Telehealth—particularly the subset of virtual care options such as remote second opinions (RSOs)—have dramatically improved health care access by connecting patients to specialists no matter their geographic location. In addition, because RSOs are typically asynchronous telehealth, they can be most useful to inform a diagnosis and treatment plan, either in lieu of or as a complement to a face-to-face encounter. By collecting patient information before a virtual or in-person consultation, RSOs can help solve for some of the challenges stemming from the increased use of telehealth, such as a lack of prior detailed health data, patient hand-offs, transfers between facilities, and the determination of care plans.
In this blog post, Les Trachtman, managing director from Purview, shares his thoughts on the benefits of asynchronous telehealth and the efficiencies RSOs create in data collection.
Question: Participants seem to be moving away from the idea that telehealth is a binary decision between an in-person or virtual visit, and toward the idea that telehealth is a tool in the care management toolkit. How do you think about this?
Les Trachtman: I agree. The use of a virtual consultation in lieu of a face-to-face visit should be based on the goals of the encounter and convenience to the patient. Some medical engagements obviously still require a face-to-face visit, because it is often challenging to physically evaluate a patient remotely. However, with the increased use of remote monitoring, we are trending toward a richer asynchronous collection of patient data without requiring a physical encounter. And patients who are less mobile or in remote areas will push the balance toward remote care whenever practical.
But regardless of the type of visit, telehealth in the form of asynchronous delivery of prior health records enables physicians to prepare prior to a consultation, enabling them to make the most of the limited time they have during a virtual or in-person visit. It is never an appropriate use of the physician's or patient's time for a doctor visit to focus on gathering or reviewing a patient’s medical records, which could have been provided earlier.
Q: Telehealth is not a one-size-fits-all solution, and the industry continues to grapple with questions about appropriate utilization and the best use cases for virtual care. How do you think about appropriate utilization for RSOs?
Trachtman: Second opinions are unique on this front. Appropriate utilization depends on the physical availability and proximity of the specialized physician to the patient and the need to perform a physical exam or in-person tests. An RSO is often an appropriate remote substitute—at least to start.
Depending on the results, this consultation may take the place of an in-person second opinion visit or may just be a way to determine if an in-person visit is required. This is especially important during the pandemic to reduce exposure. As I mentioned, proper use of RSOs should include the collection of any prior test results and diagnoses in advance of the consultation, whether that occurs in-person or remotely.
Q: With the shift to virtual care, there have been challenges in coordinating handoffs from primary care to specialists. How can RSO platforms support greater care coordination and continuity?
Trachtman: Any in-person or virtual medical opinion should take advantage of an informed prior opinion and test results to help coordinate care. Written diagnosis, physician notes, test results, and image scans are critical components that RSO platforms collect. Whether it's a cumulation and transfer of patient records or a part of a coordinated transfer between facilities, this prior information is critical to coordinating care among various providers. If necessary, it may be coupled with synchronous video or telephone consults with a prior physician, which adds to the richness of the diagnostic data and a better understanding of the prior findings.
Q: As a result of greater telehealth and virtual care use, physicians have been focusing more on clinical data aggregation and management challenges. How can health care stakeholders use RSO platforms to help solve these issues?
Trachtman: RSO platforms enable physicians to access patient information in the most convenient way to them and their patients—whether that's at the physician’s home or in some location other than the hospital or office. And while a RSO may not settle a treatment plan, every physician wants and needs to review critical patient data prior to their consult. RSOs solve for this by getting that data presented to the succeeding physician in a manner that makes it complete, convenient, and clear. Many physicians prefer to review a neatly coordinated case rather than having to piece through a complete EHR.
Advisory Board analyst Elysia Culver contributed to this post.
Learn more: Remote Second Opinions 101
Second opinions can be valuable to clinicians and patients looking for diagnosis confirmation or weighing treatment options. But in-person access to specialists and expert consultations is limited and often inconvenient, especially outside of major metropolitan areas. In these unprecedented times, when patients are reluctant to seek in-person care, remote access to specialist expertise is more important than ever.
In this cheat sheet, we review RSOs, why they matter, how they work, present barriers to success, and conversations that you should be having before implementing an RSO solution.