How to Make Telehealth Services Easier—and More Accessible—for Everyone

What follows is a look at how some healthcare providers are making it easier to use telemedicine, and the challenges that remain.

Before the visit

Doctors and hospitals have come a long way since the beginning of the pandemic, when patients and providers struggled to set up appointments using Zoom and other videoconference services. In a recent survey by consultants McKinsey & Co., only 9% of patients reporting on negative aspects of an online doctor visit cited technical difficulties as a cause.

Doctors at Texas Children’s Hospital in Houston conduct more than 14,000 video visits a month, and fewer than 300 fail due to technology glitches. Families with telehealth appointments receive visit reminders by email and text days ahead of time that include video and written instructions in English and Spanish, and the phone number of the help desk. There is also an option to test the audio and video connection. If a connection is substandard, the family is instructed to call the hospital help desk.

Johns Hopkins Medicine also sees preparation as key to ensuring a successful appointment. Because so many patients wait until only a few minutes before an appointment to log in, “there is very little time to identify and solve technical issues, which reinforces the need to try to find a way to be a little bit predictive,” says

Brian Hasselfeld,

medical director of digital health and telemedicine at Johns Hopkins Medicine in Baltimore.

In response, researchers at Johns Hopkins developed a tool that tries to identify patients who are at risk of being unable to complete a video visit. The tool looks at whether they have an active account in the portal, have completed the online check-in process, and have recently had a video visit or only a telephone visit. When warning signs are spotted, staff can reach out by text, email or telephone to offer assistance before the appointment.

Inside the portal

Making portals easier to navigate is another big focus of telemedicine. Early in the pandemic, many portals required patients to use a unique link and password for each virtual visit, and some required downloading new software. Now many use a much simpler interface. You use the same login information every time, after which you can see a list of your doctors and appointments. Click on your appointment, and start your visit.

“We realized there is a lot of cognitive overload for patients,” says

Lee Schwamm,

vice president of digital patient experience and virtual care at Boston-based Mass General Brigham. “It is stressful to have to find an email, a link and a password when you are getting ready for an appointment with your doctor.”

Some portals are also trying to make their virtual waiting rooms more patient-friendly.

Myra Davis,

chief innovation officer at Texas Children’s, says its patients are greeted by a live staff member when they enter the virtual waiting room. The hospital system is also trying to make it easier for the staff member to chat with patients and to offer them a callback if the doctor is running late.

“Patients have less tolerance for waiting when they are at home,” says

Robert H. Ball,

medical director of e-health at Texas Children’s Hospital.

Digital divide

While well-capitalized academic medical centers have invested heavily in hardware, software, help-desk staff and social-equity initiatives, smaller practices with fewer resources are falling behind when it comes to providing telemedicine. In a 2021 McKinsey Physician Survey, 45% of doctors surveyed said they invested in telehealth during the pandemic, and 41% said they had the technology to deliver telehealth seamlessly.

“The lift is huge to implement this technology,” says Dr. Ball.

Health systems want to increase access to telemedicine for disadvantaged groups, such as nonwhite, poor and rural patients. Mass General Brigham’s patient portal is now available in six languages. At clinics in underserved neighborhoods around Boston, a bilingual coordinator encourages patients to register for the portal and teaches them how to navigate the portal and participate in virtual medical visits. For those without devices, navigators have 2,000 cellular-enabled iPads to lend. And for those who have a device but a poor internet connection, there are plans for coordinators to eventually lend mobile hot spots, devices that would provide cellular-based internet service to a patient’s home.

The University of Kansas Health System provides some tablets and hot spots for patients with limited incomes. It also partners with rural hospitals to provide rooms with devices and internet access that patients can use to connect with medical specialists in Kansas City. While some patients might own personal electronic devices, the data that a virtual appointment can use up could strain their budgets, says

Jason Grundstrom,

executive director of continuum of care at the health system.

Another issue holding some patients back is lack of trust in the process, particularly among patients who haven’t had a telehealth appointment, says

Kristin Rising,

director of the Center for Connected Care at Jefferson Health in Philadelphia.

Dr. Rising says she and her team are working on an effort to target patients who would benefit from education and outreach related to telemedicine. “Telemedicine is more accessible for patients, and it is faster for getting care,” she says. “But the issue is getting people to understand that.”

Doctor skepticism

Physicians themselves have some concerns about telemedicine. Roughly two-thirds of doctors polled in a survey released by McKinsey & Co. early this year identified shortcomings in telemedicine that make it more difficult for them to do their jobs effectively.

Their biggest criticism: the lack of a physical exam. “There are some conditions where I need a physical exam to make a decision on a patient’s care,” says

Keith Sale,

vice president of ambulatory services at the University of Kansas Health System.

Collecting lab specimens can be a challenge, too. Asking a patient in a virtual visit to go to a nearby lab for testing is much less certain to provide quick, satisfactory results than collecting the sample during an office visit.

Doctors also worry about the future of reimbursement for telemedicine. According to research by the Center for Connected Health Policy, just 21 states require commercial insurers to cover telemedicine visits at the same rate as in-person visits.

During the pandemic, the Centers for Medicare and Medicaid Services loosened coverage requirements for telemedicine visits and established payment parity for in-person, video and telephone visits. Most commercial insurers did the same. Some of the pandemic-related CMS exceptions are set to lapse Oct. 13, but Congress extended most of the exceptions to March.

At that time, unless there is a further extension by Congress, CMS coverage of telemedicine for traditional Medicare recipients will return to pre-pandemic rules, with some exceptions. Coverage will primarily be limited once again to patients in rural areas, and providers such as physical therapists and audiologists will be excluded. CMS will no longer cover telephone visits except for mental and behavioral health, and its reimbursement rate might be lower for telemedicine than for in-person visits. Commercial insurers will make their own coverage decisions, and states will do the same for Medicaid.

On the plus side for doctors, the cancellation rate is lower for virtual visits, and a doctor can see more patients in the same amount of time.

“There will be a core of, I think, 20% to 25% of visits that really don’t need to be done in person and probably shouldn’t be…and there will be patient demand for that,” says Dr. Schwamm. “Covid has taught me that we can never be without this capability again.”

Ms. Oliver is a writer in New York. She can be reached [email protected].