educate and deploy it. Once health care professionals understand the value it brings to them and their patients, adoption will move forward.

Similarly, sharing best practices and learnings among health systems will help everyone better understand the challenges and benefits of developing telehealth plans.

FTR: How can the patient’s telehealth experience be improved?

JF: Telehealth encounters need to be intuitive and simple to use in order to successfully engage the majority of patients.

FTR: Can you tell us something that telehealth programs in other countries are doing that the United States is not?

JF: China is an example of a country where telehealth has really helped to meet the needs of providers and patients in the region. China suffers from a shortage of physicians, with only 1.49 doctors per 1,000 people compared with strong numbers in the US. China also has a highly rural population, a lack of existing health care infrastructure, and near-universal consumer mobile adoption. This has resulted in faster, easier adoption of telehealth technologies.

People in China are more likely to say, if given the choice, they would prefer a consultation with their doctor remotely via a digital channel for nonurgent care than people in the US.

China’s health care professionals also recommend their patients use digital health technology or mobile apps to monitor vital signs compared with peers in other countries. Sixty percent of Chinese health care providers recommend patients use digital health technology or mobile apps to monitor their blood pressure compared with the global 15-country average of 44%.

In 2017, the Chinese government designated Tencent to advance intelligent health care. Tencent Trusted Doctor, a leading nonpublic, online-to-offline health care company in China, revealed four sets of new AI-powered products to facilitate medical visits and health checkups in the first quarter of 2019.

Overall, consumers and health care providers in China generally are very comfortable using digital technologies, and that has translated well into the health system. While many Americans are comfortable using digital technologies, stronger backing of telehealth from providers and even the government would help advance telehealth use in the US.

FTR: The survey found that 58% of Americans are discouraged to visit a health care professional when they have a reason to go. One of the issues preventing them from doing so is it’s difficult to, or they are unable to schedule an appointment. Is scheduling a telehealth visit more convenient than scheduling an office visit?

JF: According to the report, the most common reasons to miss a visit to a health care professional were lack of time to visit the office, difficulty or inability to schedule an appointment, and not having a specialty or specific care available in their area. Education on coordination of telehealth visits will remain a barrier to adoption among some Americans, but the technology itself offers a solution that can directly impact their main concerns about visiting a health care professional.

FTR: The survey revealed that Americans could use a bit more education on how telehealth works. How can that be accomplished?

JF: As health care providers themselves begin integrating telehealth more into their practices, they have a strong opportunity to recommend it as an option to their patients in parallel with traditional office visits. A patient’s level of comfort should come with familiarity, so the more a provider is able to communicate to his or her patients that telehealth can be a natural, convenient extension of their relationship and care, the more comfortable patients will become.

FTR: Are some specialties more inclined to implement telehealth?

JF: While not part of the Future Health Index survey results, we have seen telehealth success across a wide variety of different implementations.

NewYork–Presbyterian Hospital, for instance, a leading provider of inpatient, ambulatory, and preventive care in all areas of medicine, expanded its telehealth capabilities for remote patient monitoring solutions specifically. Their patients being monitored with hyperglycemia reported an 89% satisfaction score using telehealth offerings and the hospital recently launched additional programs monitoring patients with congestive heart failure and new mothers with high blood pressure.

The public sector has also been a great proving ground in telehealth, with the VA being one of the largest telehealth providers in the nation. In 2017, they exceeded 1 million virtual visits, a 19% increase over the prior year, and the results are impressive. Veterans gave these telehealth services satisfaction scores ranging from 88% to 93%. The VA wants to increase the number of vets using connected care from 13% to 20% and they are making investments to do so. Increased funding is part of a five-year plan to push telehealth to vets across the US, including about 45% in rural areas, where care access is limited.

FTR: What role can telehealth play in helping to solve the “physician burnout” problem?

JF: The [Future Health Index] research found that digital health technologies help physician burnout by reducing their workload, limiting missed appointments, and enhancing their overall job satisfaction.

FTR: Could another barrier to adoption be the documentation of these encounters?

JF: Automating documentation of telehealth encounters needs to be a part of any successful solution. Complete telehealth solutions will need to take the physician/clinician workflow into account in order to reduce the burden of documentation that will come with the additional volume of encounters per provider that would come with moving patient visits to a telehealth platform.

FTR: CVS Health is launching a telehealth pilot project aimed at enabling more people living with kidney disease to undergo dialysis at home. Do you envision retailers becoming more active in telehealth?

JF: CVS is an example of a retailer that may be able to provide more efficient care through telehealth on a large scale. With its recent acquisition of Aetna, it is fully accountable for end-to-end care for its patient population, thus it has significant incentive to optimize the efficiency and effectiveness of care. Telehealth is one method to accomplish this.

— Lee DeOrio is editor of For The Record.