What You Need To Know To Have Successful Telehealth Visits From Home: An Interview for Forbes
It’s no secret that telehealth & virtual health delivery services have exploded in popularity since 2020. In fact, as part of my work as a consultant for Georgia’s Department of Behavioral health & Developmental Disabilities (DBHDD), I helped craft the clinical and operational guidelines for their telehealth roll-out. That experience changed the way I view telehealth & virtual service delivery in healthcare. Ultimately, it helped form my opinion about telehealth and its role in healthcare moving forward.
I was able to sit down with Jamie Gold for a piece in Forbes about telehealth and how patients can best prepare for virtual visits and participate in virtual healthcare services. You can check out that full article here. I figured Id share the original interview questions and answers here below.
What do you see as the biggest advantages of telehealth?
I think, to better answer this question, you must first understand what we mean by “telehealth”. That word has come to mean many things to many people. But the definition I use comes from the Center for Connected Health Policy. They define telehealth as follows:
“Telehealth is a collection of means or methods for enhancing health care, public health and health education delivery and support using telecommunications technologies.
Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Telehealth is not a specific service, but a collection of means to enhance care and education delivery.”
Given that definition, you can see how broad telehealth can truly be. So when I think about the biggest advantages of telehealth, I consider the move to hybrid healthcare; or healthcare service delivery that encompasses both in-person and in-clinic services with digital or virtual service delivery options. A hybrid model of healthcare allows for more accessibility to health services. It allows for more touch points and communication between clinicians & patients. It also allows this to happen at little to no added cost to the healthcare system. And in some cases, the addition of virtual health services —such as remote patient monitoring, secure messaging, and asynchronous service delivery— can actually decrease the overall cost of care in many ways; such as early detection, prevention, and decreasing lengths of stay or courses of traditional, in-person, care. And, as I’ve written about here, telehealth allows clinicians to deliver high quality, high value care across a wider geographic area.
And that leads to another big advantage of virtual service delivery: reducing geographical limitations & borders. The use of technology allows clinicians & healthcare systems to drastically increase their geographical footprint without necessarily having to invest in large capital expenditures like facilities and stand alone clinics.
Which are the biggest disadvantages of telehealth?
Some of the disadvantages of telehealth parallel some of the current challenges in the entire US healthcare system. One challenge is that of technological availability & access. Telehealth won’t do you any good in an area of the country where you don’t have access to the minimum broadband internet service, or the devices to support telehealth interactions. For example, I once spoke to a residential provider prior to a telehealth visit about the tech requirements and the response I received was “Oh, so I’ll need something more than my flip phone?” (yes, even in 2021, there still remains a segment of the population that hasn’t yielded to smartphone technology as of yet).
Another potential disadvantage to telehealth relates to the back end workflows or administrative processes involved with successfully implementing telehealth. Many clinics and organizations tend to approach telehealth and virtual service delivery as an “ad-on” to services they’re currently delivering. But there’s a whole lot of nuance involved when it comes to scheduling virtual visits, preparing for virtual appointments, and communicating/educating patients & stakeholders about telehealth. You can’t simply drop telehealth into your current workflows and expect it to run smoothly.
For example, when I was involved in a project helping Georgia’s Department of Behavioral health & Developmental Disabilities roll out telehealth across their state system for integrated clinical support, one of the challenges we faced was that of informed consent and stakeholder education. We had to develop a unique workflow and process for obtaining informed consent; educating & communicating with stakeholders before, during & after telehealth appointments; and completing the scheduling & administrative tasks involved with ensuring the visits went off without a hitch. All that is to say, that telehealth and virtual service delivery require a bit of planning, thought, and training (both on the provider side and the patient side) to go smoothly & to be effective.
The last disadvantage I see with telehealth is that it can potentially limit the “human” feel of a healthcare encounter. I think of this in regards to my work with Georgia’s Department of Behavioral Health & Developmental Disabilities. Especially when considering behavioral health, trust and rapport must be developed between the clinician & the patient. Interactions over zoom or video call make it difficult for each participant (both clinician and patient) to pick up on microexpressions or minute changes in body language or posture, which may impact the ability of either party to form a trusting relationship or rapport throughout the interactions. Now this is probably on a real major disadvantage in the areas of behavioral health and the like, but it’s worth mentioning.
What types of appointments lend themselves to telehealth? What types don’t?
The answer to this question varies depending on the discipline or specialty of the clinician. For example, as an Occupational Therapist and clinician involved in musculoskeletal rehabilitation, I would say that —in that context— follow-up visits lend themselves to telehealth the best, however there are some practitioners that do 100% virtual care. Initial evaluations, especially for patients who are immediately post-operative and require a physical examination do not entirely lend themselves to telehealth.
Again, though, I think it’s important to consider that telehealth doesn’t simply mean synchronous telehealth. It can also include asynchronous interactions. So someone with, say a rash on their leg, could send an image or video of it to a dermatologist; who could then review it on his/her own time and respond to the patient with their recommendations and assessment results. In an instance like that, an initial examination or evaluation can absolutely be done not only 100% virtually, but also 100% asynchronously; meaning that neither the patient nor the clinician needs to schedule time out of their day to get the pieces in place to do a “live” or synchronous telehealth or in-clinic visit.
What elements should a patient have in his or her home to make telehealth work well (e.g., certain type of wifi, certain type of device or screen, certain type of seating, completely private space, etc.)?
