Clinic 20XX: Telehealth Special Edition Patient & Physician
RESEARCH TEAM
Deborah Wingler, Melissa Hoelting, Babak Soleimani, Upali Nanda
Funds
CADRE and HKS, Inc.
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telehealth in the pandemic era
Telehealth has been poised to revolutionize the health care industry for more than a decade. Yet, patients, providers, payers, and policy makers have resisted widespread adoption until now, which has limited its application and effectiveness in the industry. Five years after the original Clinic 20XX report, we were preparing to refresh our research when COVID-19 struck. Telehealth received a boost where a majority of non-critical care moved to an online platform. During this rapid uptick in telehealth services, we asked ourselves:
1. What has been the effect of COVID-19 on telehealth and what are the implications for clinic design moving forward?
2. How did patient and provider experiences with telehealth during the pandemic influence their preferences and expectations for telehealth moving forward?
survey: patients and physicians
WHAT DID WE DO | HOW DID WE DO IT
We commissioned an unbiased, third-party independent vendor to survey U.S. patients and physicians on their primary care experiences and preferences, including both telehealth and in-person clinic visits. Survey respondents include:
330 patients (110 Millennials, 110 Gen X, and 110 Baby Boomers) who had a telehealth visit in the last nine months for primary care needs (January 2021)
103 physicians (60 Family Practice and 43 Internal Medicine) who transitioned to or expanded telehealth services during the COVID-19 crisis (May 2020)
patient expectations for telehealth: a generational perspective
WHAT DID WE FIND
While Boomers and Gen Xers expressed a desire to shift to more limited telehealth over the long-term, Millennials desire for increased telehealth use remains consistent across time.
provider perspectives on telehealth
WHAT DID WE FIND
Telehealth’s Greatest Challenges
Physicians noted reimbursement and patient adoption, especially for older adults, as the primary challenges moving forward. The need for equitable internet access for patients and potential for increased medical liability were also considered as key challenges.
Telehealth’s Biggest Opportunities
Physicians noted access and convenience as the greatest opportunities for telehealth moving forward. Physicians felt that telehealth had great potential to increase access to high-quality services for patients in remote or rural areas and those with physical challenges or transportation issues. In terms of convenience, physicians felt telehealth would save both patients and providers valuable time and effort due to the potential for extended hours, increased opportunities for follow-up for non-exam related issues, and the opportunity to engage quickly and more frequently with patients.
patient vs. provider perspectives of telehealth
WHAT DID WE FIND
While both patient and providers expressed satisfaction with telehealth visits, patients were overall more highly satisfied with their telehealth visits than what providers perceived.
Patients are more confident than physicians about whether telehealth will have a positive impact on the quality of patient/provider interactions, long term relationships between patients and providers, and the quality of health outcomes.
moving forward
WHAT IS NEXT | WHAT DOES THIS ALL MEAN TO US A A DESIGN THINKING COMMUNITY?
We believe that telehealth will be an additive component to primary care, especially for family medicine and internal medicine, allowing health providers more business continuity, extended access and greater convenience. Our overall findings are as follows:
The 2020-2021 telehealth experiment is still waiting on results.
While 79% of physicians thought telehealth would have some impact on the quality of health outcomes, of those, 35% said it was too early to know what that impact might be. However, patients had a more optimistic view with 54% of patients suggesting that telehealth would have a positive impact on health outcomes.
Telehealth’s greatest opportunity is also one of its greatest challenges.
While increased access was considered the greatest opportunity for telehealth in the future, physicians noted patient access to internet and technology as the third greatest challenge behind reimbursement and patient adoption.
We have seen a glimpse of what can be, but also the gaps in getting us there.
Physicians consider reimbursement as a primary challenge moving forward. To reflect a new era of distributed care across physical and digital realms, reforms to reimbursement and medical liability will be necessary.
Not every health interaction is tele-ready.
Some health interactions are better suited to telehealth, some are better suited to an in-person visit, and some are agnostic—they can be either in-person or virtual. For patients and providers primary care and mental and behavioral visits were the most tele-ready services, with 75% of patients receiving a telehealth visit for primary care needs and 20% for mental and behavioral health needs.
The power of personal touch is more important than ever.
Patients and physicians agree that quality time is essential to the patient/provider relationship. While 52% of patients were optimistic that telehealth would positively impact the quality of interactions with their providers, only 22% of providers shared in their optimism. If telehealth is to reach its full potential, we must create more experiential and more personal interactions that enhance the relationship between patients and physicians.
Space needs have not reduced, they have shifted.
When asked, 55% of physicians felt that telehealth will have some impact on the spatial needs of clinics moving forward. However, 32% of those physicians think the impact will be neutral. Through open-ended responses, physicians that indicated a neutral impact clarified that they felt modifications may be needed, suggesting that, although the design of specific spaces within the clinic may change, the overall footprint of clinics would remain the same.
Tele-integrated clinics help maintain business continuity by leveraging footprints & cloudprints in agile ways.
Stepping into 2022, we need systems where our physical interactions are mirrored in digital space and vice-versa, creating redundancies for care delivery. This can also provide clinics with long-term resilience.
This study has been part of a six-year exploration of how to design for change in the face of an ever-changing present. It is our hope that others will take the insights from this report, continue to ask questions, and use it as a starting point for meaningful innovation.
Read the Clinic 20XX Refresh report executive summary here.