Telemedicine is on an all-time high. The requirements of the contagious COVID-19 and the subsequent loosening of governmental regulations and commercial payer rules have finally propelled telehealth into the mainstream.

Travel to virtually any U.S. healthcare provider organization today, and its teams are conducting some kind of telehealth. Justin Miller, vice president of customer success at eVisit, a telemedicine technology and services company, did just that. He recently returned from visiting a selection of his company's provider clients from across the country to see how they are holding up and how they are innovating.

Healthcare IT News sat down with Justin to find out what he learned on his travels. He discussed where providers are excelling with virtual care, where they are facing challenges, the experiences of Global Medical Response and what he thinks 2022 will bring in the world of telemedicine.

Q. You recently returned from a tour of some of your healthcare provider organization clients to see how telehealth is functioning in the real world. Where are providers excelling?

A. Providers are getting more and more creative with how they leverage virtual care solutions. Before the COVID-19 pandemic, there was not a lot of back and forth between virtual and in-person modalities. Now we're seeing a cultural shift where organizations see telehealth as an enabling tool that complements in-person care, with many adopting a hybrid care system that uses the best of both worlds. It no longer makes sense to draw a line between the two.

Overall, I see less resistance to change; more people are embracing it. I would point out three promising trends.

First, healthcare organizations are using telehealth to save staff time by streamlining administrative tasks like scheduling, intake and payments. Second, telehealth is allowing patients to stay more closely in touch with their doctors since not everything requires an in-person visit.

Third, telehealth platforms are allowing healthcare organizations to capture more data about their interactions with patients, allowing them to make better decisions about their business operations.

Q. Where are providers facing challenges?

A. Providers and staff are managing a lot of technology tools. So, keeping continuity of the supporting toolsets can be a major obstacle. I've seen staff with up to four monitors open just to see the full tech stack they are operating to deliver care through virtual platforms. Juggling a bunch of disconnected software solutions is not efficient.

Healthcare historically has been driven by the question "What's reimbursable?" as the guiding compass. In the past year, we have rightfully moved away from that. But managing the shift toward value-based care goals has created a pinch that is difficult to manage for organizations that also are adapting to evolving state and federal policy environments and being asked to do more and more administratively.

Q. One of the organizations you visited, Global Medical Response, replaces unnecessary ambulance rides to the ER with telehealth. Please elaborate on the role of telemedicine in the real world and the application of the Emergency Triage, Treat and Transport (ET3) emergency medical response model, which CMS covers.

A. In the past, ambulance services only got reimbursed if a patient was brought to the ER. With ET3, CMS will pay emergency medical response providers to: 1) transport to an alternative facility, such as a primary care office, urgent care clinic or community mental health center, or 2) initiate and facilitate treatment in place with a qualified healthcare partner, either at the scene of the 911 emergency response or via telehealth.

The model allows patients to access the most appropriate emergency services at the right time and place. The model also encourages local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches to promote successful model implementation by establishing a medical triage line for low-acuity 911 calls.

As a result, the ET3 model can improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.

My team and I recently visited customers in Colorado and Texas to see the ET3 model in action.

Global Medical Response, the parent company of American Medical Response, in partnership with Envision Healthcare, created a program that allows for a high-efficiency triage. If, upon arrival, the patient is not in need of emergency transport, the intake process now includes a series of assessment questions that allows the medic to make an informed decision on whether to transport the patient at all.

Global Medical Response medics are trained and experienced to determine if a patient is eligible for a telehealth visit. If the patient's vitals are stable and it is not a life-threatening situation, the medic can pull up an iPad and dial in a doctor.

Some patients call 911, even if they just need primary care; they simply didn't know who to call. Oftentimes, a script just needs to be filled, thereby avoiding a costly ER visit. (On average, an ER visit costs $1,200, excluding the ambulance fee.)

ET3 gives ambulance providers a way and a protocol to allow the patient to be treated at home, lower the cost of care and save providers time. More importantly, tools such as eVisit enable EMTs to provide quality healthcare, not just transportation.

We also spent time in Texas visiting another emergency medical response customer that runs a high-tech dispatch center with a nurse navigator program. Navigators help triage folks who have called 911 and have entered the emergency response pipeline by first ascertaining if they are eligible for a telehealth call or an actual emergency visit.

The dispatcher connects the caller to a nurse who will seek to understand the patient's concerns and connect them to the right provider before they even send out the ambulance crew. The focus is on delivering the right level of care at the right time.

Q. What do you think 2022 will bring for providers in the realm of telehealth?

A. I anticipate new innovations and more integration of telehealth, which will be fueled by better measurement of virtual care as a service line and business offering. The meteoric rise of telehealth means we've captured a lot of data and insights to act on.

Healthcare organizations quickly launched telehealth programs in 2020 but haven't been able to slow down and do a full assessment. They need to determine the right ways to measure the programs within their systems so they can optimize.

I expect many will reimagine and expand their services knowing that the technology exists to enable more streamlined virtual care workflows. As the world returns to "normal," healthcare administrators will return to reviewing the quantitative data and begin to structure better policy around telehealth in their systems.

I also see an opportunity for greater autonomy, both for patients and providers. Patients are becoming more and more informed about telehealth and they're ready to fully accept what it is capable of offering them. Mass telehealth adoption also will allow physicians to practice in less structured settings. They'll be able to manage their time more effectively and apply focus in a more efficient manner.

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