The number of virtual healthcare visits has soared. Before the pandemic, only one percent of doctors’ visits were held virtually in the US. But in just the first month of the COVID-19 pandemic, that number jumped to nearly 50 percent according to the ATA, an organization that works on improving telehealth and has analyzed Medicare claims data.
This trend will affect how healthcare services are delivered in a post-COVID world. While the telehealth usage rate is no longer increasing as quickly as it was in spring 2020, it remains much higher than before the pandemic and shows no signs of decreasing.
What helps healthcare providers quickly adopt telehealth services?
The US federal government has temporarily relaxed previous telehealth restrictions during the COVID-19 crisis to ensure easier provision of telehealth services.
Some of these temporary changes allow providers to:
- Provide telehealth services to Medicare patients outside of designated rural areas and even across state borders
- Serve not only established but also new Medicare patients via telehealth
- Offer any healthcare services via telehealth at the provider’s discretion
- Charge for telemedicine visits (both video and audio-only) at the same rate as in-person visits
- Use widely available communication solutions such as FaceTime, Facebook Messenger, Google Hangouts, Zoom, and Skype, even if the solution doesn’t fully comply with HIPAA
Questions are emerging among healthcare providers as to the reasonableness of this last provision, however, and for good reason.
What’s wrong with existing communication and telehealth solutions?
First, the security of popular communication solutions leaves something to be desired. Take Zoom, for instance. Recently, the Federal Trade Commission (FTC) accused Zoom of misleading users and engaging in a string of delusory and unfair practices related to its security. The FTC pointed out fake end-to-end encryption and mentioned the software that Zoom installed on Macs without authorization in 2018 and 2019.
Second, common communication solutions don’t provide adequate APIs. This means you can’t implement additional functionality when using them, which is essential for full-fledged telehealth software systems. It might handle patient profiles, payment processing, notifications, appointment scheduling, reporting, and remote patient monitoring. Having such functionality in one web-based telemedicine system is possible only when you choose software specifically tailored to telehealth.
Off-the-shelf telehealth software
There are a number of ready-made telehealth solutions on the market. Vectera, eVisit, and Doxy.me are some of the most prominent telemedicine solution providers, as they give doctors a quick way of delivering HIPAA-compliant telehealth services.
But in the long run, these are also not optimal solutions. Here’s why:
Price. Telehealth patient communication platforms will charge you for a license or subscription, but be prepared to pay extra for essential features. With Doxy.me, for example, to get a monthly usage report or add multiple participants to a call, you have to choose the most expensive Clinic plan.
Poor customizability and feature sets. With existing platforms, there’s not enough flexibility to quickly adjust your software to fit your existing workflow, and some features you need might be unavailable. For instance, Vectera doesn’t provide e-prescribing. The eVisit feature set is even poorer: the platform doesn’t offer appointment reminders, billing, or even appointment scheduling. Moreover, if you use any SaaS solution, you can’t store data on your own servers, which is sometimes critical for a medical practice.
Unstable support. During emergencies like the COVID-19 pandemic, a telehealth platform’s support team might be too busy to be reached and there may be nobody to help you if the service goes down. That’s what happened to Doxy.me customers in April 2020 during the spring coronavirus peak. According to reviews on the Doxy.me website, users were struggling with connection quality issues and were unable to get timely help from the support team.
Any ready-made live communication or telehealth solution might aid in providing emergency telehealth services. But while you’re leaning on a temporary crutch to cover your patients’ needs, it’s high time to get down to creating a reliable custom HIPAA-compliant telemedicine application. There are many reasons to believe that telehealth will remain in high demand when the COVID-19 pandemic passes.
Why telehealth is here to stay
Obviously, COVID-19 triggered the use of telehealth services. Doctors, patients, and medical practices tried this digital health technology, and it turned out that health virtual visits can be much more convenient than in-person visits. Moreover, it seems that many things doctors initially thought they could only provide during an in-person visit might be successfully provided online. The positive experience with telehealth services and unease with in-person visits caused by the pandemic are leading to increasing demand for telehealth services from all parties.
Patients are supporting the virtual revolution
Consumers wanted telehealth long before COVID-19. The Virtual Visits Consumer Choice Survey 2017, for which Advisory Board surveyed more than 5,000 patients across the US, discovered that 77 percent of those patients wanted to participate in virtual care and 19 percent had already done so.
Since then, many things have changed:
- Patient adoption of telehealth at the beginning of 2020 was up 33 percent over 2019 according to a Doctor.com report.
- Lack of telehealth services is now one of the top 10 reasons why a patient may be discouraged from booking a visit with a provider (Doctor.com).
