The Expanding Divide between Videoconferencing and Enterprise-Grade Virtual Care Platforms for Healthcare Systems

Shayan Vyas, MD, MBA^*

Abstract: COVID19’s silver lining in healthcare technology ushered in a massive adoption of virtual care by health systems, clinicians, and patients. In the post pandemic world, as consumer/patient adoption for digital health access exponential continues to grow—Health systems, Insurers, and clinicians all need re-evaluate strategies create larger budgets, and commitments towards Digital health. The growth and rapid adoption seen during the early months of the pandemic was stimulated by removal of legislative, financial and reimbursement barriers. Healthcare systems must carefully and strategically evaluate secure, purpose built, and strategic technological investment.

While the world struggles with the current coronavirus disease 2019 (COVID-19) pandemic, healthcare executives, clinical leaders, and frontline healthcare teams continue to delicately manage the complex environment of the healthcare market, including financial and patient expectations. The post-pandemic world may look very different. According to most experts’ hypotheses at the time of this writing (June 2021), it appears to be the beginning of the end of the pandemic, with over 46% of Americans fully vaccinated vaccine rate in the US (The nation’s progress on vaccination).¹ Patient expectations have heightened exponentially due to the COVID-19 pandemic to the same level attained by that of the digital retail industry. However, the stakes are often higher for healthcare, which operates on slim margins while needing to provide the highest level of quality care and patient satisfaction. Before the pandemic, healthcare systems were often reluctant to invest in unrealized ventures for which reimbursement was questionable. The pandemic showed an untested health system reflex—the ability of healthcare systems and hospitals to become nimble and embrace digital technology. This new reflex is very enlightening and hopeful, especially for an industry during massive venture capital infusion, and more and more startups trying to disrupt the healthcare ecosystem.

The pandemic has been a robust reminder that the healthcare industry is extremely fragile. The lack of access to services became a matter of life or death, as people delayed care for routine and semi-urgent conditions due to the fear of exposure to COVID-19. It is the time for healthcare leaders to navigate a new way for serving their consumers.

Telemedicine, or digital health platforms, is not new but has emerged as a timely solution. During the pandemic, massive adoption of telemedicine by both clinicians and patients proved to provide high-quality medical care that surpassed the boundaries of a physician’s office and a hospital’s geographic reach.

Telemedicine and the concept of digital health platforms on a large scale need to be a strategic part of the plan for the “new normal” in healthcare. In the past, two main deterrents caused physicians and healthcare facilities to hesitate using telehealth services: limitations on reimbursement for these services by insurance providers and concerns surrounding the quality of care provided through these services. As the pandemic exposed multiple flaws in the current healthcare system, telemedicine quickly became the solution for the continuity of care, in addition to its safety component, given the transmissibility of COVID-19. Patients benefited as clinicians were able to access their patients safely while addressing urgent medical issues, chronic diseases, or continuity of care.

According to the Medical Economics 2020 Technology Survey, “…more than 93% of physicians used telehealth to see patients during 2020, of which 77% of them were using it for the first time.”² We have now had more experience in virtual care over the past 9–12 months than what we had in the past 20 years. As we begin to build toward the post-COVID-19 health system ecosystem, telehealth experts have projected that telehealth visits will represent 15–20% of all clinical visits. They speculate that digital health services will most likely exceed 20% of overall health system visits. Using 2016 metrics (883.7 million ambulatory US visits), 15% represents 132.6 million visits. There is a high probability that with conservative growth in 2021, telehealth could mean at least 250 million ambulatory telehealth visits.³

Combined with inpatient telehealth visits in 2021, telehealth could see as many as 400–500 million ambulatory and inpatient visits. This estimate is similar to the prediction of 400 million telehealth visits made by accounting and consulting firm Deloitte in 2021.⁴ Additional data by consulting company Forrester predict that 480 million telehealth visits will be completed in 2021, with estimates that more than 50% of practicing physicians will plan to make virtual care a permanent part of their care market.⁵ As the regularity of visits increases, the expectation is that the entire healthcare ecosystem—comprising entities such as legislators, payers, and practitioners—would cease distinguishing these visits as telehealth and accept them as routine medical visits. Post-COVID-19, telehealth will likely deliver more than 20% of the overall health system’s total visits.

What does this mean for healthcare leaders? Although the pandemic has caused unfortunate devastation, there is a window of opportunity to use digital health to treat the “whole” person. In the pre-COVID-19 world, a videoconference was exclusively used for business- or work-related meetings. Now, the pandemic has created millions of videoconferencing uses, and consumer and business videoconferencing have witnessed massive consumer adoption. However, the use of these consumer-grade video communication technologies for medical consultations has profound security and compliance implications for any healthcare clinician.

Simple conferences, social or virtual education meetings do not require hospital-grade security because patient health information is rarely shared in these settings. The standard videoconferencing vendor does not need end-to-end encryption, which curtails patient health information (PHI) exchange; this is far different from using a video meeting for a bar mitzvah or classroom education. Security and stability are unbelievably complex, considering that patients’ devices, device operating backbones, Internet connections, and locations vary greatly. These consumer-grade tools come from companies that are not immersed in healthcare. Hospitals and healthcare systems require a purpose-built telehealth platform on which to build a clinical model that addresses a range of care beyond simply creating a video bridge. With this comes a higher level of patient data security and accountability. The Health Insurance Portability and Accountability Act (HIPAA) waiver (as well as state license waivers) will inevitably be reversed and return to pre-pandemic regulations, thus closing the door for consumer-grade videoconferencing as a means of patient-clinician telehealth visits.⁶

As telehealth and remote monitoring continue to expand, consumers trust in health systems, payers, and clinicians will benefit from the established trust they’ve earned and will increase with virtual health platforms. Leveraging a digital platform to support both acute and longitudinal healthcare needs presently exists in the market. Healthcare leaders must invest time for creating a new practice flow with the patient at the center.

