The 2020 Healthcare Revolution (Part 2) – The New Patient Journey

The 2020 Healthcare Revolution (Part 2) – The New Patient Journey

“We’ll remember this time as the point when healthcare delivery and the patient experience changed. So, take note and remember the first time you encounter telehealth. Much like the internet, it’s going to change all of our lives.” I wrote that in a blog 1-year ago. At the time, few of us had heard of COVID-19, and none imagined that 2020 would play out the way it has. On the bright side, one of the stars of 2020 has been telehealth. This has been the year that telehealth sprouted from the fertile soil of healthcare innovation and has impacted the way most of us deliver and receive care. A typical patient journey through a course of care is extremely different than it was a year ago and will continue to evolve because of telehealth. Not all visits to every doctor or therapist should be done remotely, but many can and should be.


The Explosion of Telehealth

Prior to 2020, telehealth accounted for less than 1% of all medical visits. More than 50% of all visits were done via telehealth from April to August 2020. The numbers are no longer as high, but the road has been paved and patients and providers are on board. After the smoke of COVID clears, there will definitely be some long-term effects. As Dr. Anthony Fauci has stated, “It’s not going to be a light switch.” It will take time for us to heal and trust some of the old institutions and conventions we previously adhered to. Experts are telling people to continue to wear a mask even after getting vaccinated. Will we continue to wear masks when we go into all crowded places? How long with that last? At this point we don’t know, but we know that telehealth has made it easier to deal with the challenges of COVID.

                                      U of Michigan, increase in telehealth

Example of a Patient Experience

Dr. Michael Barnett is a Primary Care Physician. According to a recent Twitter thread he posted, he dislocated his shoulder and followed up with the Orthopedic Surgeon who initially saw him in the hospital ED. Dr. Barnett has been in a splint and improving since his initial injury a week ago. According to the thread, he had a follow-up appointment with the Surgeon today that lasted 7-minutes, but took up 75-minutes of his time. “This appointment could EASILY have been telemedicine.” The doc told him to come back in 4-weeks. Maybe that visit will be done by telehealth!


Innovations in the Patient Experience

When a patient has a stroke, IV medication to dissolve a clot needs to be given within 3-hours for the best chance of survival. Typically, a Neurologist in a hospital ED decides to administer this medication.  It’s extremely costly for a community hospital to have a Neurologist on staff at all times, as required by law. StatMD is a TeleStroke group in New Jersey who provides remote Neurology services to community hospitals across the country. StatMD has Neurologists on-call 24/7/365 for their contracted hospitals. They save lives and improve outcomes daily because of the access and immediate response they provide to patients whose life depends on every second.

In North Carolina, Atrium Health’s Virtual Clinic is improving access to pediatricians while children are at school. Using telehealth technology, students are evaluated by a pediatrician located remotely at Levine Children’s Shelby Children’s Clinic, and parents are invited to join in-person or via audio or video. “The students are evaluated for healthcare needs while they remain at school and their parents continue their daily activities, such as work.” The virtual clinic has reduced unnecessary emergency department visits by 55.6% among students seen via virtual appointment, changing the patient journey in a monumental way.


Adoption and Approval

Patients as well as providers have tried telehealth for the first time this year. An overwhelming number of patients have been satisfied with their experience and “would recommend telehealth to a friend.”

NRC Health is a provider of analytics and insights for healthcare providers, payers and other healthcare organizations. This year they’ve seen:

  • Nearly 30-times increase in the number of patients providing feedback on their recent telemedicine experience…and “patients seem to love engaging through
    this digital front door!”
  • Equally exceptional, telemedicine’s net promoter score (NPS) has skyrocketed. From April 2019 to April 2020, telemedicine’s NPS has increased by 125%, from 65.6 to 82.6 – that’s an excellent NPS!!!
  • Patients have been logging overwhelmingly positive responses around their telemedicine experiences


Telehealth is not for Everyone

Telehealth is not without its detractors. Some people knock telehealth for not being able to provide all the services a patient may need. A patient can’t get their hamstring stretched or use a treadmill during a telehealth visit. Maybe, but are they getting 30-45-minute one-on-one sessions with their PT when they go to a clinic? Can their healthcare advocate or family member in another state observe their session in-office? Does their PT have a world of resources at their fingertips during a clinic session? These are some of the advantages of telehealth that contribute positively to the overall patient experience. What really matters in either environment is the engagement of the provider, the system they function in and their connection with the patient.

Stacey Richter, host of the Relentless Health Value podcast, states it clearly, “From what I can see, some of the flaws that some people attribute to telehealth might be more properly construed as flaws to the ecosystem in which the telehealth is being deployed. For example, how much agency or data or infrastructure does the provider behind the camera have to see where the patient is in their treatment journey and make sure that they get to that next milestone? Because in cases where the doctor (therapist) has agency, and the telehealth visit is part of a defined patient journey, telehealth results are strikingly comparable to not-telehealth results, if not better. If we’re contemplating a patient journey or a treatment journey, writ large, the site of care at any moment in time is a secondary or tertiary factor—certainly not a primary one.”


Forging and Enforcing the Therapeutic Alliance

Ms. Richter makes it clear that agency, what we refer to as the therapeutic alliance, has a more significant impact on patient success than where the encounter occurs. Connecting with a patient and guiding them through their patient journey is what really matters. Telehealth can be a versatile tool to improve engagement, connection and the overall therapeutic alliance. Patients are people, not bodies or numbers. We want to be heard and cared for, not processed through a system. The agility of telehealth in all its forms – video, calls, text, etc can potentially bring the patient and providers closer together – when they need to be.

Now the patient journey can be about working on their health together with the support of knowledgeable, caring professionals. That’s the revolution in healthcare.

Daniel Seidler, PT, MS

Daniel has had the pleasure of being a Physical Therapist since graduating from Columbia University in 1996. He's the former owner of WSPT in the Bronx, NY. Throughout his career, Daniel has thrived as a healthcare innovator, entrepreneur, and executive. Since 2018, Telehealth PT has been his passion and his mission. Daniel provides educational programming to PT students, Physical Therapists and Physician Assistants on the basics and nuances of TelePT. He also continues to treat patients via Telehealth. Daniel is a member of the American Physical Therapy Association, the American Telemedicine Association, he is an Advisory Board Member of the Mercy College Physical Therapy program and a member of the Pace University Lubin Design Thinking Certificate Program. He loves spending time with his family, running in Prospect Park and doing the NY Times Sunday Crossword.