Telehealth’s Trouble: How Virtual Care Complicates Interoperability

The rise of telehealth didn’t create a new interoperability issue. Rather, it added another variable to an already-complex equation.

Why isn’t telehealth interoperable?

The healthcare industry lacked interoperability long before telehealth’s expansion, largely because “hundreds of government-certified EHR products are in use across the country, each with different clinical terminologies, technical specifications, and functional capabilities.”^[6]EHRs: The Challenge of Making Electronic Data Usable and Interoperable, National Library of Medicine, September 2017 Those differences make it challenging to create and implement one standard system that everyone can use.

Rather than creating a new problem, the rise of telehealth simply added another variable to an already-complex equation. Think of the healthcare industry like a logic puzzle with five combinations of issues related to interoperability. When you introduce telehealth as the sixth entity — instead of 25 issues, you now have 36.

It’s also important to understand that although the term “telehealth” often gets lumped together into one concept, the industry is actually split between two camps:

1. Telehealth providers: Telehealth companies with home-grown EHR systems that hire board-certified doctors, licensed therapists and medical professionals to provide patient care.

2. Telehealth vendors: Telehealth companies that sell technology solutions to third-party health systems, so primary care physicians can offer virtual appointments to their patients.

To muddy the waters even more, some telehealth providers with home-grown EHR systems also sell their technology solutions to third-party health systems — a hybrid model of sorts.

Regardless of which telehealth company a patient goes through — and there’s an abundance; Becker’s Hospital Review recently published a story about 260+ telehealth companies to know — the challenges are largely the same. Telehealth technology typically isn’t compatible with major EHR systems. Diagnoses, prescriptions and clinical notes from virtual appointments don’t automatically sync with patient records, leaving primary care physicians and other medical professionals in the dark.

If a patient opts for a telehealth appointment, their primary care physician won’t have insight into that appointment’s history, unless the patient requests their records. And even if they do request their records, that process can be cumbersomely manual — often, a provider will receive a print copy of their patient’s records, devoid of clinical notes or up-to-date prescription information.

On the flip side, if a patient opts for an appointment with their primary care physician via vendor-supplied telehealth technology, the doctor may have to record details of the virtual visit through that company’s EHR. Alternatively, they might have to toggle between two systems, inputting duplicate information instead of spending quality one-on-one time with their patient.

If a provider’s lucky, their preferred EHR might offer a telehealth “plug-in” to facilitate virtual meetings, but unfortunately that’s not always the norm.

What’s more, some doctors might work full-time through a traditional health system using one EHR, and also part-time as a telehealth provider using another. In that case, their patient records do not sync between both systems, even if the provider sees the same patient in person and then via video, or vice versa.

Not to mention, without face-to-face interactions, some providers can find it difficult to pick up on patient body language or some social determinants of health challenges.

Telehealth and in-person care aren’t apples to apples — one isn’t necessarily better than the other.

Understanding why some patients prefer telehealth

Beyond necessity — like during the COVID-19 pandemic — patients might prefer telehealth over in-person care for three key reasons:

1. For simple, routine check-ups for conditions that require immediate attention (i.e., strep throat and urinary tract infections) instead of waiting for an in-person appointment.

2. For untimely appointments, such as if your 6-month-old baby wakes up at 3 a.m. with a 102-degree fever — not high enough for an ER visit, but nevertheless concerning.

3. For “sensitive” conditions such as erectile dysfunction, when a patient may prefer the anonymity of remote treatment and the discreet delivery of medications.

Telehealth also proved popular during 2020 and 2021 for mental health services and support. Over half of telehealth claims in 2021 were for mental health conditions, and mental health is also the largest category represented in disease-specific digital health apps, at 22% of the market.^[3]2022 Medication Access Report, CoverMyMeds, Feb. 8, 2022

That said, telehealth and in-person care aren’t apples to apples — one isn’t necessarily better than the other. For example, a telehealth doctor can’t perform an X-ray to check for broken bones. But for a patient who lives an hour away from the doctor’s office, telehealth is probably more convenient.

How technology helps improve interoperability challenges

The benefits of technology solutions like electronic prior authorization (ePA), real-time prescription benefit (RTPB) and prescription decision support (PDS) are twofold. First, they allow telehealth providers to stay competitive with their traditional, in-person counterparts by delivering information to providers and patients efficiently and effectively.

Imagine, for instance, if a telehealth provider didn’t have an ePA solution in place. Instead, they’d have to rely on phone and fax methods to obtain prescription approval. In that case, speed-to-therapy may be delayed by administrative errors and paperwork holdups due to prior authorization hurdles, essentially negating the time-saving convenience of telehealth to begin with.

The second benefit of technology solutions like ePA, RTPB and PDS is they electronically connect telehealth providers to other healthcare stakeholders through software and data integrations. For example, if a telehealth provider and a primary care physician have the same ePA technology, they can both see if their patient’s prescription got approved through a shared interface.

Achieving interoperability requires industry-wide change

It’s highly unlikely that telehealth will ever replace traditional in-person care. Instead, the two healthcare delivery systems will continue to coexist, supporting and complementing each other — thus making the push toward interoperability even more important.

Given the size of the healthcare industry — with over 6,000 hospitals, 400 health systems^[7]Hospitals and Systems American Hospital Association, 2021 and 22 million employees accounting for 14% of all U.S. workers^[8]22 Million Employed in Health Care Fight Against COVID-19, United States Census Bureau, April 5, 2021 — there’s a massive opportunity for change, but also innumerable challenges to overcome.

In the meantime, technology solutions present a real-time opportunity for telehealth companies to advance patient care in collaboration with primary care physicians — which is ultimately the direction in which healthcare’s heading.

To learn more about how healthcare interoperability is advancing, download the 2022 Medication Access Report.