The pandemic made telemedicine an instant hit. Patients and providers feel the growing pains.

Crystal Joseph pays for two telemedicine video services to ensure that her small therapy practice in Silver Spring, Maryland, can always connect with her clients.

She has been burned before. In the space of an hour service interruption by SimplePractice In late May, PsycYourMind, which offers mental health counseling and group sessions for black patients, lost about $ 600 due to missed appointments. Lively, Joseph requested a small credit from the telemedicine service, which costs $ 432 a month for her team of clinicians and interns. SimplePractice refused, she said.

“What they offer is phenomenal, especially founded by a therapist,” said Joseph, a licensed clinical professional counselor. “But with a private practice, if you do not get paid, you do not eat.” In some sessions, she was able to jump on her backup, VSee, which costs her $ 49 each month. Some of her peers use Zoom. But even though Joseph keeps links to both her SimplePractice and VSee accounts in her email signature, last-minute switching can feel cluttered for clients, and she never charges a no-show fee when it’s an “act of God.”

Major health systems, clinics, and private practices quickly turned to telemedicine as the covid-19 pandemic forced the nation to put itself in place and patients could no longer venture safely into health care. But the video services were not exactly prepared for the titanic influx of users, said Kapil Chalil Madathil, an engineering professor at Clemson University who has investigated how easy – or difficult – telemedicine platforms are to use.

Video conferencing providers, including Zoom, tech giants like Microsoft and Cisco, and a host of telemedicine startups, absorbed an explosion of demand in recent pandemic months. PitchBook estimates that revenue from the global telehealth market will hit $ 312.3 billion in 2026, up from $ 65.5 billion in 2019. But beyond connectivity issues, some services seemed designed for dissatisfaction. They required patients to download a desktop application or have them click through several steps to log in. “On an iPhone, I can click a button to see my grandchildren,” Madathil said. “Can’t we make telemedicine systems as easy as that?”

Providers were often locked into telemedicine options from services they already used – or what they could afford. Joseph already paid SimplePractice to house his practice electronic health records, so it would have been time-consuming and expensive to move to another platform, she said.

Practitioners have relied on telemedicine to keep their business afloat during the pandemic, and Joseph plans to keep some of her sessions virtual. SimplePractice is a one-stop-shop for clinicians with private practice and offers scheduling, an electronic health care system and insurance claims filed along with its video services. The company said it hosted 17 million telehealth deals last year.

“Expectations are rising,” said Diana Stepner, vice president of SimplePractice. “Individuals want screen sharing, they want grid views, so we’ve added new options since the pandemic began and will continue to do so.”

Zoom became a poster child overnight to stay connected as employees in all industries worked from home. Dens revenues increased 326% in the financial year ended 31 January 2021 compared to the previous year. Even before the pandemic, the Silicon Valley company offered a service tailored to healthcare professionals that complied with the Health Insurance Portability and Accountability Act, which protects the patient’s privacy and could be synchronized with Epic Systems’ electronic medical records.

“It was ‘all bets are off’ when the pandemic hit,” said Heidi West, head of Zoom’s health department. West pointed to the CARES Act and the solution to the telehealth rules, which allowed doctors to be reimbursed for telemedicine at the same price as for on-site visits.

UCSF Health, which had contracted with Zoom for virtual visits since 2016, provided each physician and clinician with a personal link to their video conferencing line and a separate virtual waiting room. Telemedicine calls for outpatient treatment within the academic medical system in San Francisco, from 2% of visits in February 2020 to more than 60% by April. Doctors saw patients – who often used their cell phones – in their homes, in parked cars and in a case on skyscrapers where a construction worker stepped away for a quick doctor visit, said Linda Branagan, director of telecommunications at UCSF Health.

Zoom is not immune to error, Branagan said, but it seems to bounce back faster than many other vendors and “recovers quite gracefully.”

UCSF examined its patients and found that they were more satisfied with their video visits than their personal ones. More than a year later, nearly a third of outpatient visits are still performed virtually.

Elsewhere, the initial transition was more rocky. Dr. James McElligott, who runs the Medical University of South Carolina’s Center for Telehealth, said the hospital could not afford to upgrade its Vidyo conference system, so he chose Doxy.me, which the center already used for research and had an easy-to-use utility. interface.

“We were able to get smart, and a lot of doctors really liked it,” McElligott said. The software has a waiting room from which patients can be transferred to virtual rooms with providers. The healthcare system sent patients a text with a direct link to their appointments so they did not lose time.

“But we could not control the quality ourselves or solve connection problems,” he said. “We had a lot of patients who, despite being just a link, were uncomfortable waiting.” This led to some patients giving up visits, he added.

Doxy.me employed only eight people when the video telemedicine service saw an unmanageable increase in users in March 2020. For two weeks in a row, the company signed up 20,000 new healthcare providers a day, said founder and CEO Brandon Welch, collecting a backlog of customer service inquiries. One day, Welch remembered, there was a 30-second queue that the site could load because so many people logged in at the same time.

“We hired anyone who could go and chew gum at the same time,” Welch joked, noting that many of these early pandemic hires, who largely tackled customer service, had recently been fired from other industries, such as restaurants.

Doxy.me automated the sign-up process as quickly as possible. The service ballooned from 80,000 users to 850,000 as it assembled a team of 120 employees. And it still employs. Physicians and clinicians can sign up for the basic HIPAA-compliant service – which includes audio, video and a patient room – free of charge. But for enhanced options, like screen sharing or shared spaces, there is one price tag at least $ 29 a month.

For many doctors and clinicians, the transition to virtual visits can be permanent, even with all the technical hiccups. A study conducted by SimplePractice of over 2,400 clinicians in February found that 88% expected to continue offering a telehealth option.

Jessica Ehrman, a Santa Monica, California therapist who plans to keep her practice fully distant, finds telemedicine much easier to plan, especially for children who have short accessibility windows. Still, connection issues during the small time frame can stain the entire session.

“If you’re talking about deep childhood trauma – having your connecting class out then? It’s really frustrating when we pay for a service,” said Ehrman, who has suddenly been dropped from sessions, experienced delays and even once looked back – end coding appears in her provider portal. Like Joseph in Maryland, she uses SimplePractice through her agency and personally pays for Zoom’s HIPAA-compliant capability to avert technical difficulties.

Despite the problems, only a few healthcare providers want to abandon the technology. “Video visits are cemented,” Branagan said. “I’ll never have to have a conversation with a doctor again to convince them that you can do health care via video.”

Kaiser Health NewsThis article was reprinted from khn.org courtesy of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a non-partisan health policy research organization not affiliated with Kaiser Permanente.

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