Discussing the future role of telehealth with Dr. Til Jolly

What are your thoughts on the research?

Healthcare is woefully behind every other industry that allows you to book and attend appointments online interactively. People are used to online appointments for all kinds of things, and we make it harder than it needs to be.

It’s interesting that one of the top three things patients like about remote healthcare is easier booking. That’s interesting because there’s no reason why booking should be any easier for telemedicine versus in-person care.

Whether it’s live or telemedicine, an appointment has got to be scheduled. So, there’s a big market for that. And you have to wonder why doesn’t it happen?

So why is it? What is it in the nature of this industry?

Healthcare professionals are more modern than we used to be but we still do things in a very traditional way. You’re ordering tests and you go back and write it in, then you try to call somebody and maybe their pager goes off – we’re very old-fashioned in the way we do things and think of things in healthcare.

So the systems persist of having a person answering the phone with really long hold times. If I’ve got a patient in position and it’s between nine and five (except for lunch, of course) and I want to talk to somebody, it’s remarkable how long the hold times are – even if you want to reach a doctor’s office or hospital.

The fact is that current healthcare systems are not integrated at all. We talk about integrated health systems but we don’t have one. We have a bunch of different systems that don’t talk to each other.

It’s just very tradition-bound and partly it’s cost, partly it’s a complex issue that’s tough to tackle. We also have to consider that security is an issue now too.

And then, there’s just not huge competitive pressure to improve it. If you’re a doctor’s office or clinic and you’re running at full capacity, then you are most likely happy to let it run at full capacity.

Do you think experiences with remote healthcare during the pandemic have changed people’s expectations?

There is going to be an expectation if you look at utilization. Usage climbed rapidly through last spring, and then it has leveled off at a new baseline.

I think there is an expectation that remote healthcare should be available. But it’s interesting, there’s still a wide variation between patient populations about what they want and need.

In the US, the regulations are about to change. We had all kinds of regulations that relate to privacy and payment and other things where the waivers are probably going to go away. So in the end, what are we going to be allowed to do and supported to do after the public health emergency goes away?

What would you do to fix and improve the system?

I think one of the big frustrations for patients is the requirement to repeat information. Particularly very basic information like demographics and basic health history and things like that.

We need to do something to improve our information systems. Where the system falls apart is primary care sends you to a cardiologist or a primary care center. That information needs to be repeated because the systems don’t talk to each other very well, or even if the systems do talk to each other, people won’t trust them.

It’s really down to the information flow. If you look at billions of dollars spent 15 or 20 years ago trying to drive interoperability, that’s the big word. But the electronic health record systems, both in hospitals and in individual provider groups are kept proprietary.

From a regulatory standpoint, they’re not forced to share information. And if you are a practice, you’re not really incentivized financially to upgrade because you’re not getting paid for it. You’re operating on very, very slim margins. And you have to churn out more patients per hour because of the way you’re compensated. This is a fundamental system issue that we need to sort.

What else do you think stops progress in accessibility and convenience?

I think, as the provider community, we don’t really know how to market this. And we don’t even really know what marketing is.

If you look at the websites of provider groups, they’re all basically designed the same way. They all have: who we are and what services we provide and maybe what sets us apart and where our offices are located. And there might be a link to the telemedicine and to the scheduling.

But it’s a fundamental rethinking of how we communicate. We don’t like thinking of patients as customers. We’re taught that healthcare is a mission and a sacred trust and all that sort of stuff.

And because we weren’t taught to manage things that way, you still can have a physician/ patient relationship but you’ve got to put in place things that are more similar to the way Disney does things or Amazon or United Airlines.

People know how they interact with organizations that are fighting for market share. Knowing this, they assume that healthcare ought to interact that way. And it doesn’t. But it creates uncertainty and it creates annoyance because the system doesn’t work.

You see the signs up on highways with live updates on what the wait time is in the ER around the corner.

It drives us crazy because we know those numbers aren’t really true, but it shows tension between providing a healthcare service and that higher calling.

I once heard a presentation from an operations leader at a huge family practice group in Northern Virginia. They said they left 40% of their schedule open every day because they knew that a certain proportion of their patients would want same-day appointments.

It’s really a data management issue. You’ve got to have a data and analytics team that tells you, for example at an orthopaedics: we’re going to leave 15% of our schedule open on Monday because we know people are going to break things on Saturday and Sunday and want to come see us.