Telehealth really becomes a powerful driver of healthcare transformation when you include remote-monitoring technologies in telehealth interactions. As insurance companies expand coverage and clinical reasons for telehealth use become broader than just a common cold or a follow-up visit, the technologies that patients use during telehealth interactions can dramatically improve physician’s care and decision making.
For example, TytoHome is a “portable examination device, [which] features a touch screen that guides patients through the exam process and has attachments that capture digital heart and lung sounds; body temperature; and images of the skin, ears, and throat. The data can be used during live video encounters with physicians or stored on a mobile app and forwarded for review by a clinician at a later time.”  A partnership between AT&T and Anelto Health created HomeAssure for seniors: “The hub works with vital-sign monitors and activity trackers to decipher whether seniors are at risk for a fall or exhibiting any other troubling health characteristics. For example, if a senior using the device loses several pounds in a short period of time or has low blood-oxygen levels, caregivers are sent an alert and can quickly connect with patients through the device.”  When you couple the real-time data collection of remote-monitoring technologies with the virtual capabilities of telehealth, the opportunities for physicians to have more medically meaningful interactions with patients and, therefore, improved patient health outcomes are obvious.
The Reality of Telehealth Usage
With increased adoption of telehealth by both patients and HCPs, expanded insurance coverage, and patient’s use of telehealth in diverse medical situations, it would seem that telehealth usage should be widespread. However, while data shows tremendous growth in the adoption of telehealth, its use is still very limited in the broader context of healthcare options. For example, even though the rate of growth for telehealth was greater than any other venue of care, the proportion was still low in comparison to emergency-room visits and urgent-care clinics.  Also, consider the population of people who are ideal candidates for telehealth: the elderly, who may find getting around difficult, and patients living in remote, rural locations. However, the reality is that people in urban areas use telehealth almost three times as much as those in rural areas and the majority of users are under 60 years old.  So, while telehealth has experienced tremendous growth, the potential for telehealth is even greater than its historic successes.
As I mentioned earlier, the transformation of healthcare is truly a wicked design problem. Consider all the legacy systems, data, workflows, and user groups that are part of the end-to-end experience of a medical service. Therefore, interoperability is one of the most significant challenges for the success of telehealth. According to the American Telemedicine Association, “Telehealth clinical services and settings are fragmented and data is siloed, with low-volume telehealth services such as those for specific locations or clinical specialties standing alone rather than being designed as part of a larger, integrated system…. As these fragmented systems proliferate, they result in costly, redundant software infrastructure and endpoints that limit the potential to improve overall quality and access to care [and] make it difficult for payers—government agencies, private insurers, and employers—to gain access to the comprehensive member data needed for claims and utilization management systems…. The patient experience will not be complete without integrated communication platforms to accompany the on-demand or scheduled telehealth encounter…. Interoperability must incorporate communication platforms across the gamut of secure paging, texting, IM, chats, video, phone / VOIP, faxing / efaxing, and scanning. As standards, specifications, and interfaces become more robust and more broadly implemented, they will support an even richer telehealth infrastructure and a seamless clinical experience.” 
Moreover, a significant component of interoperability is how best to integrate telehealth into existing physician workflows. “One of the biggest challenges…is that members struggle with how to integrate telehealth into their practice workflows…. They want to figure out which patients are good candidates for telehealth, and they have to figure out how to change their procedures and incorporate new types of visits into these practice workflows,” according to a study by the American College of Physicians. 
It’s important to clarify the challenge of interoperability and understand the reason it presents a great opportunity for service design to lead the charge in addressing this issue. Because of disconnected systems and data, payers struggle to get the information they need to process claims and billing. Without an integrated platform that includes all the ways physicians and patients need to communicate and interact, a telehealth appointment or consultation won’t be as effective. Finally, physicians need help in figuring out how best to integrate telehealth into the way they run their practice and identify the most appropriate patients with which to use telehealth.
Interoperability requires a holistic solution. It’s just as much a technology problem as a people, process, education, and communications problem. Improving interoperability must start with an understanding of the entire healthcare system from the perspectives of all the people who are involved in that system. Service designers are the ideal candidates for creating and managing this understanding and driving solutions. From access to and scheduling of the telehealth encounter through making claims, billing, and payment, service designers can create service models and current and future journey maps. They can also identify all the user types who are involved in these journeys and create personas for them. Finally, designers can outline the service requirements that are necessary to create an optimal service experience, for example:
- Patient: Can I request a telehealth appointment by calling my doctor’s office as well as by scheduling an appointment online?
