Ramping up telehealth, from adoption to optimization: The importance of raising patient awareness

Although telehealth has been around for years, patients aren't always aware of the array of virtual services available to them. In short: It's up to health systems to make telehealth capabilities known.

A number of health systems are no longer looking to merely implement telehealth solutions. Instead they are focusing on leveraging capabilities across the entire care continuum.

In a Feb. 8 webinar sponsored by Avizia and presented by Becker's Hospital Review, Shawn Farrell, Avizia's vice president of business development, analyzed findings from its 2017 "Closing the Telehealth Gap" report with insight from NewYork-Presbyterian Hospital's Peter Fleischut, MD, chief transformation officer, and Jessica Zhang, innovations team manager, as well as Martin Doerfler, MD, senior vice president of clinical strategy and development for New Hyde Park, N.Y.-based Northwell Health.

For its report, Avizia — a telehealth solutions provider — commissioned two surveys to better understand the attitudes and challenges surrounding virtual care. The first survey honed in on the patient experience, targeting 403 consumers, while the second sought input from 677 providers.

Avizia found that although hospitals and health systems are rapidly adopting telehealth by investing in infrastructure, training and process reorganization, consumers still have questions about virtual care, such as how to access it or whether their insurer will cover it.

"[Because] consumers still see many barriers to telehealth ... there has been low utilization and that's due to awareness, uncertainty and, as a result, health systems experienced unsatisfactory results on return on investment with these programs," Mr. Farrell says. As a result, hospitals are developing more robust strategies to drive the use of telehealth and meet their strategic goals.

How are NewYork-Presbyterian and Northwell using telehealth?

Neither NewYork-Presbyterian or Northwell wanted an episodic, transactional telehealth program. Instead, they opted for one embedded throughout the care continuum.  

"We historically have not done a lot in telehealth," Dr. Fleischut says. "It is only about in the last two years that we have built our telehealth program. A core component of that has been that we felt we did not want a transactional telehealth program; we wanted to have a coordinated care platform. And in doing so, we felt that it was critical to have a comprehensive suite of services."

NewYork-Presbyterian's NYP OnDemand offers about 50 telehealth programs, including second opinion services, telehealth for express care as well as urgent care, virtual specialty consultations and a mobile stroke unit. Since deploying these services, the hospital — which is affiliated with Weill Cornell Medicine and ColumbiaDoctors, both based in New York City — has seen patient wait times drastically decrease. With telehealth, patients now wait 30 minutes for a virtual emergency room consult as opposed to 150 minutes, and one day to receive a second opinion as opposed to 64.

Telepsychiatry has been one of the most successful services at NewYork-Presbyterian, Dr. Fleischut says. When a patient arrives at the hospital's ED, they are able to receive a psychiatry consult within one hour. He also points to success with the hospital's mobile stroke unit. The unit is an ambulance equipped with a CT machine and video-conferencing capabilities that connect first responders to neurologists. Stroke patients are now able to receive care en route to the hospital, saving nearly 140 million brain cells with each telestroke consult.

Similarly, at a system with a reach as wide as Northwell's, peer-to-peer telehealth is imperative. Dr. Doerfler stresses the success of Northwell's eICU, which began in 2004. The eICU program is now in 12 ICUs at 11 of Northwell's 23 hospitals, and it treats 160 patients each day with an adjusted mortality rate of about 20 percent.

Working with Avizia, Northwell is now expanding its direct-to-consumer services. "We believe the future is any patient, anywhere with any provider," Dr. Doerfler says.

The health system is moving beyond the traditional urgent care virtual visits and instead pushing for a fully virtualized care continuum. For example, if a parent calls in with a sick kid, Dr. Doerfler says he wants to help that patient see their pediatrician virtually, rather than be assigned to a pediatrician who is unfamiliar with their case.

How aware are patients of telehealth?

While patients may not yet use telehealth as frequently as they can, those who do are pleased. Of the 18 percent of patients Avizia surveyed who indicated they have used telehealth, nearly 55 percent said they received care faster and with shorter wait times, 43 percent said it reduced their out-of-pocket costs and 25 percent said they gained better access to care specialists. However, many — 82 percent —  are simply not using telehealth.

"Of the 400 consumers that responded [to our survey], over 300 … are not using telehealth," Mr. Farrell says. "More than half said they just hadn't had the opportunity … [and] a third said they preferred in-person encounters, while some were concerned about the out-of-pocket costs and whether it was covered by insurance."

These findings are in line with what health systems are seeing, too. Both Northwell and NewYork-Presbyterian agree raising awareness is a top telehealth challenge. Dr. Doerfler explains that patients are generally only aware of urgent care virtual offerings, which are often more transactional. And the limited number of people receiving telestroke or eICU services may not even understand their care had been provided virtually.

"I think until we have integrated this into routine care, and people are seeing their own providers via telehealth who are offering telehealth as a component of how they deliver care to the community, we're not really going to see this change," Dr. Doerfler says.

How can providers raise telehealth awareness?

Dr. Doerfler and Ms. Zhang agree that patient awareness and interest in telehealth peaks when providers integrate telehealth services into patients' everyday care experience by offering a multitude of telehealth options. In fact, NewYork-Presbyterian has seen a 580 percent growth in visits over 2017.

"What we are doing is really making telehealth part of our care delivery standards, regardless of whether you are in the ED or in an outpatient setting," Ms. Zhang says. NewYork-Presbyterian is also trying to engage providers to improve patient awareness of telehealth.

Another key to accelerating patient awareness, Dr. Fleischut says, is NewYork-Presbyterian's array of collaborations. It's no secret patients want to been seen where they are — in other words, on their mobile devices. NewYork-Presbyterian has partnered with Samsung and Zocdoc to roll out its mobile apps, as well as with Walgreens to create mobile telehealth units.

It's time to take a new approach

Avizia notes consumer demand is not necessarily the driving force behind telehealth investments. Rather, health systems are looking to expand patient access to and familiarity with telehealth.

"The vast majority of the country is looking at this from a siloed approach — if I am doing stroke, or behavioral health, or urgent care — not really putting together the entire continuum of care," Dr. Doerfler says. Flipping that mindset could be the key to telehealth success.

To listen to the webinar recording, click here. To view the webinar slides, click here.

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