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The Coming of Age of Telehealth
Main Line Health Lankenau Medical Center. Photo Credit © Jeffrey Totaro, 2020
Earn CEU Credits:
i+s’ Continuing Education Series articles allow design practitioners to earn continuing education unit credits through an article.
Use the following learning objectives to focus your study while reading this article. To receive one health, safety and wellness hour of continuing education credit (0.1 CEU) as approved by IDCEC or 1 Learning Unit as approved by AIA, read the article, then log on to take the associated exam.
After reading this article, you should be able to:
- Describe the different models of telehealth delivery
- Present the proven benefits to patients, providers and families
- Discuss current strategies for telehealth implementation
- Provide solutions to healthcare providers as they implement and evolve their telehealth strategic initiatives
*This CEU opportunity is sponsored by SitOnIt·Seating.
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It’s important for designers to understand the changing dynamics and enormous potential open to their healthcare systems clients. This conservative market is at the precipice of a revolution in how their services are delivered and is looking for creative solutions that will fit into their business strategy while delivering the highest level of care.
Virtual Care during the Pandemic
We are living through a major societal shift that is permanently changing how people live, work, play, travel and, of course, access acute and maintenance healthcare.
COVID-19 continues to drive radical changes to our world. Many experts say that these changes were coming anyway, as we respond to changes in climate, demographics, and the evolution of how people live and work. But the pandemic certainly pressed the fast-forward button and people, companies and institutions had no choice but to keep up to the best of their ability.
The healthcare industry is naturally the first impacted by a pandemic, of course, challenging its own ability to treat surging levels of highly contagious victims, and to adapt its business model to continue to still accommodate healthcare delivery to patients not afflicted by the virus.
COVID-19 has caused a massive acceleration in the use of telehealth. There’s been a sudden and immediate need for a safer option for healthcare providers and patients by reducing potential infectious exposures, as well as the need to reduce the strain on healthcare systems by minimizing the surge of patient demand on facilities.
At the same time, a few key allowances by the healthcare community made it possible for telehealth to thrive during these uncertain times. For instance, at the onset of the pandemic, via an executive order, the Centers for Medicare & Medicaid Services (CMS) took aggressive action to reduce restrictions on where, how and with whom, Medicare patients could have access virtual care. Since the beginning of the pandemic CMS has added over 135 services to the Medicare telehealth service list, i.e. emergency department visits, initial inpatient screening, nursing home visits, mental health and cardiac and pulmonary rehabilitation services.
Overall consumer adoption of telehealth has skyrocketed, from 11 percent of US consumers using telehealth in 2019 to 46 percent of consumers now using telehealth to replace cancelled healthcare visits and providers have rapidly scaled offerings and are seeing 50 to 175 times the number of patients via telehealth than they did before.
Beyond the Pandemic
With the acceleration of consumer and provider adoption of telehealth and extension of telehealth beyond virtual urgent care, a McKinsey & Company study in published in May 2020 predicts that up to $250 billion of current US healthcare spend could potentially be virtualized. 
According to McKinsey, this shift will require new ways of working for a broad set of providers, improvements in information exchange, and broadening access and integration of technology. The potential impact is improved convenience and access to care, better patient outcomes, and a more efficient healthcare system. Healthcare players are carefully considering moves that support such a shift to improve their future position. 
According to research in May 2020 by McKinsey  and AmWell :
- 76% of consumers are now interested in telehealth, vs. 11% in 2019.
- Providers are seeing 50-175 times more telehealth visits than they did pre-COVID
- 57% of providers view telehealth more favorably, and 64% are more comfortable using it than they were pre-COVID
- 64% of parents used or planned to use telemedicine within the next year for their child
- 98% of parents said it was equivalent to or better than an in-person visit
- As of November 2020, 135 new services available for telehealth visits were added by the Centers for Medicare & Medicaid Services (CMS). And they are continuing to add more services.
Healthcare professionals and patients alike are finding that telehealth provides healthcare without further jeopardizing patient health while safeguarding provider health. Recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth to deliver acute, chronic, primary and specialty care. Telehealth can also improve patient health outcomes, and many providers are actually seeing a revenue boost with increased visits from existing patients.
