Telemedicine goes mainstream. Now what?

Coauthored by Chrissy Daniels, Press Ganey Chief Experience Officer.

Prior to the COVID-19 pandemic, telemedicine adoption was far from widespread. Despite obvious benefits of improving access, the technology wasn't in place, consumers weren't ready, and providers resisted the shift to virtual care.

2020: When everything changed

Then came the pandemic—and the need for social distancing. Suddenly, telemedicine was in high demand. As the pandemic surged across the U.S., the use of telemedicine also spiked. In June 2020, approximately 40% of healthcare encounters were conducted virtually, and use of telemedicine jumped 338% in 2021 (vs. 2019).

Press Ganey surveyed patients throughout the pandemic regarding their use of and experiences with telemedicine, and the results are instructive. It’s unlikely that telemedicine will retreat to pre-COVID levels now that patients, health systems, hospitals, and doctors’ offices have realized the benefits of virtual care and the right technologies are in place.

Telemedicine in a post-pandemic world

As restrictions lifted, use of telemedicine dropped from the highs of the 2020 lockdowns to a more stable 10–15%: In 2021, one in 10 returned MD surveys distributed by Press Ganey came from virtual visits. While 10% may seem low, that percentage represents millions of encounters. One thing that is becoming ever-clearer is that if the workflow and infrastructure for telemedicine is not supported and well-managed, medical practices will see a dramatic impact. Overall outpatient star ratings will suffer, which will affect Medicare reimbursement as patient experience becomes increasingly weighted.

Since the onset of COVID-19 in the U.S., Press Ganey has captured the voices of more than 3.9 million patients following a virtual visit to better understand their thoughts around telemedicine and what its future might look like moving out of the pandemic.

Virtual care continues to fill gaps, and, as time goes on, virtual care is poised to do so much more. Telemedicine has a huge potential to bridge inequities in healthcare, especially in rural communities with limited access to specialty care, and drive business.

Telemedicine is here to stay. The difference between now and 2019 is that healthcare organizations and providers have invested the time and resources into developing a better system and learning how to use it—and patients have more trust in the technology. It’s time to begin understanding where telemedicine works best, where it doesn’t work at all, and how it can most effectively be deployed to meet the needs of patients and of health systems.

What works, and what can improve?

Data collected by Press Ganey reveals what's working in telemedicine as well as areas for improvement.

When asked about “providers’ efforts to include you in decisions about your care” and “concern the care providers showed regarding your questions or worries,” patients reported that the virtual and in-person experiences were similar.

By mid-2021, gaps in the ease of scheduling in-person and virtual appointments had closed, as well as ease of contacting clinics regarding telehealth appointments. This was a shift from early in the pandemic, when consumers reported that it was easier to schedule an in-person appointment than a virtual visit. 

But virtual care is still in its early stages and providers are still getting up to speed. By November 2021, patients were far less satisfied with providers’ explanations about their problems or conditions during virtual visits than in-person interactions—even though they had started out on par. They were also less satisfied with providers’ discussions of proposed treatment (including options, risks, and benefits) than they had been toward the start of the pandemic.

A new method of care delivery is bound to cause patient experience scores to fluctuate—particularly when telemedicine was introduced very quickly, in the throes of a global health crisis. It’s possible that, early on, patients were simply glad they could contact their providers at all, but, as things settled down and they adjusted to the “new normal,” their expectations rose.

Throughout the pandemic, patients’ “Likelihood to Recommend” their provider for virtual vs. in-person care was extremely close. But during this same timeframe, their “Likelihood to Recommend” the practice was much lower for virtual care than in-person visits (though that measure is slowly making up ground). There’s certainly room for improvement in operations for both types of visits—particularly around how well staff worked together to provide care.

This discrepancy likely stems from the user experience with the technology as well as expectation setting. At an in-person appointment, patients generally know what to expect from a logistical standpoint: checking in at a desk and sitting in a waiting room until their appointment time. At a virtual appointment, the process is less clear. A virtual waiting room is sometimes a blank screen, leaving patients to wonder if they’ve been forgotten, if they used the wrong platform, or if they followed the instructions properly.

Ensuring the logistics of a virtual visit—connecting, checking in, waiting, talking to the provider, etc.—are as straightforward as each step of an in-person visit is critical to making telemedicine available across the healthcare system. Training staff and clinicians in how to better communicate virtually must also be prioritized.

Physicians and staff must work together to develop an advanced team-based care approach for telemedicine—one that reflects the in-person experience. During an in-office visit, a nurse or medical assistant meets with the patient first to review medications, update their medical history, discuss symptoms or problems, and check their vitals. The nurse takes notes and assists with any billing forms or documentation as the doctor’s seeing them. Then, after the doctor leaves, a nurse will review next steps with the patient. This approach should also be used in telemedicine, with virtual visits beginning before the doctor enters the “room.”

5 keys to improving the telemedicine patient experience

To make telemedicine visits successful, providers should focus on improving communication skills and interpersonal connections with patients. The following five skills are essential for effective, friction-free telemedicine.

1. Technical logistics: Brief patients ahead of the appointment on best practices with your telemedicine platform. Confirm the patient can hear you, see you, and understand you clearly.
2. Agenda setting: At the onset of the appointment, identify any priorities or concerns the patient has and communicate how these will be addressed.
3. Authenticity: Be genuine and show warmth throughout the appointment.
4. Empathy: Conveying empathy through a screen may seem challenging—but demonstrating that you’re listening goes a long way. Just like an in-person appointment, providers and staff should ask the patient about any concerns or worries and be conscientious about the language they use to put patients at ease.
5. Closing checklists: Don’t leave the patient confused about next steps. Summarize the post-visit plan, reinforcing both patient and provider responsibilities. Review questions and offer clear instructions for follow-up concerns. Sending patients a summary of what was discussed as well any action items reduces patient confusion and drives adherence to treatment. 

Now that the technology is in place and most people understand how to use it, setting up workflows and processes around telemedicine will finally let health systems, hospitals, providers, and patients take full advantage of telemedicine.

Learn more about Press Ganey’s PX surveys, which can be used to measure telehealth performance and KPIs. Or reach out to a PX expert.