How has patient trust in virtual care changed over the last two years of the COVID-19 pandemic?
I think patient trust is shifting dramatically because many patients, consumers, and citizens have used telehealth during the COVID-19 pandemic and are feeling more connected to their providers and better cared for. According to some statistics from the United States, Medicare recipients – people who are primarily 65 and older – were satisfied or very satisfied with telehealth services: 83% thought that the telehealth visit quality was quite good.
Trust continues to increase the more people use telehealth, and with the profoundly good outcomes, people are experiencing from using virtual care. But of course, there is still room for improvement in the user experience - both regarding in-person and virtual visits. We also need to strengthen the level of health literacy and digital health literacy so people know how to better navigate digital health services. These issues also impact trust.
Despite the recent acceleration in the uptake of telecare, what barriers still hamper its scaling?
At least in the United States, from a regulatory and policy perspective, we talk a lot about broadband and the ability for people to connect to the Internet easily. That's the most obvious thing we have to solve.
But we also have legislative issues here in the U.S. that create problems for consumers accessing virtual care. As the American Telemedicine Association, we want to make sure those barriers are removed at the federal and state levels.
Using technology just to replace a one-to-one visit is not a solution.One of the restrictions in the U.S. is that you have to be in a specific location to receive virtual care services that are reimbursed – this rule came out in 1997, 14 years before the iPhone was invented. However, during the pandemic, we found that technology could deliver care in ways we perhaps never imagined. Now, it's time to remove the out-of-date regulatory, legislative and technical barriers and improve affordability. Many things have to be changed in terms of interoperability and seamless data exchange to make telecare easy for physicians. We should start thinking of technology and telehealth as an enabler, and an accelerant of ensuring everyone gets care where and when they need it. So what is your call to action for policy-makers to harness the potential of telecare? We've had long-standing problems with access to care in the United States, inconsistent rollout, or availability of high-quality, evidence-based medicine. We know that technology can make this easier – we cannot certify enough clinicians fast enough to satisfy the growing needs of both the U.S. population and the population worldwide. Using technology just to replace a one-to-one visit is not a solution; we have to replace it with a sustainable, fully integrated one-to-many care model. And that's what's exciting, for example, about remote monitoring because that's exactly what it does. In practice, it means that a doctor or nurse has access to a dashboard to compare real-time patient data with clinical parameters that can quickly identify when patients really need help so that their provider can intervene before they need to visit the hospital or emergency department. Telecare improves access to care but also can lead to limited access to digital care for those who do not have access to the right technology or the knowledge of how to use it. Yes, access to care is a significant problem we have addressed at the ATA by establishing an advisory group to explore how the use of telehealth can eliminate disparities. As a result, we've created a framework that identifies levers that, when addressed, can eliminate these gaps. At the top of the framework is a notion of connectivity. Many more issues must be addressed, like the affordability of devices and the challenge of digital literacy. From my perspective, connectivity, affordability, and literacy are global problems that became even more visible during the pandemic. In the upcoming years, some challenges will gain importance: uneven health services distribution, an inadequate workforce, and workforce burnout. What are critical successes/stepstones you've achieved as an association to make telecare more accessible? We have been focused on a couple of things. One I touched on – the policy and advocacy work, and that's obviously very important. We have made great progress with both state and federal policy initiatives, and we will continue to work in that domain. The second area that we consider essential to address is access to care. We must ensure that we do not contribute to the digital divide but rather close it. Then we need to clearly identify when digital care is appropriate versus when face-to-face visits are necessary and when a hybrid model that includes both in-person and virtual care is the most beneficial. We shouldn't just push telecare; we have to develop a sustainable model of care with telecare as one of the options. Let's take a look into the future. How, in your opinion, will telemedicine evolve over the next three to five years? Consumers are going to continue to embrace – and even demand – virtual care services and continue to benefit, become more engaged in their care, enjoy better outcomes and quality of life, and appreciate a more convenient care experience. The ATA is working diligently to ensure that the necessary legislation and regulations be put in place to support telecare enrolment for the future. We will also see other technologies being applied in healthcare and that fall within the broad rubric of telehealth, such as artificial intelligence, the use of wearable technologies and machine learning. As these technologies scale, providers will increasingly become adept at leveraging these tools, which should help address issues of burnout and build resilience among our healthcare providers.
