Introducing healthcare's newest specialty — the virtualist


Part of healthcare's perpetual evolution is the emergence of new roles and functions. This is especially true in the health IT sector, as digitization creates new opportunities and challenges in care delivery.

For example, healthcare organizations have increasingly established the chief medical information officer role to address the growing need for a liaison between IT implementations and physicians. And, as telehealth offerings proliferate in healthcare — and as long as consumer demand for telehealth continues to grow — the industry may soon see a new clinical specialist: the virtualist.

New specialties are born out of new clinical needs, and telehealth as a means to deliver care is one of those needs, suggested Alan Roga, MD, in a May 24 webinar hosted by Becker's Hospital Review. Dr. Roga is senior vice president and general manager of the provider market for Teladoc, the nation's leading provider of telehealth services. He is also an emergency medicine physician, another recently created specialty.

"The specialties, intensivists and hospitalists, were both born in my [life]time," Dr. Roga said. "In addition, 30 years ago, you'd have whatever intern is just off their rotation working in the ER and taking care of people. Ultimately, we found the people were not being served the right way. So [emergency medicine] became a real specialty with training behind it, and it's evolved into the gateway for modern healthcare and for people to access their care now."

Telehealth is following this same pattern, according to Dr. Roga.

"I do believe that this is becoming a new specialty or subspecialty. It's the era of the virtualist, and we need to treat it as such," he said. "It's important to set up everybody for success."

While a telehealth program relies on technological infrastructure and capabilities, a successful program is more dependent on organizational management, leadership and the people providing the virtual care.

"This is about operations and leadership. It's not actually about the technology," said Judd Hollander, MD, associate dean for strategic health initiatives at Sidney Kimmel Medical College and vice chair for finance and healthcare enterprises in the department of emergency medicine at Philadelphia-based Thomas Jefferson University. "The wrong technology can hurt your program, but the best technology still can't actually create your program. The creation of the program is dependent upon having the right team of people together to utilize the technology to help solve the problem of access."

That success begins with approaching telehealth as a main organizational strategy. Often times, healthcare providers view telehealth in terms of use cases and identify areas where telehealth can be injected, but this approach doesn't harness the full potential of telehealth, according to Dr. Hollander.

"Tele[health] has to fit into the main institutional strategy. Tele[health] isn't a game, tele[health] isn't a toy. It's a way to deliver care to patients," Dr. Hollander said, adding telehealth services should not focus on just one clinical area like teladermatology, for example. He said that while teledermatology might be "perfectly good," it is still a dermatology program and not an institutional strategy.

This type of organizational planning and strategizing includes board involvement, governance, quality controls, protocols and guidelines, according to Dr. Roga.

"One of the key challenges to implementing a telehealth program in any large enterprise is change management, which requires strong leadership," added Thomas Heatherington, a senior advisor with ADVI. Mr. Heatherington said telehealth requires a shift in the way healthcare providers think about delivering care.

"In some ways, telehealth challenges longstanding norms for how we think about medical care, especially the geographically centered, legacy model for delivering that care," he said. "A major challenge is therefore culture change."

That culture change extends from the executive leadership level — in terms of gaining buy-in and viewing telehealth as a strategic organizational asset — to the clinicians who are actually providing the care. A common question regarding telehealth care delivery asks what skill sets and training are needed for virtual care.

"No matter what people say, it's not exactly the same as a face-to-face [consultation] in the office visit," Dr. Hollander said, but a little creativity can go a long way. And, suggesting an in-person visit is always an option.

"You have to be able to live with a little bit of uncertainty," Dr. Hollander said. "That doesn't mean you can't get to the right answer virtually all the time, but you need to know when you can get enough information that you are at the right answer, or when you need to say, 'Okay, you do actually need an in person face-to-face visit.'"

In his experience, Dr. Roga said many physicians require specific training to provide top quality virtual visit experiences to patients. That included reworking how providers intake patient histories, listening more and not automatically ordering tests or running to physical exams, speaking slowly, looking into the camera instead of at the screen and making sure they are in an appropriate location to maintain patient privacy.

Mr. Heatherington also mentioned other non-clinical skills required of clinicians delivering telehealth, and highlighted the customer service training offered by many of the world’s best consumer-facing companies.  This training includes active listening, behavior change, and assessing a consumer's ability to self-manage their personal situation.

"If you keep in mind you're going to do what's right for the patient, you can find creative ways to help the patient. Otherwise, you can coordinate their care and arranged for a face-to-face [visit], which is totally fine," Dr. Hollander said.

In the consumer-facing, retail-oriented healthcare environment, telehealth is likely to be a guaranteed mainstay in healthcare delivery in the next decade, experts agreed. Mr. Heatherington predicts telehealth will be a key differentiator in an increasingly competitive environment, and organizations that incorporate it into their long-term strategy will have a leading edge.

Dr. Hollander said telehealth will become so integrated that we won't even be using the word anymore.

"My guess is 10 years from now we will never hear the word telehealth again. It will just be health," Dr. Hollander said. "If you're not doing video calls and you're not using this technology 10 years from now, you're not going to be providing any care to patients 10 years from now."

To view the webinar, click here

To view past webinars, click here.

More articles on telehealth:

Intermountain Healthcare launches telehealth service for Utah, Idaho patients 
VA to establish 5 mental telehealth hubs
Less than 1% of Medicare rural beneficiaries receive telehealth services, study finds 

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