Telemedicine and the Patient Experience

       Video-based telemedicine is being adopted by healthcare institutions, physicians andsmartphone-2471545_1920 advanced practitioners at a significant pace.  This is driven by the ease and convenience of use as well as opportunities to improve access and decrease cost.  There are new useful tools that improve the telemedicine experience that allow physicians to listen to a patient heart and lunge, check blood pressure and even look inside someone’s ear from a great distance away connected electronically.  No one can predict what might be on the horizon for telemedicine.
       As we focus on the technology that allows us as physicians and advanced practitioners to provide telemedicine we must not forget the patient experience.  With attribution to Amazon’s Jeff Bezos, we should focus less on what will change and ask what will not change?  What will not change about the patient experience in a video-based telemedicine encounter compared to an in-office encounter?  What will be true about a patient wants today and in the future, regardless of whether that visit takes place in real-space or cyber-space?  There are several key points about the patient experience to remember.

 

Distracted Doctoring: Patients want to be the center of their physicians attention when they seek medical care.  They want to know that their provider is there for them and allowing them to tell their story.  My own patients will let me know, sometimes subtly and sometimes not, when they think I am looking at my computer more than them.  All healthcare providers can fall into that trap of reviewing the chart and starting their documentation while trying to listen to their patient.  This is no different for telemedicine video visits.  Focusing on the “second-screen” with an EMR, a telemedicine provider can seem just as distracted.  Multitasking with your patient lessens the patient experience online and in person
Quality Medicine: No matter the venue – a medical practice office, hospital or virtually from home, all patients seeking care just want to feel better.  They need a physicians or advanced practitioner with excellent clinical acumen.  One can not expect that telehealth will always be low-acuity, easy diagnoses.  High quality medical care also incorporates education and motivation that provides patients with the tools to reach their health goals.
Relationships Matter: Trust is the foundational reason that patients continue to visit a specific provider.  They trust that they will be seen, trust that appropriate tests will be done, trust that their physician will place their best interests first and trust that they will feel better.  It takes time to develop that trust and in a field like telemedicine where a patient may never see the same provider on a regular basis, the relationship is developed with the brand itself.  Standardized operations providing consistently good service will help reinforce positive experiences and create a repeat customer.  Just like in regular clinical practice, that trust is communicated to family and friends who can promote the use of the brand.
Cost: Patients are increasingly bearing the costs of healthcare.  Insurance companies are shifting that burden to patients who are having to become experts in their own insurance plans and cost-conscious consumers.  Price transparency is an important factor for patients making decisions.  They are looking for cheaper and more cost effective ways to seek healthcare.  The allure up-front pricing of telemedicine options allows patients to make more informed decisions.  Price transparency will continue to change patient consumer behaviors virtually as well as in clinical practice.
Time:  In medicine, it seems there is always too little or too much time.  The benefits of telemedicine will be diminished if it falls down the same path as outpatient medicine.  If the wait time to obtain an appointment it too long, if appoints are delayed by physicians and advanced practitioners running behind or if there is a delay in the next step in diagnostic testing then the patient really was no better on virtually.  If the patient is feeling rushed by a distracted physician, if they can not discuss all the medical issues they have and have no time to tell their story then the convenience of telemedicine is diminished.
       Focusing on the patient experience through the virtual healthcare landscape can sharpen the focus for any telemedicine provider.  Successful integration of the technological advances we will encounter depend on continuing to provide the the patient what they need first.
(This post was originally published on for the ATA18 Connectors Blog.)

Digital Springtime

       Spring is here and that brings thoughts of blooming plants and warmth, growth and

Spring Monet

Spring by Claude Monet

regeneration.  Everyone tends to revere spring, things are new and the cold dark winter is ending.  For me the winter coincided with a a rather trying period of time in my real day job.  While I love writing and blogging and learning everything I can about Digital and Connected Health, my day job doesn’t really involve a significant amount of that field.  Recently there have been numerous work priorities that involved a significant amount of my time and what time was left I dedicated to my family.  So my site here has been sitting fallow for a little while.

