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What patients like — and dislike — about telemedicine


As the Covid pandemic swept across the U.S., providers nationwide switched one third or more of their in-person care to telephone and video encounters. While the volume of telemedicine visits has declined in recent months, it’s clear that the technology is here to stay — though there’s work to be done. A national Press Ganey survey that returned 1.3 million completed patient questionnaires found that while patients appreciate the convenience and, perhaps surprisingly, intimacy of virtual encounters, there is enormous room for improvement in the processes of telemedicine.

Across the 154 medical practices surveying both in-person and telemedicine visits between January and August 2020, telemedicine visits peaked at an estimated 37% of all encounters in early May, decreased to 22% in early July, and then leveled out around 15% by mid-August — still far above the pre-pandemic baseline of less than 1%. Overall adoption ranged between 18% to 22% across all age groups up to age 79, falling slightly (to 13%) among those 80 and older.

Even though most clinicians and patients were new to virtual visits at the start of the pandemic, patients have clearly come to appreciate them. In fact, in our survey patients were just as likely — or even slightly more likely — to give high ratings to their care providers after telemedicine visits compared with in-person care. This finding held true across specialties and for all measures of providers’ concern, ability to establish a connection, and trust-building. Among the reasons the telehealth connection seems to resonate with patients is that providers can actually seem more attentive on-screen. One patient commented that while her doctor always seemed distracted by a computer screen during in-person visits, during video visits the doctor looked directly at her. Some providers have also suggested that simply scheduling a televisit can signal a doctor’s attentiveness. As Jon Slotkin and colleagues at Geisinger wrote in HBR, “A shift in patients’ perception of telehealth has perhaps been the most important in increasing adoption, with attitudes moving from, This provider must not think my problem is important since they are seeing me via telehealth, to This provider cares about me and therefore is seeing me via telehealth.

That’s the good news. The bad news is that patients clearly feel that the process of telemedicine (logistical things like ease of scheduling and making audio/video connections) falls short: while 89% of patients would recommend their provider after having had a telemedicine visit, only 76% of patients would recommend a video visit following a telemedicine visit.

What’s needed?

The wide gap between patients’ ratings of the processes of telemedicine and in-person care did not narrow over the six-month period — indicating that improvement cannot be expected to happen organically. From observing how telemedicine is being used around the country, three recommendations can be made about how to accelerate improvement.

First, organizations should develop a central resource team to efficiently scale up telemedicine operations for all specialties and effectively support patient, provider and clinic-workflow needs. This will require redesigning care delivery to support the office flow and staff allocation for telemedicine, just as is done in the in-person setting. To this end, the central resource team should focus on optimizing the technology for video visits, integrating visits into providers’ workflow (e.g., launching from the EMR), and arranging for telephone visits if patients or providers are unable, or reluctant, to use video. (Yale Medicine’s approach to some of these issues provides a useful model.)

Insight Center

Second, aided by the central team, all specialties should develop telemedicine capability to support organizational efforts to deliver a virtual patient experience across specialties. While not every visit can be done virtually, providing this option when possible should become the standard approach (one academic medical center found that at least half of care could be provided virtually). Each specialty should develop protocols for triaging patients to in-person or virtual care, opting for virtual visits when possible to reduce patients’ hassle-factor and free up in-person visits for those requiring them. Specialists should benchmark their telemedicine rates against others in the same specialty, looking for untapped opportunities to provide virtual visits.

Third, providers and office staff should be trained in virtual-care operational and communication practices to support the goal of delivering a consistent, cross-specialty patient experience. For example, patients should encounter a similar telemedicine “rooming” process (where they wait for their clinician to virtually arrive) across the organization. With fewer real-world sources of patient stress to contend with (traffic, parking, and crowded waiting rooms), even organizations in disseminated campus settings have a real opportunity to create a seamless, branded virtual patient care experience.

Using what we have learned from the initial six months of telemedicine during the Covid pandemic, we have an opportunity to accelerate the strategic use and operational efficiency of this tool in ways that can greatly benefit patients, providers, and organizations. Doing so in a strategic and comprehensive way might even accelerate efforts to transform patient experience in ways we have yet to do in our traditional in-person environments.

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