The COVID-19 pandemic has necessitated a new era in medicine in which telehealth appointments are a core aspect of the patient-provider relationship and provide broader access to healthcare.

So what has the healthcare industry learned about telehealth usage over the past year, and how can it use those learnings to deliver more accessible and high-quality healthcare for all?

Jessica Sweeney-Platt, vice president of research and editorial strategy at athenahealth, has telehealth insights learned from athenahealth's vast nationwide network data sourced from 18.4 million appointments held by 60,000 providers.

Healthcare IT News interviewed Sweeney-Platt on the subjects of telemedicine adoption, utilization, scheduling and permanence, seeking her expertise and lessons learned from athenahealth's treasure trove of telehealth data.

Q: In your experience, what was telehealth adoption like over the past 12 months? Where were you seeing most of the adoption, and in which specialties?

A: Despite the fact that telehealth has been around, in one form or another, since the 1950s, it was the almost total shutdown of the country in March and April of 2020 that truly established it as a mainstream access point. Not surprisingly, early adoption patterns followed the path of the most acute COVID-19 breakouts. We saw early spikes in the Northeast and the Western regions of the country, followed by the Midwest and the South.

States in the Northeast had the highest percentage (nearly 70% in April 2020) of virtual appointments initially but were overtaken by the West during the second wave of the pandemic in June and July 2020.

The Midwest has been consistently the second-lowest adopting region percentage-wise (a little over 40% in April 2020), and the South is consistently lowest in terms of percentages (roughly 30% in April 2020). The Northeast is also much more consistent than other regions, with high virtual rates throughout each state.

In all, we've seen telehealth go from less than 1% of total athenahealth network volumes to as high as 32%, before settling in at around 10-11%. The Northeast and the West lead the country for adoption and sustained volume of primary care telehealth appointments.

In terms of specialties, not surprisingly we've seen mental health and primary care use telehealth the most. Mental health has seen the largest percentage of appointments held virtually, with 33%, followed by primary care at 17%.

Q: You noticed that practices that have settled in at higher rates of utilization also tend to be practices that had some experience with telehealth pre-COVID-19. Please elaborate on what this tells you.

A: This tells us that the adoption of technologies like telehealth may be, in part, due to a trusted person that has already figured out how to make it work in that particular organization. These "IT champions" might help overcome some of the initial uncertainty that accompanies any new way of doing things – some of the basic infrastructure and knowledge may have already been in place.

This may be a helpful insight moving forward as physicians and medical groups look to implement other technologies. Never underestimate the power of a good pilot or experiment.

This pattern was just one of the observations that led us to believe that (at least from what we can see in our data) patients' use of telehealth is driven more by their practice than it is by individual preferences.

We saw some surprising findings when we looked at adoption levels across different racial and ethnic groups, and when we looked more closely, we realized that these patterns were driven by the overall adoption patterns of the practices. As is true with so many other care decisions, if your doctor or care team tells you that this is a safe and acceptable option, patients will likely follow that advice.

Q: In your experience, you noted that scheduling has a big part to play in the logistical outcomes of telemedicine services. What did you observe? What were the results?

A: Overall, the patterns that we see in the scheduling of virtual visits is quite different from the scheduling of in-person visits. We were working from a de-identified data set of 18.4 million appointments that took place between November 1, 2020, and January 31, 2021, and which covers 60,000 providers on the athenahealth network.

What we saw was that compared to in-person visits (4%), telehealth visits are more likely to occur after-hours or on weekends (7%). Telehealth appointments are almost two times as likely to be scheduled for the same day as compared to in-person appointments.

Finally, telehealth appointments are typically shorter. They are more likely to be under 15 minutes long (70%), compared to in-person visits (62%). Altogether, this paints a picture of patients integrating care on somewhat of a "just-in-time" basis, which allows for more spontaneous access, at times that are perhaps more convenient for folks trying to juggle a lot of other commitments.

We have also heard from physicians that telehealth has allowed flexibility in their own schedules. This is a little more anecdotal, but the physicians and providers that we've interviewed talk a lot about how telehealth is something that allows them to interact with patients from wherever they happen to be.

One physician talked at length about how important it was to him that he could do a telehealth visit from his car, then go in and see his son play basketball, whereas he would have missed that opportunity before. The impact on the provider schedule is something that we would actually like to dig into a little more over time from a data perspective.

Q: So, we've seen remarkable adoption of telemedicine in the past 12 months, but will it hold? What kind of permanence will it achieve?

A: On balance, we are bullish on the future of telehealth and virtual care. This is not to say that there still aren't things that the system needs to work out. One big wrinkle is long-term reimbursement for these services. It's still an open question as to how much of the regulatory and payment restrictions that were removed in early 2020 will be made permanent. So, any prognostication has to have that giant asterisk next to it.

But again, we are bullish on the future, mainly because we see that virtual care helps address real pain points. Whether it's busy people trying to squeeze a physician visit into their day, or a patient with chronic illness who just needs a check-in and med check, or as a way to make behavioral health services available to more people in more places, virtual care is a valuable addition to the care toolkit.

And for providers, virtual care has helped reduce cognitive burden and improve work/life balance. They can take telehealth appointments from the office or at home, which allows them to have more freedom, while still providing top-notch care for patients.

We may have seen adoption surge initially as a result of COVID-19. But, assuming that it remains financially viable, we think telehealth will have great staying power, because it provides flexibility, convenience and lower-cost access for those using it.

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