       By thinking about what topics to cover next, I found myself asking the question, Do I really even care about Digital and Connected Health?  Is it that Digital Health can fundamentally change the landscape of healthcare or am I seduced by the luster of technology?  Am I sucker taken in by the shiniest new objects in medicine?
       The truth is I don’t think there is a technological solution to every problem and that is especially true for medicine.  Technology in medicine does circumvent the modern behemoth that the American healthcare system is can speak directly to the people seeking care, our patients.  What I am most passionate about is Access to Medical Care and Patient Empowerment.  That is where our current system has failed and where Digital and Connected Health can lead.
       We now work as Physicians and Advanced Practitioners and we are patients in a system that is built on the infallibility of Physician.  It is a “Just Trust Me” model.  Do what I say and things will be fine.  For a myriad of factors that system is just not tolerated any longer but most people still have to seek care from his system.  Patients have to navigate this system as best they can.  Right now though patients want more control, more information and to take charge of their healthcare journey.  They want to make their own choices.
       The burden of paying for healthcare has been shifting towards the patient as well.  They are shouldering the cost of the care they receive and want a greater voice in how they use it.  Some people choose to exert control by not seeking care at all, eliminating interaction with a system that bypasses their wishes and is often unaffordable.  Others may seek alternative healers than the traditional modern doctor, who offer simpler options for patients to take more control.
       What limits patient access and empowerment today?  What about just asking your physician a question without an appointment?  Most people would laugh even at the thought.  It is not that as physicians we do not want to discuss important matters with you but often times we just can not find the time.  After a long day in my practice, a full day being 20-24 patients, reviewing lab results, refills medications and then actually charting and billing for visits there just isn’t a spare moment to eat lunch, let alone have conversations over the phone.  It may have a huge impact on a patient to talk through a medical issue, but spending 10-15 minutes of uncompensated time just isn’t viable for most physicians on a daily basis.
       What about being able to actually come into the office to have an appointment?  Most Physicians are booked out for weeks.  Many doctors wear that as a badge of honor and their administrators like to see that demand.  What happens to that patient that needs to be seen today, who needs advice and care and the biggest impact for positive change is today?  Will the impact of the message about their health be the same in 3 weeks?  Where else will they turn for information and care?  What about refills for chronic conditions that are vital for longevity but as a healthcare system we determine that you need to come into our office, our space, follow our rules just to keep you blood pressure in good range?  Hard to take a day off from work? Sorry we don’t see patients after 4pm.  We don’t open on Saturday.  Holidays?  You must be joking.
       Digital and Connected Health can be the flexible solution patients need.  They can take charge of their own health with newer tools that empower them and work outside the current unofficial rules just discussed.  Can’t get into your physicians office for weeks?  Well there is a telemedicine group ready to take your video call right now.  You can choose the time and you can do it from your desk at work over lunch or at home on your couch after your shift at work.
       Do you need a refill on birth control but it has been a year since your last PCP visit?  Well, you could wait another couple weeks or use an app on your phone to connect with clinicians who can review your history and prescribe the medication you need.  On your time and your direction.
       Those medical questions you have, the resources are endless.  It is almost cliche to refer to “Dr Google” but who doesn’t use a search engine to find necessary information before making any decision?  You can spend hours researching the car you want to buy before ever having to set foot in a dealership.  Between WebMD, Mayo Clinic, Patients Like Me and numerous other medical sites, finding detailed and relevant information has never been easier.  (Check out this post.)  No one has to wait for their physicians medical assistant to call back and relay a generic message.  No waiting for an appointment.
       Our current Healthcare System does not have the needed incentives for all parties and enough inertia to provide the broad access to care and empowerment of patients that we need to have an impact.  Digital and Connected Health provides everyone with an option that can empower everyone to access the care they need when they need it.