As we're all too aware, the pandemic has accelerated measures to meet increased demand for virtual care. Telehealth utilization rose rapidly in the first few months after March 2020 and has remained higher than pre-pandemic rates. But apart from behavioral health services, telehealth rates have since declined from peak levels. And while there has been growth in virtual care delivery within the past year, telehealth for specialty services is overall less mature than for primary and behavioral health care.
Despite this, providers remain interested in expanding their virtual specialty care services, even among specialties that don't currently have robust offerings. Below we'll explore the strategic imperatives for three main applications of virtual specialty care from most to least mature.
IT governance: Stopping the “Yes Machine”
1. Remote patient monitoring
Use cases:
Remote patient monitoring (RPM) refers to the collection and transmission of clinical data to providers outside traditional settings, and among the virtual specialty care applications we explore here, it is the most mature application. Although estimates suggest that only 37% of U.S. institutions offer RPM pathways, patients and providers express high satisfaction and confidence in using RPM particularly for managing chronic conditions.
Around 70% of provider practices surveyed reported increased revenue and higher patient satisfaction from implementing RPM pathways. Among patients, digital tracking is most used to monitor heart disease, diabetes, and obesity, and studies indicate that tracking can effectively manage heart failure and type 2 diabetes.
Implementation imperatives:
One of the most important strategic imperatives to scale RPM programs is centralized decision-making to design and implement standardized risk assessment protocols. These protocols screen for at-risk patients who may benefit from remote monitoring programs from the outset.
Coordinating initiatives to educate physicians on the use and benefits of remote monitoring is also key in alleviating concerns and supporting RPM implementation among providers, if wider spread access and use of the tool is a goal of your organization.
Read more in: Telehealth: Scaling Remote Patient Monitoring Programs
2. e-Consultation
Use cases:
Less frequently adopted than RPM are e-Consultations or e-Consults. Here we're not referring to virtual visits between a patient and specialist, rather asynchronous virtual services where a physician requests a second opinion for diagnosis, treatment, or symptomatic management from another provider. Historically, most e-Consults occur between the requesting PCP and a specialist, which can improve access to specialty care and obviate the need for patients to schedule face-to-face consults themselves in some situations.
Based on research on the Veterans Health Administration, the nation's largest health system containing the most extensive data on e-Consults, around 10% of specialty consults are performed as e-Consults. For some specialties, like hematology and gastroenterology, this rate is even higher, with more than one in five consults completed as e-Consults.
Implementation imperatives:
Especially as systems gain more experience conducting e-Consults, it is key to create referral guidelines, to help providers assess which cases are most appropriate for e-Consults. Such risk-stratification protocols can upskill PCPs to tackle more specialty cases, reserving more complicated cases for the consulting provider to treat. Leadership should work with clinicians to devise referral protocols, and can also appoint invested physician champions to ensure protocol adherence.
3. Virtual treatment technology
Use cases:
Lastly are virtual treatment technologies, which are just starting to proliferate across specialty care. One promising application is home-based physical therapy to provide rehabilitation to patients following surgeries, like total knee arthroplasty.
The FDA-approved Virtual Exercise Rehabilitation Assistant (VERA) tool features a digital coach that models therapist-approved exercises for the patient. VERA is equipped with 3D-tracking to assess patient movement and provide feedback. This tool is used with weekly virtual sessions with a physical therapist, who tracks the patients' performance and communicates the data with the surgeon. Virtual reality (VR) is another frontier for virtual treatment delivery, particularly for pain management and PTSD treatment.
In 2021, digital therapeutics company AppliedVR developed EaseVRx, an FDA-approved prescription treatment for chronic lower back pain. EaseVRx uses VR to deliver evidence-based techniques, such as cognitive behavioral therapy, to ease pain. VR treatments are expanding to other areas and include treatment of amblyopia and a potential ADHD treatment.
Implementation imperatives:
To scale virtual treatment programs however, systems need to implement strong EHR integration capabilities to monitor and communicate treatment among providers. To achieve this, it is important not only to focus on technical implementation, but also to establish strong leadership oversight. Engaged leaders, who keep a strong pulse on clinician's preferences, can placate resistance and ensure that the EHR is customized to meet provider-specific needs.
RPM, e-Consults, and virtual therapeutics are bridging the gap between virtual and in-person care, an important trend as organizations gauge how they will integrate virtual care into traditional care pathways. With systemic improvements triggered by the Covid-19 outbreak, we expect more innovation to disrupt the virtual landscape and find its way into specialty care delivery.
The success of a CIO and the IT department hinges on the effectiveness of their governance process. But our surveys show that most organizations struggle with IT governance. Too often, non-IT leaders work around—rather than through—the governance process, or the governance “Yes Machine” approves more initiatives than can be completed within a reasonable timeframe.