As a general rule, to successfully complete a synchronous telehealth visit (one where the clinician and patient are interacting in real time over a video platform), both parties should have access to a broadband connection with at least a download speed of 15 Mbps and an upload speed of 5 Mbps. You can do video calls with slower speeds, however the video quality begins to deteriorate, which can negatively affect patient engagement & experience with the visit. Obviously, this needs to be a secure connection, however all of the major platforms designed for telehealth have the necessary security measures in place.
From the device perspective, to complete a synchronous telehealth visit, both parties need to have a device with a screen (smartphone, tablet, or computer). Make sure that they’re charged, plugged in, or that you have a power supply at the ready, as some devices deplete battery at a faster rate when they’re used for video conferencing.
Again, when it comes to security, you must also address the environments(s) where services are being provided. For example, educating patients about the importance of making sure they are in a safe, secure environment is important to ensure that their privacy is maintained. This can typically be done by starting every session with a statement similar to “Please be aware that we are communicating on a secure platform and that I (we, if multiple providers) am in a secure & private environment. I cannot, however, guarantee that your environment is secure. In order to maintain your privacy, please make sure that your environment is secure and that no one can overhear information we may discuss during this session.” In my experience, many clinicians don’t stop to think about making sure the patient’s environment is secure. Taking this step does 2 things: 1) establishes a safe/secure environment for service provision and 2) communicates to the patient that the clinician truly cares for and is sensitive to protecting the privacy of the patient. This helps increase compliance, engagement, and satisfaction with services.
What are some findings from your work with Georgia that would inform a patient about whether telehealth is right for him or her, and what they should have in place to make it work well?
After my work for GA’s DBHDD, and other private organizations, the factors that would indicate whether telehealth is appropriate for a specific patient depend on 1) the type of telehealth service being offered 2) the clinical situation being addressed and 3) the technological capabilities or access of the patient.
For example, if a patient is trying to decide whether a to participate in a synchronous telehealth visit to address some dysfunction, such as shoulder pain, the factor that influence that decision include: the type of internet speed/service they have, whether they have access to the necessary device, whether they feel comfortable completing certain shoulder movements on camera to allow the clinician to assess, and whether they’re able to secure an environment where they feel comfortable and secure doing so.
Another factor, which I encourage every patient or clinician to consider, relates to clinician competence or experience utilizing digital services. For example, as I’ve written about here, delivering virtual healthcare services can require clinicians to rely on a different skill set than traditional, in-person treatment. For example, especially in disciplines that rely heavily on physical exams & treatments (orthopedics, chiropractors, physical therapists, etc.), clinicians must address their patient’s issues without laying hands on them. This requires a bit of practice and experience. That being said, if I was a patient that had a physical or musculoskeletal issue, I would want to inquire about the clinician’s experience delivering virtual services in order to determine whether it would be a good fit for me and my situation. That’s not to say that it wouldn’t be a good fit if the clinician had minimal experience with virtual service delivery, but it would be something to factor into the decision.
Anything you’d like to add that I haven’t asked above?
I think the biggest takeaway that I would want readers to walk away with is the idea that telehealth is so much more than “zoom calls” with your doctor or clinician. Like I mentioned above, clinicians (and patients) must take the viewpoint that telehealth isn’t a specific service or treatment, but is rather a tool in a clinician’s toolbox to address whatever the diagnosis or condition is. I believe a hybrid model of health will dominate the future of healthcare; where virtual service delivery blends seamlessly with in-clinic or in-person service delivery. Telehealth, and all that it emcompasses, has the ability to radically transform the way healthcare is delivered. IT even has the ability to change payment & business models. We just need to think a little bit more broadly and creatively when it comes to how we define “telehealth” and how we educate stakeholders about it.
In fact, our program, The Telehealth Roadmap™ helps healthcare organizations implement virtual service delivery in a way that maximizes patient engagement & experience, improves clinical outcomes, and moves towards that hybrid model of healthcare that we know will be the future of the industry.
Do you have any tips or strategies successfully implementing telehealth? Share any additional resources that you found helpful in the comments below!
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Rafael E. Salazar II, MHS, OTR/L (Rafi) is the Principal Owner of Rehab U Practice Solutions and the host of The Better Outcomes Show. He has experience in a variety of rehab settings, working with patients recovering from a variety of injuries and surgeries. Rafi has worked in a variety of settings, from orthopedic and musculoskeletal rehabilitation, to academia, and even healthcare consulting. He spent the majority of his clinical experience working at Charlie Norwood VA Medical Center, where he was the lead clinician and clinical education coordinator for the outpatient specialty rehab program. In this role, he treated many veterans with chronic pain and helped to establish an interdisciplinary pain management program. He has worked on projects ranging from patient engagement initiatives to marketing communication campaigns to a multi million dollar project assisting the State of Georgia’s Department of Behavioral Health and Developmental Disabilities transition individuals out of state institutions to community residences. His work on telehealth has been discussed in Forbes. He also has experience as a core faculty member at Augusta University’s Occupational Therapy Program, as a Licensed Board Member on the GA State OT Board, and he serves on the Board of Directors for NBCOT. He works to help healthcare clinics and organizations deliver uniquely impactful patient experiences by improving service delivery through training & advisement and through courses & training programs.
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