I know it is a well-documented issue, but it is hard to overstate the true scale of the predicament faced by the U.S. healthcare system. Experienced physicians, nurses and allied health professionals have been lost to retirement and resignation: In fact, in a survey led by Brigham and Women’s Hospital investigators (via The Harvard Gazette), 28.7% of healthcare workers reported an intent to leave their job. Americans’ life expectancy is falling. Patients are lined up on gurneys for hours in hallways waiting for inpatient beds or transfer to a more appropriate care setting. Hospitals are closing services and laying off staff. Large, internationally renowned healthcare systems are reporting losses in the billions of dollars. Solutions are needed, stat, and should be adapted in creative ways to fit organizations’ unique needs. This is why I have been thinking a lot lately about the word “platform.”
It’s a term everyone in business understands. It usually describes hardware and software that facilitates the standardization of processes and workflows to achieve operational efficiencies and better outcomes.
In my field of healthcare, “platform” most often references the electronic medical record (EMR), which provides secure access by clinicians, business office staff and others on an as-needed basis to patients’ medical histories and current status. There are myriad other platforms within a health system that either do or don’t link up to the EMR, including those for radiology, purchasing and supplies, infection control and revenue cycle management. In some cases, they work well together. In others, not so much.
I run a telehealth company but have found that the word telehealth has become a stand-in for technology, which many organizations can't afford anymore unless it has an immediate ROI. My company doesn't sell technology; we provide the people and processes that drive telehealth, using whatever technology the hospital or system has at hand or we recommend. There are other models out there, but our “platform” is a national network of doctors working remotely—usually from home—and virtual nurses who help support bedside staff, many of whom are younger nurses who lost a generation of veteran RN mentors to retirement and resignation.
I am trying out a new phrase, “service as a platform,” to describe this model. Many health systems are confronting the fact that they have disparate telehealth systems spread across the enterprise. Some larger organizations have dozens of systems, legacies of one-off programs such as telestroke and more recent panic-buying during the height of the pandemic. Few of these systems communicate with one another; they are used for different purposes and have different workflows.
From hundreds of conversations with leaders of hospitals and systems large and small, I am sensing a growing understanding that telehealth, if implemented systemically, can play a huge role in helping healthcare emerge from its current state. Health systems are maturing from panic buying to thoughtful enterprise-wide telehealth strategies in inpatient care and beyond.
This isn’t just about filling gaps in care; it’s about a complete redesign of care delivery through optimized clinical workflows, streamlined administrative tasks and improved care coordination.
If your organization wants to offer this model to healthcare facilities, remember that success with acute care telehealth is dependent on relationships. You need to have first-rate doctors and other health professionals who are licensed to practice in the states you serve and who can prescribe medicines and other treatments. The virtual doctor should also be able to instantly access the electronic medical record. Without all of that, telehealth providers are limited to providing generic advice and guiding a bedside care provider through a procedure.
Telehealth providers should also be dedicated to a system or a few hospitals, so they learn the culture, processes and the people who work bedside. Healthcare is a team activity, and a doctor who just drops in via video every so often is likely to provide less value to the hospital than a doctor who is on a first-name basis with the client's medical staff.
Much of the history of telehealth service providers is in single clinical applications, such as telestroke and cardiac care. Today, many hospitals and health systems need help across the enterprise. For example, health systems might need support from psychiatrists for treating behavioral health and addiction issues, including the fentanyl epidemic and a growing crisis of youth suicidality. According to a 2018 report from the University of Michigan School of Public Health Behavioral Health Workforce Research Center (via the Association of American Medical Colleges), more than half of all U.S. counties had no psychiatrists at the time of the report. At the same time, patient acuity may require you to provide tele-intensivists as part of your platform to manage a wide range of critical care needs.
A key to care quality, patient satisfaction and better outcomes is keeping patients flowing to appropriate care locations. ER doctors are often overwhelmed by surges of patients, which can be unpredictable if patients delay seeking treatment until they are critically ill and arrive by ambulance. Others, lacking health insurance or facing huge deductibles and copayments, may wind up using the ER for primary care. A complete telehealth service platform should include capabilities for assessing and moving patients out of the ER as quickly as possible and following them through the care process, avoiding “hot spots” such as radiology and using the medical record to make sure information flows with the patient.
As I mentioned previously, telenursing is now something any virtual care organization should consider including in their offerings. Many nurses left bedside care in the past two years. If they work for a telehealth company, these nurses can provide high-quality remote care.
Healthcare is famous for its variability. One literature review estimated that roughly a quarter of all health spending in the U.S. is wasted due to failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud and abuse and administrative complexity. Efforts to turn around in this situation have run into myriad obstacles. Telehealth service platforms should ensure best practices are finally carried out across the care continuum.
For these reasons and more, I believe service-as-a-platform telehealth has matured from a pilot to a significant medical and financial benefit for organizations.