The (remote) doctor is in: 5 ways telehealth is changing design
February 25, 2022
February 25, 2022
Telepresence will change health delivery, the size of hospitals, and even your home
This article first appeared as “The (remote) doctor is in” in Stantec Design Quarterly, Issue 14.
We’re at the beginning of a virtual healthcare revolution, and we can already see the advantages of telemedicine/telehealth. Take this recent case for instance. A family doctor examined a sick child in a remote rural area. The diagnosis was such that the physician would typically suggest a transfer of this patient to an acute care children’s hospital environment far away. However, because of the telemedicine capabilities between the facilities, they were able to keep the patient at the clinic close to home, diagnose and treat the child remotely. The $18,000 cost of the transfer was eliminated, as was the stress and travel expense for the family it would have required—all thanks to telemedicine technology.
Telehealth, virtual healthcare, telepresence—whatever terminology we use—has expanded. It’s taking hold and achieving greater acceptance over the past two years. There are three reasons for this.
1. Remote tool evolution
Huge advances in remote diagnostic tools have improved the clinician's ability to accurately view and interact in real-time with a patient. High-definition video, new camera technology, and improved remote diagnostic tools—such as blood pressure monitors, heart rate monitors, temperature monitoring, remote ECG sensors, respiratory rate monitors, and more—form a wide array of telepresence technology. This broad range of technology allows healthcare professionals to provide remote consultative diagnosis and prescription.
2. Cultural acceptance
Before COVID-19, there was often reluctance by patients and providers regarding the use of telemedicine, especially among older patients. The pandemic, which necessitated remote work and virtual family gatherings, also laid the groundwork for telehealth visits. Thus, seniors and other groups that may have been technology averse, were thrust into using digital tools every day. This accelerated cultural change, familiarity with remote communications, and adoption. The result is that we’ve taken a relatively small portion of the industry and rapidly expanded it. A study by nonprofit group FAIR Health suggests a greater than 4,000% increase in telehealth claims across the US from 2019 to 2020.
1. Financial viability
A decade ago, an enterprising physician may have been able to interact with or advise a patient by electronic means, even email, but there was no mechanism to charge for the service. Today, reimbursement for remote healthcare services is becoming more widely accepted by government agencies and insurers. In 2020, a Medicare waiver expanded telehealth coverage in the US to include office, hospital, and other visits (including in patient’s place of residence) furnished via telehealth. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, now can offer telehealth. More than 40 states and Washington, DC, have policies that cover telehealth claims.
As designers, we must be aware of how virtual healthcare will influence healthcare delivery and facility needs. We can already forecast a few areas of change.
1. Hospital size: Hospitals are amongst the most expensive building types to design and construct. As telehealth expands, healthcare providers can reduce their brick-and-mortar presence to bring costs down, while maintaining quality care.
As designers, we must be aware of how virtual healthcare will influence healthcare delivery and facility needs.
2. Rethinking clinical spaces: Clinical spaces are designed for inpatient treatment, they’re not always conducive for telemedicine/telehealth visits, remote diagnostics, and treatment. We will have to rethink for clinical spaces. We’ll have to accommodate remote flexibility, consider new space types suited for virtual work, or a mix of both approaches to meet rising demand for remote healthcare.
3. Colocation of telehealth with command centers: Critical care, emergency rooms, operating rooms—these spaces aren’t going away. But we will be challenged to design clinical spaces with telehealth in mind. One thing we’re likely to see is a colocation of telehealth areas where clinicians can remotely interact with patients via central command centers as part of a data-driven approach to health.
4. More tech in more places: As we’ve noted, remote monitoring and diagnostic equipment has improved and will continue to do so. Consumer home health technology is already available online and will get better and cheaper. At some point, every home will have a technology kit for remote diagnosis and monitoring, just like most homes have a first aid kit today.
5. Robust networks required: The greatest single point of failure in telehealth is not with the doctor or patient systems but with the network or latency in communicating over long distances. To enable this revolution to take hold and maintain a quality of care and interaction, networks are critical. Care quality will increasingly be a consequence of throughput.
One needn’t be a futurist to see that virtual healthcare will continue to expand. A 2020 McKinsey report analyzing claims data highlights that $250 billion in US healthcare spending could shift to virtual care models. The data identified virtual care use cases could comprise approximately 20% of all Medicare, Medicaid, and commercial spend.
The principal technologies required, like the ability to make audio-video calls, are now commonplace and can still be refined. We will see virtual reality and augmented reality enter the mix with visuals that use diagnostic info and other patient data. Networks are a critical, yet often overlooked, aspect of healthcare master planning efforts. Healthcare organizations with multiple sites and large campuses have complex network needs. Future-ready network infrastructure for telehealth will be essential.
We are a long way from a consistent optimal telehealth experience, but uptake of virtual health is increasing rapidly and even faster than we predicted in the Design Quarterly in 2019. The core building blocks—improved technology, patient demand, a desire for preventative healthcare—are already in place. The public and practitioners have overcome its biggest obstacle, cultural acceptance, by necessity of COVID-19. It won’t be long before digital house calls are the norm.