- Over 60 percent of Medicare-eligible seniors state they’ve adopted technology more during the pandemic according to this year’s survey from healthinsurance.com. 43 percent of those surveyed want to use telemedicine once COVID-19 passes.
There are several reasons for this high demand:
Time and cost savings. The ability to use telehealth patient functionality via a phone or desktop saves time and eliminates the need for take off work and pay for gas, travel, parking, etc. People with tight work schedules and those caring for elderly relatives or children often have difficulties visiting a physician in person.
Accessibility. For individuals living in rural areas, it can be hard to access quality healthcare. Transportation issues are even more evident for those who have serious health problems, which makes it challenging to access in-person care.
Privacy and health security benefits. Some individuals might be intimidated or anxious about searching for care related to sensitive health issues. These might include family planning, mental health, and various aspects of women’s and men’s health. Also, people vulnerable to COVID-19 such as seniors and people with underlying medical conditions are likely to benefit from telehealth.
Telehealth to simplify doctors’ work
In April 2020, Sermo conducted a survey among physicians. They discovered that after the pandemic ends, healthcare specialists are planning to use telehealth technology more often than they used it before.
Specialties that are willing to use telehealth the most include oncology, hematology, cardiology, and neurology. Roughly 60 percent of doctors intend on using telehealth more often, with 20 percent stating they plan to conduct patient video meetings or use other web and mobile apps for telehealth significantly more often than in the past.
The reasons for this demand for telehealth among doctors include:
Improved work–life balance. Doctors want to use telehealth, as it enables a more flexible schedule and helps to reduce burnout. Telehealth doctor functionality helps them provide real-time remote services and have greater access to patients. According to a 2019 report by American Well, the specialists that want telehealth most are those with the highest burnout rates. These include specialists in urology, emergency medicine, infectious diseases, neurology, psychiatry, pediatrics, and oncology.
Ability to attract and retain new patients. Doctors consider virtual visits helpful in ensuring convenient, patient-centric care that might widen their patient bases and retain patients. Moreover, by providing timely and easy access to care via virtual visits, doctors think telehealth may improve patient outcomes.
Ability to handle common or minor health issues. According to data by the Association of American Medical Colleges, the US might experience a shortage of 54,100 to 139,000 doctors, including both primary and specialty care physicians, by 2033. Virtual visits might reduce time spent on in-person visits. Telehealth itself and technologies such as artificial intelligence can improve the efficiency of available providers. As a result, doctors can serve more patients faster and ensure that common and minor health issues are solved without their intervention.
The physician shortage is already being acutely felt by medical practices. But telehealth promises them other benefits.
Benefits that telehealth promises for medical practices
Here are some of the most prominent benefits offered by telehealth to healthcare organizations.
Fewer costly patient no-shows
Patient no-shows seriously block a practice’s revenue stream. A study by Health Management Technology determined that no-shows cost the US healthcare system $150 billion annually and cost the average doctor $200 per unused time slot. Whether or not a patient shows up, a medical practice still has to pay its workers and cover expenses such as rent and the use of equipment.
By delivering remote care to patients wherever they are, providers can not only reduce their no-show expenses but can even increase their revenue, as it’s more convenient for a patient to see a physician virtually. At the same time, providers can fill no-show appointments at the last minute by keeping a waitlist for same-day visits.
Getting reimbursed for telehealth services
Medicare reimburses telehealth services at the same rate as the comparable in-person services based on the current Medicare physician fee schedule.
Specialists at distant sites that can get paid for covered telehealth services (subject to state law) include doctors, physicians’ assistants, nurses, nurse midwives, certified nurse anesthetists, clinical psychologists and social workers, nutrition specialists, and registered dietitians.
Most commercial insurers at least partially cover telehealth services, including the largest insurance providers like Aetna, BCBS, Cigna, and United Healthcare. The American Society of Clinical Oncology has compiled a list of many private insurance providers that cover telehealth services along with conditions of coverage provided.
Reduced hospital readmissions
About 82 percent of 3,080 hospitals participating in the hospital readmissions reduction program by Medicare from 2016 to 2019 were penalized for overly high readmission rates according to revcycleintelligence.com.
High hospital readmission rates are a common problem due to the gap between discharge and homecare. During this time, patients can get conflicting instructions and consequently fail to follow their treatment plans.
Telehealth can facilitate treatment outcomes and reduce hospital readmissions while at the same time facilitating the continuity of quality care. This can be ensured through continuous patient medical education and remote monitoring of a patient’s state of health by tracking vitals after a patient is discharged from the hospital.
