The present and future of telehealth: An interview with Dr. Aditi Joshi

As we have seen in our series so far, telehealth uptake is growing rapidly as the world adjusts to the new normal of physical distancing. More healthcare professionals are offering virtual services to patients, who are increasingly at ease with the transition. 


But will there be a future where a doctor’s appointment over video chat feels just as routine as an in-person check-up? We spoke with physician and telehealth expert Dr. Aditi Joshi about the growth of telehealth, what clinics should consider when implementing telehealth services, and what the future of virtual healthcare may look like.




Who is Dr. Aditi Joshi?

Dr. Joshi is a resident physician in Emergency Medicine at Philadelphia’s Thomas Jefferson University Hospital. She has also become one of the nation’s leading telehealth experts. Her research revolves improving healthcare through technology and she has worked for the past seven years in telemedicine and digital health. She currently serves in a number of roles that involve telehealth education, training, and expansion, including running a fellowship aimed at training future physicians who are interested in leading virtual care.


She is also a regular contributor and speaker on digital health and innovation.


Q&A with Dr. Joshi

What do you see as the benefit of telemedicine and telehealth?


It is, in short, convenient care. It allows for various types of healthcare that can be outside the normal four walls. In general, I frame telehealth in the following four parameters: access, experience, effectiveness, and costs. Telehealth, depending on the structure and goals of the program, can improve any one of these for the individual, the health system, and the community. 


How have patients and healthcare professionals felt about telehealth?


Initially, there was little engagement by either. This was mostly due to lack of education and understanding of how to use it and the advantages it can have. However, due to the COVID-19 pandemic, a large influx of providers had to adopt it and this has improved their understanding of what it can do. There will be those who go back to in-person care, of course. However, more will continue to offer telehealth and make it part of their standard practice.


Generally, provider concerns are about access and how to ensure quality of visits and the standard of care. As more research is conducted, many of these questions are being considered and answered. 


How has telehealth evolved so far?


Telehealth has expanded considerably due to COVID-19 and the crucial need to evaluate and treat people who are sheltering in place, save PPE by using iPads/tele-triage, and decrease exposure. Prior to this, it was seen as a niche aspect of medicine, used sporadically or in small silos of first adopters. Now, the changing landscape has given a larger group of providers an understanding of telehealth. The next step will be continuing to lobby for regulatory changes and legal updates, expanding use cases as we understand more of what can be done, updating medical education to include this modality, and a further dive into what technology will do to change health and society. 


What are the incentives for a clinic to implement telehealth solutions?


I would frame this as defining what that specific institution needs and then creating a telehealth program based on those goals. For example, a clinic wanting new patient acquisition may consider telehealth for urgent complaints and consults to bring in new patients. Those wanting to improve their patients’ access to care, expand use to those who have trouble traveling, or engage family members or caretakers, would use it as an adjunct for existing patients. Eventually, with value-based care it can decrease costs as well. 


What are the most important factors when clinics are considering implementing telehealth?


The most important factors are the goals of their program, new patients who need access, improving care for existing patients, cost savings, etc. Doing research prior to creating a telehealth service is vital. When the COVID-19 pandemic began, there was a specific use case that everyone needed to use, which helped streamline telehealth’s expansion for screening, testing, and remote patient care. 


We looked at:


  • What platform will support the targeted needs?
  • Who will be staffing it and what training and education will that entail?
  • What processes for quality assurance are in place?
  • What kind of tech troubleshooting and clinical support are required?


What can actually be done in a telehealth appointment versus what requires an office visit?


Much more can be done virtually than anyone at first may imagine. Some advantages of doing a virtual visit include close counseling due to lack of distractions from busy clinical environments, getting more information on diet/meds/environment, the ability to explain things in detail, and the ability to see the patient’s home environment. 


How to do a physical exam tends to be the biggest question for providers. However, with creativity, you can do quite a bit over video. Also, the goal is actionable information, knowing the next best step for the patient whether it is monitoring at home, following up in a week, or the need for immediate care. 


How can specialists devote time to telemedicine when they may already be overbooked with local immediate needs?


Telehealth visits, when streamlined, actually save time as there is less time needed to register (all of this is done beforehand) and the visit itself averages about 15 minutes or less. Considering it as a more efficient use of time can help to improve how fast an in-person clinic runs. This is, of course, dependent on reimbursement allowing virtual care to be billed. Otherwise, it will just be extra work. 


Where do you think telehealth will be in 5–10 years?


In that timeline, there will be no need for the “tele” moniker, as virtual care will be just another type of visit available to anyone seeking healthcare, including pre-hospital care, as well as chronic care. We will be able to do more “home visits” over video, whether it is for patients who are admitted, just needing an observation, or just needing a check-in. All of that will be part of virtual care.



Telehealth: Here to stay

The message is clear: Telehealth is here to stay and it’s only going to get better as we continue to learn more about how to best serve patients’ needs using technology. In the first article of our series, we looked at the basics of telehealth, how it’s being delivered, and what challenges it brings. 


From there, it was all about how your practice can best benefit from telehealth, including tips on getting started with setting up telehealth services and understanding the limitations and opportunities. In the third instalment, we looked at what makes a great telehealth platform and some of the currently available telehealth software options.


Healthcare professionals around the world have been in a pressure cooker situation since the outbreak of COVID-19. The healthcare landscape is changing in response and telehealth is very much a part of that change and an important part of the future of healthcare services. 


Eager to stay on top of telehealth developments? Considering offering virtual services to your patients? Schedule a complimentary discovery session where we can gain an understanding of your business, your stakeholders, and your unique IT needs. We will use this information to provide a concise report with actionable recommendations for achieving better results from your IT overall, as well as everything you need to know to begin expanding your practice into virtual services. 

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