By Kira Radinsky, PhD
COVID-19 has upended the healthcare space and accelerated the adoption of new technologies that are shifting how we receive and deliver medical care. The pandemic has ushered in a revolutionary new period of hybrid virtual-physical medicine.
Providers are reporting seeing 50 to 200 times more telehealth patients than they did before COVID-19, with almost 50 percent of patients saying that they are using telehealth, compared to 10 percent before the pandemic, based on a recent report published by McKinsey and Co.
In light of these changing patterns, a new strategy around telehealth must be created and implemented. However, this requires more than merely transitioning from a physical office visit to a video call. Telehealth is a hybrid model of physical and virtual visits, bridged by technology to ensure that all patients receive efficient, cost-effective, and high-quality care.
Digital Triage Enables Rapid Change
One of the toughest challenges of this transformation is deciding how to best streamline patient triage and navigation through different modalities.
With a rapidly growing number of patients turning to virtual care, it will not be feasible to continue coordinating and scheduling appointments using human providers alone. The transformation requires a human-machine hybrid triage system.
Imagine a patient with a urinary tract infection (UTI) who requires routine treatment. A digital triage system examines the patient’s medical history and identifies that she has a high probability of contracting UTIs. The system automatically recommends that her provider order a urine test. Once the test comes back positive the system updates the probability for a UTI and alerts her primary care provider who can then remotely approve and prescribe an antibiotic treatment that can be delivered to her home.
In this case, the patient was treated partially by an automated system, and the doctor was only involved when required. Patients with more complex cases will continue to be treated on site when physical examinations are required. If examinations are not needed, the patient can be moved to a telehealth provider.
Many routine requests and monitoring may be done by a fully autonomous digital system. In this scenario, patient care is simplified by delegating the routine, repeatable workflows of the providers to digital systems while the doctor works to maintain an ongoing relationship with the patient.
The triage systems can also identify the type of treatment needed and the specialists required to help navigate the patients to the correct level of care. This optimization creates opportunities for democratized healthcare and increases the availability of doctors to focus on the most challenging cases.
Making the Move to Asynchronous Medicine
Medicine today is synchronous, or as defined by the US Department of Veterans Affairs (VA): “… requires the presence of both parties at the same time and a communication link between them that allows a real-time interaction to take place.”
The question remains: Should virtual and physical medicine continue to be synchronous? I think that many parts of the clinical appointment can be decoupled and handled asynchronously.
For example, medical data acquisition can be transferred to the medical provider at their convenience. Although several articles claim that synchronous approaches are more efficient, as they allow physicians to “refine details pertinent to the care episode during the session, by seeking additional information or data, and in many cases providing a clinical decision or advice within the session,” it’s feasible the same benefits can be gained by utilizing a hybrid approach if the medical condition does not require a long back and forth conversation with the patient.
The categorization of the medical case to synchronous or asynchronous is yet another goal of the digital triage system that will navigate the patient to either a fully automated patient intake process followed separately by a virtual care session or will create a joint hybrid session.
Measuring the Success of a Hybrid Virtual-Physical Strategy
Virtual health has the potential to automate many of the routine clinical visits via digital triage systems. These systems will help navigate patients to the correct medical settings (telehealth, physical primary care appointments, specialists, urgent care, or the ER), while preparing the patients for the clinical meeting. Such preparation will include information collection, patient education, and automated follow-ups.
These in turn will relieve doctors of administrative burdens, enable them to focus on high-risk patients, and reduce the time they spend on routine treatments.
But what should a successful hybrid virtual-physical strategy look like?
Ideally, one would want noncomplex patients to sustain or increase clinical quality and patient satisfaction metrics while moving a certain percentage of their care to virtual care. This would help to decrease the physician time spent on these patients and increase the number of patients treated and improve outcomes in complex cases.
This will allow health systems to begin to measure complexity of patient cases, number of visits (virtual vs. physical), doctor time spent, standard clinical outcomes, and patient experience metrics (patient time saved, fewer ER visits, overall satisfaction). These metrics measure the alleviation of physician burden, track dollars saved, and the virtual health transformation of the organization. As more organizations adopt hybrid virtual-physical medicine, we will move closer towards a greater goal of ensuring that healthcare becomes more efficient, effective, and affordable for all patients.
Kira Radinsky (firstname.lastname@example.org) is the cofounder, chairperson, and chief technology officer at Diagnostic Robotics.
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