Having considered the benefits of telehealth for patients, physicians, and healthcare organizations, let’s touch on the key terms you need to understand before getting down to custom telemedicine app development.
Components of telehealth
When discussing telehealth, we often hear the term telemedicine. Although the terms telehealth and telemedicine are often used interchangeably, they’re not the same.
Telehealth is much broader than telemedicine
Telemedicine is a subset of telehealth, which covers healthcare information, education, and other healthcare services in a broad sense. Telehealth includes helping patients not only directly but also indirectly by assisting, informing, and educating healthcare providers so they can better care for patients.
There are three use cases of telehealth:
To ensure providers’ support and enable collaboration
Tele-ICU (Telemedicine Intensive Care Unit) technology helps off-site clinicians to provide bedside staff with e-consulting on patient care. A centralized team of consultants can assist many geographically dispersed facilities in real time and share health data electronically.
Via audio/video calls and a real-time exchange of patient data from several interfaces, a doctor working from a virtual medical center in Los Angeles, for instance, can rapidly care for a patient in Santa Barbara at any time of day. This connectivity allows an intensivist to quickly provide quality care.
To remotely monitor vital signs
Remote monitoring ensures the real-time transmission of data from a patient to a provider. Patients can systematically forward health data including weight, heart rate, pulse, and blood pressure.
Data collection and transmission is typically facilitated by means of the Internet of Things (IoT). Wearable devices include the Apple Watch, Fitbit devices, smart touchscreen glucose meters, and implantable cardiac devices. Receiving this information in a timely manner helps a provider promptly adjust treatment and consequently provide better care.
The recent survey from healthinsurance.com that we previously mentioned found that among 1,000 Medicare-eligible seniors that used a telehealth service, 28 percent tracked their vital signs using a wearable device.
And according to the survey cited above by Sermo, among 1,392 doctors, over 90 percent are conducting virtual patient appointments. However, this survey also shows that remote monitoring tools are more widely adopted by doctors from Asia and Europe than those from the US. Only eight percent of US doctors reported using them. These statistics suggest that demand for remote monitoring in the US is three times higher than supply, so it’s high time to strike a balance.
By the way, Healthfully, an all-round healthcare management solution with virtual visit functionality that was created by Yalantis, provides remote patient monitoring tools by means of fitness trackers and medical devices.
To ensure patient engagement via patient portals
Patient portals are secure websites that give patients easy 24-hour access to their personal health data. By logging in with a username and password, a user can check health data such as recent doctor visits, lab results, and medications.
In addition, some patient portals enable patients to schedule non-urgent visits, text their doctors, learn about health-related matters, and even benefit from social community components.
We implemented community components in Healthfully. Medical personnel, relatives, and friends can build a patient-centered community in Healthfully with different levels of access to a patient’s health information. There are also anonymous communities devoted to different health problems in which patients can share their challenges and experiences.
Telemedicine as a component of telehealth
Telemedicine refers specifically to serving patients remotely using telecommunications technology. This includes sharing medical images, remote diagnosis and health assessments, online video consultations, and audio calls.
Video conferences and pre-recorded video guides enable providers to ensure patient-centric assistance for even the most expensive and difficult to treat conditions, including heart disease and diabetes. Paying a virtual visit to patients with these conditions might prevent an unnecessary hospital trip or even save a life.
Synchronous and asynchronous telemedicine
When researching the topic of telemedicine, you might notice mentions of synchronous and asynchronous telemedicine. It’s important to understand how they differ and why implementing both is essential for achieving the goals of your software solution.
Synchronous telemedicine is conducted via video calls.
Asynchronous telemedicine is when a patient transmits medical data to a provider from an offline assessment conducted at a convenient time for the patient. Examples of asynchronous telemedicine are sending still images like X-rays, MRIs, or photos of a skin condition for analysis. Another example of asynchronous telemedicine is when a patient participates in an online doctor survey.
Software such as Healthfully allows doctors to conduct surveys to monitor patients’ conditions and satisfaction. Setting up trigger parameters in a patient survey in Healthfully allows doctors to receive notifications so they can adjust treatment or suggest extra screenings.
To develop an all-round telehealth solution, you need to make sure you cover synchronous and asynchronous telemedicine functionality. You also need to take into account your healthcare specialization to make sure you meet the needs of your patients and staff.
Telehealth for different healthcare specializations
It’s crucial to understand when telehealth is not sufficient. There are many cases that require detailed examinations (in proctology, dentistry, gynecology, etc.), screenings (fluorographies, gastroscopies, mammographies), and surgeries. Add to that list providing emergency medical care when a patient suffers from loss of consciousness, chest pains, coughing or vomiting blood, or any traumatic injuries.