The Taskforce on Telehealth Policy known as TTP (the American Telemedicine Association + National Committee for Quality Assurance and Alliance for Connected Care+ 20 leading Healthcare organizations) have recommended that most of the pandemic policy changes be integrated into the US Healthcare system permanently. Making these changes permanent would require congressional action, but there is interest from the public and both parties to make this happen.
Modes of Delivery
Telehealth delivery can be broken into seven general modes. These different modes are being supported in different ways as it relates to physical space. They need to support a variety of services – private offices dedicated to telehealth, flexible exam rooms to be used for in-person and virtual visits, a provider’s home office, medical triage telehealth centers, etc. A healthcare system may be considering any combination of these types of spaces to support an integrated telehealth strategy. It is important to understand each of these modes and how they can be integrated into different healthcare systems to meet their needs. , , 
1. On-demand virtual urgent care/teletriage as an alternative to lower acuity emergency department (ED) visits, urgent care visits, and after-hours consultations. These care needs have been historically the most common telehealth use cases today among payers. This allows a consumer to remotely consult on demand with an unknown provider to address immediate concerns (such as an acute sinusitis) and avoid a trip to the ED or an urgent care center. Such usage could be further scaled to address a larger portion of low acuity visits previously seen in EDs. 
2. Virtual office visits with an established provider for consults that do not require physical exams or concurrent procedures. Such visits can be primary care (such as chronic condition checks, colds, minor skin conditions), behavioral health (such as virtual psychotherapy sessions), and some specialty care (select follow-up visits such as virtual cardiac rehabilitation). An omnichannel care model that fully leverages virtual visits includes a mix of telehealth and in-person care with a consistent set of providers, improving patient convenience, access, and continuity of care. This model also enables clinicians to better manage patients with chronic conditions, with the support of remote patient monitoring, digital therapeutics, and digital coaching, in addition to virtual visits. 
3. Near-virtual office visits extend the opportunity for patients to conveniently access care outside a provider’s office, by combining virtual access to physician consults with “near home” sites for testing and immunizations, such as worksite clinics or retail clinics. For example, a virtual visit of a patient with flu or COVID-like symptoms could be followed up by a trip to a nearby retail clinic for a flu or COVID-19 test, with a subsequent follow-up virtual check-in with the primary care physician to consult on follow-on care. 
4. Virtual home health services leverage virtual visits, remote monitoring, and digital patient engagement tools to enable some of these services to be delivered remotely, such as a portion of an evaluation, patient and care giver education, physical therapy, occupational therapy, and speech therapy. Direct services, such as wound care and assistance with daily living routines, would still occur in person, but virtual home health services could enhance the patient’s and caregiver’s experience, extend the reach of home health providers, and improve connectivity with the broader care team. For example, a physical therapist could conduct virtual sessions with elderly patients at their home to improve their strength, balance, and endurance, and to advise them how to avoid physical hazards to reduce risk of falls. 
5. Tech-enabled home medication administration allows patients to shift receiving some infusible and injectable drugs from the clinic to the home. This shift can happen by leveraging remote monitoring to help manage patients and monitor symptoms, providing self-service tools for patient education (for example, training for self-administration), and providing telehealth oversight of staff (for example, an oncologist overseeing a nurse delivering chemotherapy to a patient at home and monitoring for side effects). This would be coupled with home delivery of the therapeutics. 
6. Clinic-to-clinic access to remote specialists. An AmWell case study on Michigan’s Spectrum Health  explores the use of telehealth between central and remote clinics. Spectrum Health needed to deliver specialty care—historically only available at its flagship hospital in Grand Rapids—to local communities in need. Telehealth allows specialists infectious disease and sleep disorders to “see” patients and consult with local care providers, saving hours of travel and reducing patient appointment wait times from 4.5 months to 2.5 weeks.
7. Store-and-forward (asynchronous) telehealth, (ie. My Portal, My Chart etc.) which allows for the capture and storage of clinical information (e.g., data, sound, image, video) commonly used in radiology, dermatology, and ophthalmology. Store-and-forward telehealth information can be stored in multimedia formats and evaluated later. 
Benefits for Families, Clinicians and Providers
The idea of enabling patients to virtually visit with a doctor is not new. The Jetsons, a futuristic TV cartoon program popular in the early 1960s, about a futuristic space-age family with jet packs and domestic robots, envisioned a sophisticated telehealth video link.
