Before the COVID-19 pandemic struck, patients often had to wait for hours in hospital and doctor's office waiting rooms. After the pandemic quickly mainstreamed telehealth and prescheduling technologies, patient wait times were significantly reduced.

So what does this mean for patients and providers moving forward?

Dr. David Berg, cofounder and chairman of the board of Redirect Health, a primary care national healthcare organization featuring telemedicine and mobile health, believes the healthcare industry should reduce unnecessary inconveniences – such as extensive travel or wait times – from the healthcare experience.

Healthcare IT News interviewed Berg to gain some of his telehealth and mobile health expertise. He discussed why doctors should work to mitigate long patient wait times through prescheduling tools, the negative impact of long wait times and how they impede care, telemedicine's impact on in-person visits, and the future of the waiting room.

Q. How can physicians work to mitigate long patient wait times by using prescheduling tools?

A. Prescheduling is inherently designed to save time. All of those pages and pages of forms you get at a doctor's office? Filling those out is what makes the wait time on your first visit so long. With prescheduling, doctors are able to populate your medical record before you get there.

When we get information about your medical history, including any ailments you have, medications you are taking, diseases that run in your family, etc., we can be more ready to go when you arrive. Prescheduling can be done even if you don't need to make an appointment at that time. You're setting up a relationship before you need to see the doctor.

Installing a secure portal so all privacy measures are met is the first step for your doctor. Then, your doctor will need to adjust their workflows to take advantage of this new tech-enabled capability, which is easier said than done in a busy practice. If they are successful, a few months down the road efficiency will be created for them and their customers and wait times should be reduced.

The other important thing to realize is that not everyone does things at the same speed. Younger people with few health issues may breeze through the forms, while those with more health issues to report – especially if they are less confident with technology – are going to take a lot longer. With prescheduling, people can fill out the forms at their own pace, and it doesn't impact waiting room time.

Best of all, in the era of COVID-19, cutting waiting room time means cutting the risk of exposure. When COVID-19 hit, all medical offices shut their lobby doors almost overnight. Suddenly, doctors were forced to redo their workflows to become more virtual. Patients weren't permitted to check in by filling out paperwork in the lobby. Whether they were checking in from their car or home, prescheduling instantly became the norm.

Q. What is the negative impact of high waiting room times, and how can this stop patients from seeking care?

A. To answer that, we need to divide people into two groups. There are healthier, younger people with busy lives. They have kids with soccer games and [have] careers to build, and they don't want their time or money wasted.

Then there's the group with chronic health issues that need to be managed: people with things like diabetes, heart disease and COPD. These people are afraid that without ongoing care they will get really sick or have huge medical bills. For them, it's not so much about, "Don't waste my time or money," but rather, "Please take care of me, I'm scared."

When it comes to the negative impact of high waiting room times, we have to look at it through the eyes of these two groups. COVID-19 is an enormous factor. Even with masks, everyone is afraid of being in enclosed spaces with other people – but the second group is obviously more concerned.

They are predisposed to problems, so they are not going to want to spend more time than absolutely necessary in the waiting room. High waiting room times might make them stay away from the doctor, and their care will be affected.

With the first group – the younger, healthier people – they might not show up because they think, "Oh I can get that physical next month," or "I'll see the doctor after my kid's soccer season is over." 

On top of that, over the course of COVID-19, they have become accustomed to conducting all of their appointments online, and they don't have the time, patience or desire to go back to the traditional way. No matter what the reason, high waiting room times will discourage them from seeking care.

Q. What is telehealth's impact on in-person doctor visits, and how does telehealth affect waiting times?

A. Without a doubt, telehealth decreases waiting times. Just like in-person visits, a patient is put on a schedule. However, as far as staying on time, that schedule is much easier for doctors to manage when the appointment is virtual.

When a patient invests two hours of their day taking time off work and driving to and from an appointment, they will do it much less often. On top of that, when they do go in, they want to take care of everything – even the things that are not yet problems. Just in case, they want to talk about them because they have taken the time to go there.

With telehealth, people invest almost no time in this appointment, so they're perfectly fine with a five-minute call. They know they can call back later if anything else comes up.

Let's face it, healthcare in general has a negative brand perception. Unlike other industries such as auto repair (where the negativity centers around being told something is broken when it isn't), healthcare's negative brand perception is all about waiting and wasting peoples' time. Anything we can do with technology to decrease wait times is going to make it better.

Keeping up with new technology is important. However, it's not necessarily about the best technology. It's about the most appropriate technology and the workflow coming together to meet the needs of users (staff, patients and family members).

I can tell you plenty of stories about "cutting-edge technology" that functioned exactly as it was designed to, but ultimately failed because it simply didn't work well with the workflow and workforce within the office space where it was implemented. This breakdown led to longer wait times for patients. So, technology alone isn't the answer.

Q. What is the future of the waiting room, and how does telehealth intertwine with this future?

A. Things already have shifted dramatically in the COVID-19 era, and there's no going back. Because of this, I believe waiting rooms are going to get smaller and parking lots are going to get busier – a lot busier, perhaps.

Your waiting room now will be your car. If you don't fill out all those forms at home, you're going to have to fill them out in your car. When the parking lots start overflowing, more and more people will see the benefit of filling out their forms at home before arrival. Like anything, it's a domino effect. I also believe the number of exam rooms needed will decrease as well, which could impact real estate needs.

As for the future of telehealth, it's not just healthcare that's impacted. The future is tele-everything. That means we need to change workflows and business models.

For unregulated industries like retail, this isn't as hard to do. But with healthcare, it's complicated at best and litigious at worst. Our industry is highly regulated, which means it's not an easy transition.

Right now, physicians are required to hold a license in the state where they practice. That's fine when patients physically go into an office, but what if someone is on vacation out of state and needs to have a telehealth appointment with their doctor back home? Technically, depending on the state, it could be in the grey area of what is legal or not. As you can see, things get complicated quickly.

Ultimately, my hope is there will be a bipartisan federal telehealth law that eliminates the licensing in individual states. When that happens, the future of telemedicine will be very bright indeed.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.