December 16, 2020

Marc Harrison's 7 key telehealth lessons from the Covid-19 pandemic

Daily Briefing

    When the coronavirus pandemic struck, Intermountain Healthcare took it's existing network "and put it on steroids," Intermountain President and CEO Marc Harrison writes for Harvard Business Review. Harrison outlines the seven biggest lessons the health system has learned about telehealth during the pandemic.

    Marc Harrison: How Covid-19 has transformed Intermountain—permanently

    The 7 biggest telehealth lessons learned during Covid-19

    1. Telehealth has led to better and more accessible care

    Although Intermountain already "had a head start on telehealth"—with a total of 830,000 patient interactions via telehealth between 2015 and 2019, an average of 454 a day—Covid-19 rapidly accelerated digital services uptake, Harrison writes. So far in 2020, the system has had 1.3 million telehealth interactions, an average of 4,300 a day, and Intermountain's online Covid-19 symptom checker garners 1,800 clicks each day.

    According to Harrison, Intermountain's telehealth services have increased care access in three key ways. First, it has ensured patients can get the care they need whenever they want, at home or elsewhere in their community. Second, it's allowed highly trained specialists to treat patients in remote areas, working alongside local primary care providers. And third, it's decreased the number of patients being transferred to an ICU at a referral center within a large city, which in turn allows patients to remain in their local hospitals—and ensures ICU beds at larger hospitals are free for Covid-19 patients.

    2. Telehealth is safer for everyone amid Covid-19

    Telehealth has also made care delivery safer for everyone, Harrison writes. He explains that a Covid-19 patient, when using Intermountain's "virtual hospital," doesn't necessarily have to see their doctor in-person, or physically visit an urgent care facility; instead, such patients will receive a technology kit that allows Intermountain to remotely supervise their health. Conversely, health care providers aren't risking exposure to the new coronavirus.

    And because providers also don't need to put on personal protective equipment to talk to a Covid-19 patient virtually, Harrison adds, those supplies can be saved at a time when they're often in short supply.

    3. The clinical quality of telehealth is excellent

    Intermountain uses "detailed protocols that show how care for over 100 common conditions should be provided," Harrison writes. This means providers consistently "deliver excellent outcomes without the variation and waste that reduce quality and drive up costs" no matter where they deliver care, whether in a 25-bed rural hospital, a 510-bed Level 1 trauma center—or via telehealth, Harrison writes.

    Harrison cites several other examples of the "clinical benefits" of Intermountain's telehealth services, including an internal review that found Intermountain's tele-critical care program was associated with a 36.5% drop in mortality within one year, which translates to about 125 fewer deaths, and evidence that the health system's antibiotic use in telehealth services is as good as it is in its brick-and-mortar clinics.

    4. Telehealth services are aligned with where health care is going

    "Telehealth supports value-based care" and results in "a greater emphasis on preventive care—which reduces unsustainable health care costs," Harrison writes. And because Intermountain cares for a significant population of "at-risk, pre-paid consumers," the more they utilize Intermountain's telehealth services, "the easier it is for them to stay healthy—which reduces costs for them and for us," Harrison writes.

    "This is worth emphasizing," Harrison continues. "If we can deliver care in lower-cost settings, we can reduce the cost of care." He cites several examples to demonstrate this point, such as how the average cost of a telehealth visit at Intermountain is $367 less than a visit at an ED, physician's office, or urgent care facility, and how a small internal study demonstrated how telehealth access saved rural patients an annual average of $2,000 in driving costs and lost wages.

    5. Many doctors like telehealth

    In addition to the numerous patient benefits, providers too seem to enjoy telehealth, Harrison writes. As one Intermountain surgeon said, doing post-op follow-ups is easier virtually because he can see where patients live and how his patients eat.

    And other physicians appreciate how much their patients value telehealth services, Harrison adds. For instance, an oncologist who was initially skeptical about using telehealth for cancer care ultimately found that "'[i]t's much more rewarding than you can possibly imagine'" because of how highly the patients enjoy digital care delivery.

    6. Security, privacy, and technical issues are continuing priorities

    Harrison acknowledges that at least one tedious aspect of technology won't go away any time soon—namely, upgrades—but he writes that Intermountain has worked to implement top-level security standards for its digital services.

    For example, according to Harrison, Intermountain has "standardized a single consumer identity (username and password) all patients can use to access services like patient records and telehealth, increased our firewall capacity to support increased telehealth volumes, and added training and guidelines to support remote work configurations."

    7. Telehealth technology needs to simultaneously be simple and comprehensive

    When Intermountain first set up its telehealth services, the health system was proud its platform worked better than those of other health systems, Harrison writes—but that was the wrong comparison, because Intermountain patients were still struggling with the services. "We should have compared ourselves to Google or a weather app," he explains.

    In response, Intermountain redesigned its process to make its telehealth services simpler. Now, 90% of telehealth visits require just a single click from both patients and providers, and the health system has "launched a personalized digital experience, called My Health+," that lets consumers manage their health with just one app.

    Harrison writes that the experience of one family in particular sums up the impact of the lessons learned about telehealth: The patient, who was diagnosed with breast cancer in April, has had much of her care delivered virtually, and according to her husband, "We felt cared for, and we felt safe … The quality of her care was better because so much of her care was provided through telemedicine. We're passionate about how well it works" (Harrison, Harvard Business Review, 12/11).

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