Physician viewpoint: 4 strategies to avoid 'the pitfalls' of telehealth

While telehealth adoption has allowed clinical care to safely continue during the COVID-19 pandemic, virtual visits have presented some unintended consequences for patients and clinicians, according to Lisa Rotenstein, MD, and Lawrence Friedman, MD.

In a Nov. 20 op-ed for Harvard Business Review, Dr. Rotenstein and Dr. Friedman described some of the pitfalls of telehealth and ways to avoid them.

"Across specialties, we know that the technology can exacerbate disparities in access for vulnerable populations in the U.S. including racial and ethnic minorities, non-English speakers, the elderly, those with low incomes, and others," they wrote. "Clinicians are experiencing video fatigue, longer workdays, and erosion of work-life boundaries — all challenges to wellbeing for a profession already suffering high rates of burnout."

Here are four main strategies to help reduce the unintended impacts of telehealth, according to Dr. Rotenstein and Dr. Friedman.

1. Preserve the clinician-patient relationship. Ensure equitable access to telehealth services by providing digital assistance and language interpretation services, lending patients the necessary hardware and provide Wi-Fi access. For example, UC San Diego Health medical students taught patients how to use telehealth platforms and troubleshoot access problems early on in the pandemic so they can easily stay connected to their care team.

2. Build up patient and families engagement. Drawing on the abilities of mobile technologies and Bluetooth-enabled devices helps providers bring remote monitoring to patients who may not need inpatient monitoring but would benefit from extra attention. There are many opportunities for patients to measure their own vitals, symptoms and heart health at home.

3. Avoid creating extra work for clinicians. Telehealth services must be carefully managed to avoid clinicians having to take on extra work; virtual visits shouldn't be added on top of a full slate of existing clinical responsibilities and systems must be interoperable to avoid duplicate information or work requests flowing in from multiple channels, such as messaging, remote monitoring and virtual and in-person visits.

4. Don't build walls. As health systems across the U.S. develop their own digital health tools, they must design them to be compatible with other applications or systems. By creating incompatible systems, virtual patient data gets locked within one application or system.

Dr. Rotenstein is the assistant medical director of population health and faculty wellbeing at Brigham Health, and Dr. Friedman serves as associate dean for clinical affairs and interim chief of general internal medicine at UC San Diego Health. The co-authors also acknowledged Dave Chokshi, MD, health commissioner of New York City, for initial discussions about the article's topic.


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