The future of virtual care

Telemedicine and virtual health now play an important role in the way we're able to access and receive care. To understand the benefits of virtual care and what changes to this technology and approach we might expect to see in the future, we spoke with Jeff Phillips, MD, from Newton-Wellesley Hospital.

Dr. Phillips is a primary care doctor trained in family medicine and is the medical director for the new virtual primary care practice at Newton-Wellesley Hospital. We’re sharing some video highlights along with the full transcript of our interview on this timely topic.

.

Q: What is digital health?

Jeff Phillips, MD: Generally speaking, digital health is the delivery of health care that involves using technology in some way to enhance the process. That can be something very simple, from using an electronic health record or a pedometer, to fancier things like ambient computing, artificial intelligence, and machine learning. Digital health encompasses all of those and is a very broad definition.

Q: As a physician, what excites you most about digital health?

JP: What excites me the most around digital health is that it provides an opportunity to collaborate with patients in a way that I otherwise couldn't. All of the data that patients generate around them, if used the right way, can really help me tailor a specific health plan to that patient because we're able to collect a lot more individualized data.

We can change the way that we deliver care and we can change the type of care that we deliver through digital health.

I think it is important to remember that digital health is health. Digital health care is health care. It’s a tool in our toolbox. It's really part of what we do; and it has the potential to make care better for everybody.

Q: How can virtual care improve the experience for the patient?

JP: I think that in terms of improving the experience for patients, virtual care really provides some additional options that people didn't have before. We think a lot about access and convenience in primary care. It's something that traditionally primary care has struggled with, frankly. So [by being able] to offer a same-day virtual visit for our patients, they don't need to come in five days from now. We can now see the patient more on their timeline than ours, [and] we know that patients like that.

The other advantage of virtual care is simply convenience. Even for someone who is young and healthy [going to the doctor’s office] is an inconvenience. You may need to miss time from work to drive in and sit in the waiting room and then get room to be seen. It’s at least an hour out of your day in the best of circumstances. So as we've been doing a lot of virtual care, a lot of our patients are doing their visits from work. If they have an office, they’ll close the door and have some privacy and do that. A lot of patients will go to their car and do their virtual visit from their car because it's a safe, private place. They can just do a 20-minute visit and then go right back to their job without necessarily missing anything. So, access and convenience are really important for patients and we understand that. Virtual care provides us with a way to do that now, which really enhances the care delivery for everybody.

Q: How does it improve the experience of the provider?

JP: I think that being able to see patients in their home environment [...] is extremely helpful, especially with elderly patients where they may be at risk for falls or have other orthopedic issues. Being able to see their environment and be able to see, “Oh, they’ve got a loose rug over there,” or “They should have a grab bar there behind them,” or “Look, they’re supposed to use their walker but it's over in the corner and they're not using it.” [This insight] really can be very powerful.

I think our job as providers at a very simple level is to help our patients live healthy lives and meet their health goals. We think that we can do that through virtual care just as well as in-person care. Essentially, providers like virtual care because they see the benefit it provides for patients. We feel like we're doing something really good and really powerful for our patients and that’s exciting for us.

Q: Do you think the idea of a virtual practice will grow?

JP: I think that the idea of the virtual practice will grow if we do it right. We know from other examples that if we just throw technology at a problem for technology’s sake then that's going to leave people very unhappy and leave us with a lot more work rather than less work.

I'm of the belief that technology really works best when it blends into the background and enhances our ability and gives us actionable data at the right time, but it's not in our face. So, for example, as we've got gotten better at doing virtual care over the past year, our interfaces have improved; and it's become much easier to connect with patients.

The focus really should be on the patient and the patient-provider relationship and collaboration. So, if the technology works well and gets out of the way and really enhances our ability to deliver care, then I think virtual care is going to take off.

I'll say that as someone who has been a booster of virtual care for many years, I was always the crazy person until the pandemic came along and forced our hands. It forced health care to change and health care is very slow to change traditionally. So if there's any silver lining to this horrible pandemic, it’s that it’s given us some really great new tools in health care that I don't believe are going to go away as we come out of this pandemic. We have really proven the value here over the last few months, so I do think it's going to grow.

