Back to the Basics: Telehealth in the age of COVID and Beyond

When we encounter something unfamiliar and new to us - we often find ourselves going back to the basics. These fundamental principles provide the foundation for our understanding and serve as a starting point for expanding our thoughts and ideas.

Long before COVID-19, many medical and allied health professionals have been starting to recognize the value of adding virtual care to their existing brick and mortar practice. Specialties like occupational health, cannabis clinics, midwives, physiotherapy, nutrition, dentistry, speech pathology, and mental health have found that virtual care can enhance their practice.

According to Dr. Eric Wallace, medical director of telemedicine at the University of Alabama, rescheduling essential care 1-2 months out in advance was impossible during COVID-19. Healthcare workers were already working at 100%, and it was not realistic to have them try to catch up with backlog months down the road by working them at 200%. The only possible way to provide care and minimize risk of exposure was through telemedicine. Dr. Eric Wallace notes that while he still enjoys physical visits, he successfully treats his patients online, looking at swelling, breathing, and analyzing individuals' eyes and mouth. He predicts that two years from now, 40-50% of all appointments will be online and that all appointments should be accommodated per patient request, in either case, should they want to use telehealth or a visit in person.

Here, we thought we would provide our input on the eight fundamental truths (including its benefits and challenges) about telehealth.

1. Telehealth breaks down barriers to accessibility 

As the literature from Pediatric Research has shown, telehealth allows providers to practice in a wider geographical range and significantly increases access to underserved areas. Offering a telehealth option can encourage patients with busy lives to maintain consistent appointments to improve their overall health and wellbeing. By eliminating the dreaded commute, that we're all so familiar with, or perhaps the need to find childcare at the drop of a hat - telehealth can make attending an appointment as simple as clicking a button. Virtual sessions for kids can be especially advantageous. As long as the platform is easy to use, virtual care can easily reach kids on the devices they are already familiar with and may already be in their hands. With such convenience and not having to depend on family members to get them to their appointments, kids can engage with providers with comfort and normalcy that can surpass some adults. 

For a provider, telehealth can present the opportunity for increased outreach. Additionally, providers can continue to support their patients as they go through the ups and downs of life, and when they need the most support. Imagine a child being able to retain their beloved speech-language pathologist while moving to a new school and adjusting to many changes. That is the power of access anywhere!

2. Virtual care is effective 

There is a growing body of research demonstrating the effectiveness of offering virtual care and teletherapy. It can be equal or, in some cases, more effective than in-person depending highly on the barriers the virtual care helps to overcome. For example, a study in the journal of telemedicine and telecare sought to make a direct comparison between virtual psychiatry appointments and in-person psychiatry appointments and found that after one month, "Telepsychiatry clients felt that they could present the same information as in-person (93%), were satisfied with their session (96%), and were comfortable in their ability to talk (85%); this was similar to the in-person clients."

3. Can enable better work processes 

Technology has made it easier than ever to run a healthcare practice online. From automated patient reminders to secure document sharing, & automated intake forms; the options are endless. Providers can focus their attention and time on connecting with patients. Providers should be able to access a dashboard that allows them to update their appointment availability so that anyone who wants to book an appointment can do so without the need to call the office, clinic, or provider. Automated patient reminders will keep the patient up to date and avoid the risk of no shows. Both parties should easily be able to access the video call without a download, anytime, and anywhere.

Now all the healthcare provider needs to worry about is connecting and helping their patient. When systems work well, there should be a minimal amount of effort required to set up and manage a patients’ appointment.

4. Enables easier collaboration

Using virtual care allows providers to collaborate with other providers, multidisciplinary teams, third parties (eg. support person, family members, or translator) in one group session to provide better care for patients. 

Also, screen sharing is an excellent opportunity to increase collaboration because a provider or patient can easily follow along on the screen, whether it's a presentation, demonstration, training, or providing guidance. When a patient has access and visibility to the notes that a provider may take, it allows them to feel more engaged and in control of their healthcare plan.

5. Better work-life-balance for providers 

One of the most significant benefits of telehealth is the flexibility it can create in providers' schedules. As a provider, by choosing your schedule, you can have more control over your practice. Having the option to work from home can provide that much-needed break from external physical stimuli, and also long commutes. You can plan your day around personal matters in your life, whether that be picking up the kids from school, running errands, or taking the time to relax and prevent overburn.

The Challenges with telehealth 

If we're keeping it real, we have to admit that some fundamental challenges also accompany telehealth, impacting both patients and providers. Here are four challenges that are faced and how one can over come them. 

6. Emotional connection can be more challenging to establish 

Establishing bonds and building rapport using technology has long been discussed in our increasingly digital world. Fortunately, this isa challenge that we can overcome with just a bit of extra consideration. There are tips and tricks scoured throughout the internet, highlighting the importance of good lighting, camera positioning, and eye-line angles. HD videoconferencing allows you to engage in a real-time conversation where you can see one another rather than audio alone. Video calls allow for the context of body language and nonverbal cues to still play a prominent role in communication and have been found to increase bonding compared to audio-only significantly. 

7. Can patients easily find privacy outside the provider's office?

Some patients may not have access to space where they can conduct their sessions in complete privacy. For example, therapy sessions may not feel safe and secure if patients do not think they can speak freely.However, there are tips that providers can offer their patients to best ensure patients feel safe. This includes offering secure messaging as an alternative to a voice or video call. As telehealth plays a larger part in healthcare delivery, it is essential to be mindful of this barrier that some patients may have. Checking in with patients at the start of each session and in some situations having a “code word” may be a helpful way to gauge the level of privacy to ensure this is the case. 

8. Not all technology is equal

When including a telehealth solution into a clinic, there are many options a provider has when it comes to considering which virtual care software they should use. However, beware that despite most virtual solutions offering basic teleconferencing, the ease of use for providers and patients, level of security and technical support, and even view on-screen when conducting conference calls can vary significantly. Check out our article on 10things you need to consider when choosing a telehealth platform.

In summary, "the fundamentals" of telehealth remind us that telehealth is about breaking down barriers to access and enhancing healthcare service workflow for the benefit of both patients and providers. However, the ultimate goal always remains to provide better service and care, and sometimes that means going offline. For that reason, we think an online-offline hybrid healthcare offering not only can allow providers to provide the benefits of virtual care in overcoming barriers for the patients who need it but also maintain a connection to their community. For any practice looking to implement virtual care, it is essential to remember that virtual care is meant to enhance your current practice and not necessarily replace it.Take the time and care to choose a solution that offers tailored solutions to best meet the needs of your practice.