Here we are, data dilettantes, on our long journey into the unknown.
At the prompting of online colleague John Lynn, we look back at telehealth usage at UCHealth in the past few months. The above graph depicts January 1 to present, the curve of in-person visits at UCHealth (purple) and telehealth visits (cyan). You see that telehealth visits temporarily outpaced in-person visits.
First of all, I feel very sophisticated for writing “cyan” instead of my first (caveman-male) instinct “blue-ish”.
Second of all, notice the curve above compared to our evolving curve from March, 5 months ago (remember, those purple divots are from Thanksgiving and Xmas holidays):
Be careful how you extrapolate, right? Based on this original, one would have thought “Holy Smokes! Telehealth is going to rule the world in a few more weeks!”
And one would have been wrong.
So, now it comes upon us Armchair Data Scientists to hypothesize: why? Why did the curve do what it did? Well, our first external data point is: Colorado Governor’s Safer-At-Home order expired on April 26. On the top graph, this corresponds to the day our 2 lines cross in April, with in-person visits rising again. This also corresponds to our surgery clinics opening up again to see patients.
Averaging the last few weeks of data, we are seeing about 8000 telehealth visits vs 60,000 in-person. Or about 13-15% of appointments being conducted by telehealth. REMEMBER, this is unvalidated data, so, take with some salt.
What have we learned? From anecdotal evidence, I have heard from quite a few patients (most of mine are over 65) that they prefer in-person visits when possible, although telehealth has been “acceptable” when fears of contagion are high. Also, much of internal medicine requires blood testing, vital signs monitoring, examination. Also, I’m finding that non-verbal communication, although “acceptable” via telehealth (tone of voice, body language), it is much richer in-person.
Even when we were conducting 2/3 of clinic sessions exclusively by telehealth, our in-person clinic slots were full, and our telehealth clinics routinely had open time slots. Now that we are scheduling 75% in-person, all our in-person slots are full, and our telehealth slots still sometimes are open.
It will take some intrepid ethnographic researcher to pull interesting trends out of this, as I’m hearing from other parts of the country that telehealth visits are preferred to in-person. Is this: geography and distance needed to travel? Is it the rarity of the specialist’s expertise? Is it access to surgeons? Is it the (gasp) lack of skill of the telehealth provider (please, no)?
We are also still struggling with CMS (Medicare) regulations that, for example, for home vital signs to be “acceptable” for quality reporting, either the MA or the provider MUST view the actual blood pressure from the display of the machine over the video link, or view a printout from the machine, otherwise it “doesn’t count.” Hmm. I get why administrators want good data provenance (proof of authenticity), but isn’t telehealth hard enough? Why make it even harder for patients and docs? Who is going to be so motivated to PAY their co-pay for a telehealth visit, have that visit, and then LIE about their actual blood pressure reading at home, so that they “look good” for the doc, or the doc can “look good” for the regulators, payors? Ridiculous.
Nevertheless, our pandemic / telehealth story evolves. With the fall approaching, schools reopening, flu season coming, watch this space for what happens next.
Things are briefly, perhaps, not as dire as in March and April, in Colorado.
CMIO’s take? Telehealth was gangbusters in March, April, and is now settling down to 13-20% of total volume of clinic visits. We are back to 95% of original clinic volumes (in person plus telehealth together), so there are still some patients who haven’t returned to see us. And, although we have learned a lot, I think we still haven’t optimized “best practice” on when to use telehealth with patients. I think there are still some adjustments and opportunities out there. Let me know in the comments what you’re seeing!
Dr. Lin – what are you hearing from your provider colleagues regarding their experience and comfort level in using the virtual visit platform? In my interactions with medical groups across the enterprise and beyond the early adopters of telehealth (pre-pandemic) are back to baseline. As you said, algorithms for using the platform are not well defined. Converting a face-to-face to virtual on the fly, especially when support staff are not available to do that, seems to be a challenge for some. Thanks for your post. I’ll share with my PopHealth team. – Christy Howell, Population Health Project Manager