- Physician: Can I conduct an appointment on any device?
- Patient: Is my patient health information already part of the records at my doctor’s office and my medical-insurance provider?
- Physician: Can I easily toggle between my in-person schedule and my telehealth appointments?
- Patient: Will I get a reminder near the appointment?
- Physician: Is all the patient health information ready when I need it—before, during, and after the appointment?
- Patient: Can I see and hear my doctor? Can she see and hear me?
- Physician: Am I able to change viewing and audio settings easily to ensure a good dialogue?
With the necessary support from business analysts in revising workflows, data scientists in defining data strategies, technical architects in revising infrastructures, UX designers in creating touchpoints, and change-management experts in the management of training and communications, service designers can help ensure the telehealth experience is seamless for everyone.
Telehealth and Creating Trust
Throughout my career—whether I was working on a Web-site user experience in earlier years or service experiences in later years—a consistent theme has been the need for trust. For example, tactical, detailed interactions supporting navigation within a digital space require that users trust that the actions they take would lead to on-screen behaviors that make sense and are easy to understand. When that trust is eroded, people experience frustration and dissatisfaction. Collectively, detailed interactions across multiple channels make up a holistic customer experience—of a service and a brand—and determine people’s trust in them. In many ways, a designer’s ultimate accountability is to create trust. For telehealth, the opportunities to create trust are multilayered and numerous and include the following:
- addressing the very wicked problem of interoperability and the place of telehealth within the greater healthcare ecosystem
- ensuring a telehealth system is easy to use, enabling physicians to have medically meaningful dialogues with their patients
- creating educational communications and onboarding materials to help physicians successfully integrate telehealth into their practice and existing ways of working
- connecting users’ interactions and information from wearables and remote-monitoring devices to the telehealth experience—thus, providing physicians with the best patient data for a medically meaningful dialogue
The entire, end-to-end healthcare journey—including that of healthcare providers—is undergoing a transformation. In fact, the very definitions of healthcare and health management are becoming broader—encompassing remote-monitoring devices and the data they collect. But regardless of the changes that are happening, the interactions between doctor and patient remain at the center of the healthcare experience. While the context of these interactions has evolved from house calls to office visits and now to telehealth, the constant is that physicians want to have medically meaningful dialogues with their patients and patients want their doctors to understand them. Service designers can support the doctor / patient relationship through their leadership of the telehealth evolution.
Dolan, Shelagh. “Telehealth Industry Defined: The Services, Systems, Benefits & Trends of a Growing Digital Health Segment.” Business Insider, May 1, 2019. Retrieved May 10, 2019.
Marketers Media. “Telehealth Market to Reflect Impressive Growth Rate of 29.8% During 2017-2023.” Market Watch, December 17, 2018. Retrieved May 11, 2019.
American Well. “Telehealth Index: 2017 Consumer Survey.” American Well, Retrieved May 11, 2019.
National Conference of State Legislatures. “State Coverage for Telehealth Services.” National Conference of State Legislatures, January 2016. Retrieved May 9, 2019.
Gelburd, Robin. “Telehealth Continues Growth as a Versatile Venue of Care.” US News, April 2, 2019. Retrieved May 9, 2019.
Lagasse, Jeff. “With Physician Shortage Looming, Hospitals Turn to Telehealth Tools.” Healthcare Finance, June 1, 2018. Retrieved May 11, 2019.
Roth, Mandy. “Physician Telehealth Usage Wallops Early EHR Adoption Rates.” Health Leaders, April 15, 2019. Retrieved May 15, 2019.
Roth, Mandy. “Telehealth Device Puts Power of Medical Exam into Consumer’s Hands.” Health Leaders, April 18, 2019. Retrieved May 12, 2019.
Bryant, Bailey. “AT&T: In-Home Remote Patient Monitoring Ready to Take Off.” Home Health Care News, May 9, 2019. Retrieved May 15, 2019.
Miliard, Mike. “Telehealth Is Past the Tipping Point: How’s It Doing with Interoperability?” Healthcare IT News, April 15, 2019. Retrieved May 12, 2019.
Frieden, Joyce. “Barriers to Telehealth Adoption Remain, Survey Finds Internists Struggling to Fit Telehealth into Daily Workflow.” MedPage Today, April 12, 2019. Retrieved May 15, 2019.