Are Portals and Telehealth Being Utilized and Do they Increase Value?

By | January 15, 2019

We continue to focus on improving access and services using technology as we move towards value-based care. Furthermore, we have experienced similar shifts away from direct human interactions with online retail and self-service banking, airline ticket purchases, etc. As we progress within this technology realm, numerous questions arise. Are consumers willing to sacrifice face-to-face visits with their clinicians and will these innovative methods of connecting impact the patient-physician relationship? Are they as effective? Finally, will technology widen the disparities in healthcare that already exist?

As with any innovation, while adaptation occurs, it is crucial to monitor results and make adjustments when it is required.

A recent Health Affairs publication revealed early information related to several of these questions. When recently navigating the healthcare system for a health concern, I was amazed at the simplicity and ease of use of my health portal. To my delight, I received several emails and texts reminding me to interface with the portal, review my results, and prepare for my next face-to-face interaction. However, despite my own ease in utilizing the system, Anthony et al. found that 63% of survey respondents that had access to a portal did not use it. One of the primary factors of usage was one’s race.

Additionally, those identified with only a high school education, not having a regular provider, or on Medicaid were also less likely to utilize a portal. Therefore, while continuing to advance our use of such technology, we must also focus on expanding usage while engaging the disenfranchised and those less likely to use such advancements. Technology is not genuinely innovative without the overcoming and resolution of these issues.

When reviewing the impact of telehealth, it is imperative we answer whether the care delivered is as efficient as our present models. As a practicing physician, I found using telemedicine to be very beneficial for the expansion of my services and efficiency, but was I delivering equivalent care?

A recent review by Shigekawa, et al. revealed that telehealth visits across a broad spectrum of services are generally comparable to in-person care. Though the design of this review is not as an in-depth study of specific use cases or populations, however it is directionally helpful. Another form of telehealth; telemonitoring, is gaining popularity, especially in certain conditions such as heart failure – based on a recent meta-analysis by Pekmezaris, et al. which showed mixed outcomes with a decrease of all-cause and heart-failure related mortality at 180 days but not at 365 days. They also reported a reduction in ED visits, but not all-cause hospitalizations. From these results we can determine telehealth can help decrease short-term problems and offers efficient use of services but is less impactful on the underlying disease process.

We must also be realistic concerning our expectations of what specific technologies can provide: Albritton et al. revealed a decrease in neonatal transfers in those infants that required resuscitation when telehealth was used to connect neonatologists at tertiary care centers with providers at smaller hospitals. And Telestroke services have been shown to improve the quality of care provided in rural areas.

Early indications are quite affirming that telehealth improves access and certain aspects of care. Continuing to investigate the outcomes will only enhance our understanding of its benefits and elevate our approach to the care we deliver. It is essential that we are careful not to implement technology in a fashion that increases utilization or that does not enhance care in the name of consumer benefit.