I think that we've got really good data to say that patients really like getting care this way. We've got good data that the providers like it. What we need to really focus on now is proving that the quality of care in the long-term in terms of managing chronic disease is equal to if not better than that of in-person care and traditional models. I think that we're making some real progress in that direction.

Q: Has digital health changed the way providers collaborate?

JP: I think that digital health as a broader category has significantly improved the way that providers collaborate. And the most basic example is the electronic health record (EHR), which for all of its faults in the way that it was designed and rolled out, is an incredibly powerful tool that allows us to share one record per patient.

It wasn't that long ago that if you were a patient and I referred you to a specialist you’d have to show up at that specialist and they would have no record of anything about you and you would need to totally start from scratch. Whereas now when I refer you they open the same chart that I open and they know your meds and they know your problems and they can get down to the business of the purpose of the visit. We forget that it really wasn't that long ago that we did this large push into using electronic health records that are shared.

Now they’re not perfect, all the EHRs don’t talk to each other, the EHRs aren’t particularly well-designed so there's a lot of work to be done. But I think that provides the most clear example of how providers are able to collaborate on patients using digital health.

Q: What are the challenges of virtual care? Are there technologies on the horizon that could address them?

JP: There a couple of buckets that I would kind of lump [the challenges] into. One is really cultural, and that’s I think largely on the physician side of things. People in medicine tend to be very slow to change. They may be wary of new technologies and I think sometimes rightfully so. So before the pandemic this really was an uphill battle.

I think that, again, the silver lining of this horrible pandemic in this difficult year is that it's really opened the eyes of a lot of providers to say, “Hey, I can do at least some of my care virtually,” even as a traditional provider, and that's been huge. But there are still cultural challenges. There are still providers who are not interested in this and feel like it’s something separate from medicine. Which is why I harp on the idea that virtual care is care. Virtual care is health care. It really is just a different way to deliver this care.

So that's one challenge. The other challenge is more technological, and this is a bit easier to overcome and it's getting a little bit better every day. But again, I think the pandemic has spurred us to move a lot faster than we would have otherwise. So those tools are getting better. When we started doing virtual visits the technology was pretty clunky and buggy and it's now not perfect but it's gotten much, much, easier.

There are a number of technologies in the pipeline that I mentioned earlier. I think ambient computing is what I'm most excited about, which essentially just lives in the background. For example, you can have a virtual scribe where the system, your Zoom, is essentially listening to your visit with a patient—with everybody's permission, of course—and it's able to put together a note and order the labs for you so that you as the provider and the patient can just focus on the relationship piece. And of course machine learning and artificial intelligence is beginning to insert itself into our daily lives as providers. The technology challenges will be overcome, the real work is in ushering along cultural change.

The one thing that we really need to be mindful of as we're evolving virtual care is equity and inclusion. You don't want to exclude people and make accessing care harder. The point is to make it easier. So we're very cognizant of that and a lot of our efforts more recently have gone into developing platforms and programs that really meet that need of not having to have the newest smartphone to access virtual care, not necessarily even needing a Patient Gateway account or a portal, things like that. Because the last thing we want to do is exacerbate health care disparities, which we know exist for a number of reasons and we don’t want to make that worse.

Q: How would you like to see the technology and the virtual health care approach grow and expand?

JP: Honestly the best thing that I could take away from this if I look back in 20 years and say, “What was that digital health thing all about?” is people say, “What you mean, ‘digital health’?” Because it's just part of how we deliver care, there’s nothing special or fancy or different about it. Providers are doing it, patients expect it, payers are paying for it, and it's just part of health care.

I'd like to see the technology really fade into the background. The experience should be seamless; it should be simple. The tech on the back end can be incredibly complex and there's people that need to worry about that; but in terms of the experience for the provider and the patient we really want [the technology] to just disappear. Technology should be an enabler, not something that we have to trudge through. So that’s how I see it going. If we do it right and get patient feedback and really design this well, I think we’re going to end up with a system that looks like that.