In 1968 Dr. Kenneth Bird created the first real-world two-way telemedicine system, connecting a medical station at Boston's Logan Airport with doctors at the hospital who supplied remote diagnosis, treatment and medical image transmission.
With the access to technology and the growing number of services being provided by apps and the internet, there is an increased need for telehealth services. Providers are offering more services via telemedicine and patients are wanting services from the comfort of their home as they do not want to risk exposure to viruses. Telemedicine has many benefits for patients, clinicians and providers.
Telemedicine also extends access to patients who:
- Live in rural areas
- Live outside of your delivery system
- Need to be triaged
- Need to see specialists only available in certain locations
- Can’t otherwise travel to care
1. Improves patient outcomes.
Managing patients with chronic conditions can be challenging because of the time required to monitor them. Telehealth can improve patient quality outcomes by enabling easier chronic health management through remote technology. This is especially true for patients who live in rural areas who wouldn’t otherwise be able to access quality specialists without significant travel to health facilities. It’s also particularly relevant now, as patients who may be at a higher risk of complications from COVID-19 can minimize their exposure to the deadly virus while still receiving the care they need via technology.
This allows patients to see specialists that may only be accessible in certain areas or regions. The access to technology allows patients and providers to expand their services, which allows for an improvement in diagnosis and outcomes.
2. Minimize in-person follow-ups (check-ups).
Many patients make unnecessary (and high cost) trips to the emergency room or urgent care clinics to get the care they need, especially after an acute health issue. With heightened anxiety about COVID-19 symptoms, many people are seeking immediate care in-person, which increases their risk of exposure to something serious and provides unnecessary strains on provider services. In contrast, educating patients about follow-up care using technology can help reduce hospital re-admissions and costs. In addition, written post-discharge instructions and ongoing communication using remote monitoring can help patients better manage their conditions away from healthcare facilities and minimizes multiple check-ins from providers.
3. Increases patient engagement and satisfaction.
Although COVID-19 is at the forefront of everyone’s mind, there are many other health conditions for which patients need care. However, going to the doctor’s office may cause additional anxiety and increase risk of exposure to possible infection, especially for high risk patients such as the immune-compromised or those with pre-existing conditions. That’s why telemedicine is a great option for patients to get the care they need and want from the comfort and safety of their homes. This also allows the provider to put into place more resilient infection control policies to limit any exposure to those that do need to come into their facilities.
Patients choose physicians that make it convenient for them to stay healthy and seek care when and where they need it. Features like online scheduling and appointment reminder text messages are expected in a world where patients can arrange for food delivery or vacation reservations with the touch of a finger. And shorter wait times inherently associated with telemedicine increases the likelihood that patients will be satisfied with their care.
With an increase in chronic health conditions, using telehealth for remote monitoring is just one way that medical providers can improve outcomes while managing costs for all. Today, telehealth is being used to report metrics from the comfort of the patient’s own home, while remote teams act as coach and counselor as they engage patients in their own journey toward health. 
4. Improves access to healthcare.
Telehealth allows providers to expand access to care and services. Many providers struggle to improve patient access to care, whether due to resource constraints or that they serve difficult to reach populations – offering convenient care availability to patients can be a challenge for many. This is especially true in rural areas and those that do not have reliable means of transportation. When patients do manage to get an appointment, they may spend a considerable amount of time in the waiting room, leading to dissatisfaction with their entire care experience.
In today’s society, technology can be used anywhere, at any time—this makes it easier to offer extended services in the evening or even weekend hours without needing additional staff to come into facilities. Telemedicine allows for providers to see patients without the barrier of travel time – this allows for a reduction in patient no-show rates along with extended access to patients that normally would not be reachable.
The convenience of telemedicine removes the transportation barrier, allowing your patients to attend the appointment from wherever they are without needing to worry about travel time (and high costs). As a result, you can significantly reduce no show appointments, and improve efficiency, access, and costs of care
5. Cost-effective for both patient and provider.
In addition to reducing costs per visit, telehealth is less time-consuming, both for the patient and provider. Telehealth can allow physicians to bill for virtual visits while also extending hours to capture more billable time. Telehealth cuts down on no-shows and can improve the efficiency of a practice. Telehealth can also provide a competitive advantage, attracting and retaining more patients with new models of care.
