The big risks for health systems as more care goes virtual

The uptick in telehealth and virtual care has many benefits for patients during the pandemic. But there are also challenges and risks.

Here, eight CIOs and IT executives answer the question: What are the challenges and risks for health systems and physicians as more care goes virtual?

Heather Nelson. Senior Vice President and CIO of UChicago Medicine: Reimbursement. CMS keeps kicking the can down the road, which has been great for us, but it would be even better if they formally acknowledge and 'put in stone' the payment models so we aren't worried the reimbursement is going away. It will be a harder sell if the reimbursement isn't there.

Patient access to technology and the internet is another challenge. In urban settings, there are pockets of the community where there are 'Wi-Fi deserts.' While most patients have cellphones, sometimes their connection isn't great, and it makes for an unpleasant engagement between the provider and the patient. It can be frustrating. IT can control what is happening within the four walls of the hospital or the clinics and practices, but we can't control what is happening within the four walls of a patient's home.

Todd Czartoski. Chief Medical Technology Officer at Providence (Renton, Wash.): The biggest drivers of telehealth will be the move to value-based care and the willingness of CMS to extend COVID-era provisions which allow for expanded reimbursement. Within this framework, it is also likely that we will continue to see a significant variability in utilization by discipline. Cognitive fields, such as behavioral health, will likely continue to utilize virtual care more.

The value of a team approach to caring for patients and populations will continue to emerge, especially as providers may choose to work remotely. The clinic-based practice we have known for years will be less recognizable as roles shift and automation and asynchronous care drive efficiency into the care model.

As a society and health system, we must remain vigilant about safety and security. Providence has been doing virtual visits for 15 years, but nothing close to the scale of 2020. This year will exceed 1.6 million face-to-face telehealth encounters. As this has moved into a mainstream care delivery modality, we continue to develop and refine standards for best practices in virtual care.

Audrius Polikaitis. CIO of UI Hospital & Health Sciences System (Chicago): One challenge is ensuring that quality of care remains unchanged through this virtual care transition. Certain specialties absolutely require physical examination and assessment. Very personal discussions of life circumstances and barriers to wellness are likely not as effective when not face-to-face. I am not sure whether true empathy can be effectively conveyed over a mobile device or video monitor. There is still a personal element of healthcare delivery which entails the trusted relationship between patient and provider. I am not yet clear whether this type of trusted relationship can be established solely in the virtual realm.

Tara Matthews. CISO of Einstein Healthcare Network (Philadelphia): The challenge for the health systems and virtual products is to improve data-sharing and interoperability, not to mention cybersecurity risks regarding networks, devices or otherwise. From a physician perspective, workflow redesign will be needed as we move toward a more consumer-centric model in addition to soft skill training to remain connected and provide empathy while engaged in the virtual setting.

Rich Temple. Vice President and CIO of Deborah Heart and Lung Center (Brown Mills, N.J.): Virtual care is a great equalizer, inasmuch as health systems will find themselves enmeshed with a whole new set of competitors – retail stores, pharmacies and other entities providing cloud-based virtual care. These entities generally don't carry the same overhead in terms of salaries or physical plant costs as health systems do and can provide very satisfactory primary care at a very competitive price point. Virtual care also lends itself to be more preventive in nature, which is a great thing from a public health perspective, but real-time monitoring of chronic diseases can result in a reduction of some of the high-margin services that health systems count on to keep the lights on.

Striking the balance that allows health systems to continue to thrive by finding the most appropriate niche for themselves in a changing healthcare landscape is going to be one of the big strategic imperatives for not just health systems, but public health, in general.

Jonathan Witenko. System Director of virtual health and telemedicine at Lee Health (Fort Myers, Fla.): Not every patient, service line and circumstance is right for telehealth. Therefore, finding the right balance for both patients and caregivers will be the biggest dance over the coming months and years.

Lonnie Johnson. CIO of KVC Health Systems (Olathe, Kan.): While I see many potential challenges that could create speed bumps, there are four I feel will be consistent across most organizations. They are HIPAA, cybersecurity, adequate technology and reimbursement.

Ensuring that HIPAA compliance is being maintained in the homes of the provider and even the patient can be challenging. Ensuring that conversations with protected health information, especially diagnosis information, is contained to healthcare works in the home only, and not their relatives and friends, can be risky, especially during a video conference. Additionally, written and digital documentation in eyeshot of nonclinical individuals in a home is a huge risk.

Home networks and unencrypted personal devices can create vulnerabilities for many small- to medium-sized agencies that may not have the cyber acumen to adequately manage all the risk of a breach into the network or unauthorized access to information on home devices.

Adequate technology creates a challenge for the remote worker and the patient in that they may not have satisfactory internet bandwidth to carry the video conferencing. Having good modern devices with proper screen size and video capacity would be another challenge. Finally, having the right software to do telehealth could be a third challenge with technology.

Lastly, I see reimbursement as the final challenge. Getting reimbursed for telemedicine services can be a problem for some healthcare providers and physicians.

Raymond Lowe. Senior Vice President and CIO of AltaMed (Los Angeles): Virtual care will support consumer-centric healthcare and allow for timely treating patients where they are most comfortable — in their homes. There are three areas we should consider:

1) The current legislative process regarding telehealth reimbursement in this pandemic. If we relapse and lose current progress on reimbursement (the trend in California is not supportive of telehealth anymore), this may significantly reduce the amount of telehealth from peaks of 50 percent to 60 percent down to 10 percent.

2) From a technical perspective, we need to consider the patient's technological aptitude, or the physician or care team could end up being the IT help desk to assist the patient. For underserved or rural areas, there may be gaps or spotty coverage of cellular or Wi-Fi that will preclude patient participation in virtual care.

3) Physician bonding may suffer with the provider and patient not having a trusted, almost familial relationship. Patients traditionally want a doctor that they know and that knows them, so a blend of both traditional and virtual care may be the best solution.


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