However, any practice that provides the above-mentioned care can still at least partially use telehealth solutions. For example, pre-operative, post-operative, and other consultations don’t necessarily require in-person visits.
Telehealth works very well for primary, preventive, and chronic care, nutrition, radiology, and less severe yet urgent matters including coughs and colds, migraines, irritable bowel syndrome, erectile dysfunction, allergies, and behavioral health via tele-mental health solutions.
Lots of essential physical exam findings, including rashes or difficulty breathing, might be diagnosed by means of videos or photos. For other examinations, physicians may need extra tools that vary depending on the specialization.
Optometrists may ask patients to take online visual acuity tests and fill out dry eye questionnaires prior to a consultation.
Endocrinologists might use connected glucose meters to automatically upload blood glucose levels to a secure digital account that can provide patients with real-time, personalized suggestions.
Cardiologists might take advantage of the Apple Watch, some versions of which contain an FDA-approved application that can perform and transmit information on EKGs in real time.
It’s vital to consider the specifics of your healthcare domain when you’re planning a real-time telehealth solution.
Basics of how to create a high-quality and secure telehealth solution
Let’s now look at some basic technical peculiarities and tips from our company’s experience related to developing a telemedicine app.
Telemedicine app and video module architecture
How can you build custom telehealth solutions? Use telecommunications technologies. Start with an out-of-the-box streaming video and audio solution like Flashphoner, TokBox, Ant Media, or Wowza. Each offers its own SDK that provides developers with flexibility to create an app that meets your product requirements.
These ready-made solutions free developers from handling load balancing, traffic prioritization, and lost packages. Moreover, they provide developers with ready-to-use architectures that can be adapted to specific telemedicine software development needs.
Establishing high-quality video and overall security
A secure connection, data storage, and HIPAA compliance are the three pillars of telehealth security. Although US authorities aren’t currently requiring telehealth services to comply with HIPAA, we strongly believe that healthcare solutions must be secure from the outset.
To provide secure patient-provider communication, you need to implement a network security protocol like SSL or TLS. Both help to ensure secure network connections between two systems.
What impacts the quality of a video stream? There are multiple factors including how the route between a streaming source and an end user is built and how your router is set up. It’s almost impossible for developers to manage such issues. But we can use technologies that allow us to establish an optimized real-time connection.
Peer-to-peer vs client-server networks
There are two approaches to ensuring a video connection. The first is building a client–server network in which video is streamed to a server and then distributed to end users.
This approach is better for pre-recorded videos, as a server can ensure more storage space than most external storage devices attached to a peer-to-peer network. The HLS and MPEG-DASH protocols help to ensure adaptive playback by streaming a video file in parts.
But in order to minimize interruptions during live conferencing, it’s more appropriate to implement a peer-to-peer network, as it provides a better real-time connection. The WebRTC protocol helps to transmit all multimedia communications in real time.
Establishing secure data storage and HIPAA compliance
To ensure data security, you should keep all passwords and sensitive user data encrypted. Also, use up-to-date security approaches (for example, an SHA hashing algorithm instead of the outdated MD5).
How to ensure HIPAA-compliant video conferencing and data sharing
At Yalantis, our specialists have experience developing HIPAA-compliant software. This is what we did to make Healthfully HIPAA-compliant:
- Followed HL7 standards for sharing medical and administrative data online and ensuring secure and simple storage and data transfers.
- Recorded activity logs of all users’ activities to comply with HIPAA (logs must be kept for at least six years) and to enable Healthfully to analyze its processes to increase productivity and improve the customer experience.
- Deployed the software on Amazon Web Services to guarantee that all data is encrypted and to allow for building a HIPAA-compliant structure.
To be able to create healthcare software fast and with high quality, a development team should be well-versed in healthcare industry requirements for e-clinics. Understanding user roles, the needs of each target audience, and technical specifics is a must.
On-premise and cloud-based EHRs, virtual clinics, and other eHealth projects also require lots of integrations, often with legacy systems and poorly documented technologies. It takes developers much time to learn how to use each technology if they aren’t familiar with it and decide on the best technical stack to choose for a particular project.
Our business analysts and technical specialists are experienced in all of these things which helps them choose the most suitable technology stack to develop web and mobile health solutions. If you want to build an on-premise or cloud-based telehealth software solution, we’ll create it for you on short notice. Want to improve your practice’s doctor–patient interactions? We’ll gladly stand by you providing our outsourcing and outstaffing software development services as we know how to develop a telemedicine platform.