The first step is looking at the needs of a patient through the lens of a consumer. Traditionally, healthcare has been built around clinicians; however, today both patients and clinicians are the consumers.⁶ If we do not treat physicians as consumers when it comes to healthcare, particularly when embracing new technologies that will affect them, we will not be addressing the epidemic concerns of physician burnout or physician adoption.

More in-depth clinical and financial models would need to be developed to address the needs of patients with complicated conditions that involve ongoing care in a virtual setting, for example, transitioning patients who require home care, hospital inpatient care, seniors, people living with chronic conditions, and those patients who require critical care or are acutely ill. There are other challenges to consider, such as the demographics of patients and the support they may need to navigate these platforms or the availability of Wi-Fi to support virtual care. While there are many care options available, consumer videoconferencing tools are not built for whole-person virtual care, as they are not secure or suitable for the rigors and demands of healthcare.

Virtual care solutions that are built for healthcare settings also provide a hyper-personalized experience. This involves capturing patient data, algorithms, and artificial intelligence (AI) through passive measures and more proactive measures, such as glucose monitoring. All this information can be aggregated into relevant data to improve the patient experience.

As healthcare leaders and clinicians want to virtually support more patients’ whole-person health without sacrificing the quality or outcome, they will need more intelligent, integrative virtual platforms. Healthcare leaders will have two paths to proceed. One path is to use outdated consumer video tools that provide no positive impact on healthcare analytics, quality, or overall outcome. As the delineation and separation between the consumer-grade video technology and enterprise virtual health platforms widens, the path of keeping consumer-grade technology will create a significant tech debt, cost and eventually significant local or regional disadvantages. The other path is to use those healthcare systems that embrace purpose-built virtual health platforms that will enable them to provide hyper-personalized, higher quality, whole-person virtual care. Using consumer-grade video technology for virtual care is similar to using VHS (video home system). VHS cassette tapes which have been obsolete provided user such a poor quality and significant limitations compared to today’s technology. This decision to use consumer grade video technology vs virtual health platform is akin to choosing to invest in VHS cassettes and dial-up versus live streaming and 5G.

Organizations that embrace an enterprise-wide virtual health platform should build a strong financial plan, long-term strategic thinking, and enterprise-wide commitment. Scalability is an important aspect when developing the foundation of digital health platforms, as is the ability to keep data centralized through a single vendor that offers an enterprise-wide, hospital-grade, secure, stable, and integrated telehealth solution that can work across multiple clinical workflows.

As most, if not all, healthcare systems invest millions or billions of dollars in their electronic health record (EHR) system, as well as their physical infrastructure, telehealth must be equivalently investigated, resourced, and staffed by healthcare systems. Infrastructure investments must be made along with an enterprise telehealth solution. An all-enterprise telehealth solution fulfills this vision of a digital front door. Several studies have shown that the cost of purchasing and installing an EHR ranges from $15,000 to $70,000 per provider.⁶ Hospital leaders will have to decide what they are willing to spend in order to stay ahead in this rapidly changing healthcare market with growing number of competitors.

There are many new emerging technologies that not only accelerate the development of new drugs but also introduce a completely new class of therapies and treatment procedures, such as digital health, which are software-based solutions that can treat and support a specific type of disease or health condition. Digital healthcare has an advancing impact on the delivery of healthcare services and provides the opportunity to tackle the next frontier in healthcare by shifting the focus from treatment to prevention. Recent advancements in digital healthcare and human-centric solutions have greatly affected the overall experience of patients, physicians, and caregivers. If digital health services meet the demands and expectations of patients, more than 75% of all patients are expected to use such services in the future.⁷ The implementation of digital health enables better monitoring of the progression of disease and tracking of general health. It also enables physicians to provide better, more personalized care and to diagnose patients effectively and efficiently through a variety of methods, such as by providing access to quality data, interoperability, and delivery of healthcare.

Digital health services ensure the delivery of evidence-based interventions for the prevention, management, treatment, and monitoring of health conditions, medical illnesses, and diseases, and are driven by high-quality software programs, whether as a stand-alone monotherapy or an optimization to support the current medication and treatment.

The COVID-19 pandemic has exponentially altered the course of the digital healthcare industry; in fact, it has altered the entire US healthcare system. Healthcare systems that build on this momentum and use purpose-built telehealth solutions are well positioned to build a sustainable virtual care infrastructure—one that will allow healthcare systems and clinicians to expand access to high-quality care.

Conflict of interest: Dr. Vyas is a physician executive leader at Teladoc Health (TDOC), is global leader in virtual care and is a publicly traded company on the NY Stock Exchange.

Unpaid: Advisory Board Member of Telehealth and Medicine Today

Funding statement: Dr. Vyas has not received any funding or benefits for this editorial.

Conclusions: The Healthcare ecosystem rapidly embrace of virtual care amidst the COVID19 pandemic showed that healthcare is entering an era of digital transformation. Arguably aside from EMR (electronic medical records) adoption, the healthcare industry might be one of the last industries to fully embrace digital consumer transformation. Digital health transformation is akin to banking and retail’s digital health adoption-security and digital customer experience is a must for health care systems transitioning into digital health. During the pandemic, many clinicians used consumer grade solutions for video conferencing, which cannot be sustained or scaled long term.

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