Physician Telehealth Usage Wallops Early EHR Adoption Rates

Burned-out specialists are chomping at the bit to give telehealth a try, according to a physician survey American Well released today at the ATA19 conference in New Orleans.

Physician adoption of telehealth increased 340% between 2015 and 2018, far outpacing adoption rates in the early years of electronic health records (EHR). In addition, certain burned-out specialists—the ones least likely to have engaged in this form of practice—are now the most willing to try it, according to a survey that will be released today by American Well at the ATA19 telehealth conference, which kicked off Sunday in New Orleans.

Telehealth Index: 2019 Physician Survey reexamines territory that was covered in a similar study conducted in 2015, providing a basis for comparison over time. During those three years physician adoption rates accelerated, along with their willingness to engage in video visits.

The most recent study, fielded in December 2018 by a third-party, M3 Global Research, surveyed 800 physicians: 62.5% were primary care physicians; 37.5% were specialists. American Well, the Boston-based telehealth platform company, which covers more than 150 million individuals through health systems and health plans, is offering a free eBook summarizing the survey results.

Physicians Are More Eager to Use Telehealth Than They Were to Adopt EHRs
 

According to the survey, 22% of physicians have used telehealth to see patients, up 340% from 2015 when only 5% of physicians reported ever having used telehealth. In a similar three-year span—2003 to 2006—EHR adoption among office-based physicians only increased by 68%," the report says, citing data provided by the Centers for Disease Control and Prevention.

"The most significant finding, as well as the most surprising, is that physicians are adopting telehealth much faster than they adopted EHRs at a similar stage of market development," says Sylvia Romm, MD, MPH, vice president of clinical transformation at American Well. She points out that there were many incentives to adopt EHRs, including monetary, yet the practice of telehealth is occurring at a much faster pace.

Another key finding: 69% of physicians said they would be willing to use telehealth, up 12 percentage points, from 57% in 2015.

"There’s certainly been a shift in telehealth readiness," says Romm, "as physicians want to improve patient access to care, improve patient outcomes, and attract and retain patients. But the truth is, it’s not so much that a lightbulb switch has turned 'on' and created this drastic attitude change or added interest. It’s been an evolution process for telehealth to become more popular and widely accepted."

Among the top reasons surveyed physicians say they use telehealth:  

• 93% Improves patient access to care
   
• 77% Makes more efficient use of time
   
• 71% Reduces healthcare costs
   
• 71% Enables high-quality communications with patients
   
• 60% Enhances the doctor-patient relationship

"There’s a socialization of telehealth that’s happened in the last few years—not just because it’s convenient and available, but because it’s the right thing to do for the patient," says Romm. "Safety and effectiveness are at the forefront of why providers make the decisions they do. Technology has gotten better, and telehealth has more recently proven itself both safe and effective. It’s a big reason why physician attitudes and interests have—and will continue to—evolve."

Burned Out Specialists Express Greater Interest in Telehealth
 

The study also revealed a striking correlation of trends among specialists: those expressing the strongest interest in telehealth are the least likely to have used it. These physicians also practice in specialties experiencing the greatest burnout, according to the Medscape National Physician Burnout, Depression & Suicide Report 2019, as reported by The Advisory Group in January 2019.

Urologists, emergency medicine providers, and infectious disease physicians responding to the American Well survey were among those most willing to try telehealth and also reported the lowest past usage rates. These same physicians were among the top five specialists with the greatest degree of burnout, according to the Medscape report.

The greatest degree of interest comes from the following specialists:

• 91% of urologists, who have Medscape's top specialist burnout rate, expressed a willingness to use telehealth, yet only 9% have used it.
   
• 89% of emergency medicine providers, who have the third-highest specialist burnout rate, are interested in exploring telehealth; only 11% report trying it.
   
• 83% of infectious disease specialists, who rank fourth of the list of burned-out specialists, are willing to try telehealth, with 17% having tried it.

Psychiatry is the only specialty with a high willingness and high usage rate among physicians, according to the study. They rank sixth on Medscape's list of burned out specialists. Neurologists, who rank second on the burnout list, were the second-most likely specialty providers to be using telehealth, which is possibly connected to the large number of telestroke programs across the country, the report suggests.

Internal medicine and family medicine practitioners also ranked highly for burnout, but because they are primary care providers, were not examined on the list of specialists in the American Well report. Physical medicine and rehabilitation physicians, as well as endocrinologists and specialists providing diabetes care had high burnout rates, but did not appear at the top of the list of physicians most interested in using telehealth.  

Historically, video visits have been used almost exclusively to treat urgent care conditions, according to the report. "However, as more specialists adopt telehealth, the range of services offered via video will drastically expand."

Barriers Remain an Obstacle to Many Physicians
 

The report also addresses barriers to physician use of telehealth. The top reason respondents said they have not adopted this practice include:

• 77% Uncertainty around reimbursement
   
• 72% Questions about clinical appropriateness
   
• 60% Lack of physician buy in
   
• 44% Poor leadership support

"As counterintuitive as it might seem," says Romm, "telemedicine can be uniquely personal, perhaps even more so than an in-person [visit]. A physician seeing a new mother for a lactation consultation is invited into her home. The physician can not only assess the patient’s situation, but also her physical environment. This personalization not only benefits the patient, but also the physician—many of whom are looking for a more balanced work life. There’s convenience, safety, and effectiveness for the patient, but the provider benefits from all these things too. This is going to be a big part of telemedicine’s evolution as the technology is more widely accepted and adopted."