For years, this industry has been talking about how telemedicine was going to move a significant amount of outpatient care from the traditional healthcare setting into a “care anywhere” model. Discussions considered the impact that an uptick in telemedicine would have on access to care and care delivery and how this would affect the buildings where healthcare is delivered. Yet, over all of these years, only incremental progress was made to truly incorporate telemedicine into practice. There were constant hurdles, ranging from regulations to reimbursement to the comfort level of patients and care teams adapting to a new way of doing things. Then the COVID-19 pandemic hit and, overnight, mountains were moved.
By the end of 2020, virtual care visits are expected to soar to more than 1 billion, according to Forrester Research. Yet, the research states, only 24 percent of U.S. healthcare organizations had an existing virtual care program in place at the start of the year.
Though telemedicine has its limitations that come from not physically being in the same room as the patient, such as taking vitals and listening to a patient’s heart and lungs, the challenge of providing outpatient care during a pandemic served to heighten the benefits it has to offer, as well. Some systems credit the rapid adoption of telemedicine with allowing them to work quickly through large backlogs of patients who had been waiting for in-person visits. It’s also been a critical tool to help slow the spread of COVID-19 by limiting caregivers’ and patients’ exposure to infectious diseases including COVID-19; lower the cost of cleaning between patients; and provide an easier and safer way for frail, elderly, less-mobile, and high-risk patients to receive care. Telemedicine has also served as a helpful tool for screening and triage, with nearly 900 million of the more than 1 billion telemedicine visits expected this year to be related to
COVID-19, according to Forrester.
What isn’t known yet is the quality of these virtual visits and the impact they may have on long-term outcomes versus in-person care. University of California San Francisco Health (UCSF) has been providing telemedicine services since 2015 but saw a dramatic uptick in participation with the onset of COVID-19, jumping from 3,600 visits in February to more than 50,000 in April. Seeing an opportunity, UCSF is in the
process of analyzing data collected during these visits to ascertain if its platform is improving access to services for those who weren’t previously receiving care. Other healthcare systems, like Geisinger Health, are working to uncover if certain conditions are more easily addressed through a virtual platform than others. They’re also embarking on a study to see if readmission rates and emergency room visits are impacted differently for patients who saw their care providers virtually.
From a design standpoint, we need to better understand how aspects of the physical space, such as lighting and camera placement, affect outcomes, especially around critical issues like diagnostic clarity. We also need to understand what the long-term impact of telemedicine might be on brick-and-mortar real estate dedicated to in-person visits. The Centers for Medicare & Medicaid Services is currently providing reimbursement flexibility during the pandemic, allowing telemedicine to be more financially feasible. Whether that will be a permanent change is still to be seen.
In September, The Center will be holding a day-long virtual workshop, “Telemedicine: The Genie’s Out of the Bottle,” that will feature what we’ve learned to date, including policy changes, design best practices, and relevant research, and will spotlight innovative new models that are starting to emerge. Because the workshop will be limited in size, we’ll have the opportunity to break into small virtual groups to problem solve and learn from one another. For more information, visit healthdesign.org.
Just a few months ago, telemedicine was on the “near horizon.” Now, with a worldwide pandemic, we’ve been pushed to learn quickly how to produce the same level of care as in-person visits when it comes to patient experience, quality of care, and privacy in telemedicine. The consensus of opinion is that we likely won’t stay at the level of visits that we’re at now, but it’s clear we’ve hit a watershed moment and telemedicine will continue to be a more integral part of our care system moving forward. It’s important that we spend the time now to get it right.
Debra Levin is president and CEO of The Center for Health Design. She can be reached at dlevin@healthdesign.org.
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