Episode Details

Sometimes when I overhear a conversation/argument about telehealth, it occurs to me that there's a lot of fighting words about some things and very, very little about other things which I'd regard as equally, or maybe even more, important. Some of the sparring tends to jump immediately to tactics and UX (user experience), absent of strategy and CX (customer experience). In my experience, you can't talk about a user interface until you talk about the overall customer experience and journey and what your goal is.

So, here's what I mean: Let's take urgent care as an analog. Say a patient goes to urgent care with symptoms consistent of allergic asthma. The NP (nurse practitioner) gives the patient strict instructions to take an antihistamine and Flonase and Flovent. She tells the patient to be sure to make a follow-up with their PCP (primary care provider) to evaluate how it's going.

If the patient doesn't make a follow-up visit, do we suggest it's because the live in-person visit should have been telehealth? Or if the patient is nonadherent and winds up in the hospital with a full-blown asthma attack, do we suggest that live in-person visits diminish adherence? Let me respectfully suggest that it'd be a solid no on that.

This is exactly why, whenever I listen to a diatribe about how telehealth did not work out for a patient, I find it interesting to ask a couple of questions. The question that I tend to ask when someone starts talking about some telehealth fail is "How did it fail?" How did it not work out? And the answer to this question tends to be similar to the above allergic asthma example: that the patient needed lab work or imaging or a follow-up visit, and that couldn't be done via telehealth. There was no resolution to the patient concern, in other words.

Okay … so, first of all, most practices don't have immediate on-premises lab work or imaging, so the patient would have had to have gone somewhere else to get it anyway. But even if they did, as far as I know, you can't have a follow-up visit at the same time that you have the first visit. Not to be cheeky, but that's why they call it a follow-up visit.

Then the next logical question is, if the patient doesn't show up for a follow-up, if the patient were in person, what's the greater likelihood that they would have gone for the lab test and/or come back for the follow-up? This is when you start to realize that the setting of care (ie, virtual or in person) may be a little bit less important than the agency of the provider involved. And it may be a little less important than the structure of the organization sitting around that patient encounter. Said another way, strategically, what are we doing here? What are we trying to accomplish? What's our road map to get the patient from where they are now to wherever that goal is?

A patient visit is a tactic. It's one point in time. And that's true regardless of whether it's a remote visit or an in-person one, synchronous or asynchronous. A patient visit or interaction is not a care pathway. It is rarely, if ever, a magic bullet one and done. But that doesn't stop us from thinking about patient encounters, one encounter at a time, which may be exactly why we wound up with a fragmented health care system that doesn't work very well. But I digress.

So, 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 behind the camera or the telephone or the text message has agency and the telehealth visit is part of a defined patient journey, telehealth results are strikingly comparable to not telehealth results, if not bet