Considerations for Telehealth Across the Continuum of Care
“Every organization’s vision of the future with telehealth will be different; what matters is defining how telehealth will enable the organization to reposition itself to meet the growing needs of diverse patient populations.” - Huron Consulting, “Repositioning for the Future with Telehealth” 
To fully integrate telehealth as a vital component of care delivery, healthcare organizations are carefully considering multiple variables including the facilities and spaces used by providers. As we’ll learn, change is happening faster than some healthcare systems can accommodate. The solution is to meet demand with flexible, adaptable solutions, allowing providers to experiment with different approaches without compromising the quality of care or experience for the patient while considering the productivity and ergonomic needs of the providers.
While the demand and efficacy of telehealth continues to grow, the concept does face challenges stemming from consumer preferences and concerns, privacy and regulatory practices and standards.
The concern about the accessibility and use of technology was, unexpectedly, not a major barrier telehealth adoption. Only 16% of seniors were concerned about technology—the same percentage as millennials—which suggests seniors are becoming as tech-savvy as the younger generations. When asked more about their technology use, 51% of consumer said they use mobile health apps.  
Hybrid Care Model: Telehealth can “expand the pie” by providing increased access to healthcare and producing more live-care follow-up appointments. It provides a convenient point-of-entry which will increase patient commitment and retention, leading to more in-person appointments. It will be critical for providers to respond to consumer demands, reimagine care pathways and develop a seamless experience for patients and providers alike.  
Privacy: Healthcare’s regulatory environment is dynamic. As organizations look to the future, many will be challenged to keep up with state and federal mandates, ensure their telehealth programs remain HIPAA compliant and maintain valid licensure as they develop and grow. To get ahead of regulatory changes, leaders can establish a process for regularly reviewing requirements, guidelines and mandates, and effectively communicating any confirmed or expected changes back to appropriate leadership. From there, the organization can make informed decisions regarding what to change and how, to remain compliant. Additionally, digital trust will only become more essential as organizations receive and exchange increased amounts of consumer data. The severity and sophistication of cyberattacks is growing exponentially, making both healthcare leaders and consumers uneasy. To show they can be trusted with private health information across all types of sites of care, organizations will need to prove to all stakeholders that their telehealth programs are safe. 
Medical Licensing: The pandemic may have marked the beginning of the end of state physician licensure. State medical licensure has been a historical barrier to clinicians practicing across state lines. But the COVID-19 pandemic unearthed what some see as a need to reform licensure rules to ease the adoption and proliferation of telehealth. During the COVID-19 public health emergency, the Trump administration suspended rules requiring physicians to be licensed where a patient is located in order to bill Medicare and Medicaid for medical services. Nearly all states followed suit by allowing out-of-state providers to practice without a permanent license during the pandemic. Some states waived in-state licensure requirements altogether; others let out-of-state providers apply for temporary licenses. Still, some experts and policymakers say it’s time to start thinking about reforming licensure at the federal level. There is a growing concern that the current patchwork of state medical licensing rules could slow telehealth’s growth and impair the nation’s response to the next pandemic since most states will likely return to their pre-COVID rules as the crisis subsides. 
Reimbursement: The use of telehealth has exploded as many regulatory barriers to its use have been temporarily lowered during the COVID-19 pandemic: For the duration of the official public health emergency, CMS has granted payment parity for a wide range of telehealth services that industry leaders have said are essential to the healthcare industry’s response to COVID-19. The regulatory flexibilities significantly expanded Medicare coverage of services traditionally only paid for if a provider renders them during an in-person visit. New policies also widened the list of providers and locations eligible to bill for telehealth services. Many private payers have followed suit, enacting their own telehealth coverage and reimbursement policies during the crisis. Payment parity, as well as clear telehealth billing guidance from CMS, is necessary for ensuring a smooth and safe transition to normal operations for the healthcare industry and healthcare leaders are also urging policymakers to consider permanent implementation of other telehealth billing flexibilities, such as the ability to provide care remotely in the homes of patients.   
Expanded “Allowable” Telehealth Services: During the COVID-19 crisis CMS (Centers for Medicare & Medicaid Services) added 135 allowable services, more than doubling the number of services that beneficiaries could receive via telehealth. Examples include emergency department visits, initial nursing facility and discharge visits, home visits, and physical, occupational and speech therapy services. Medicare also ensured that health care providers like physicians were paid for these telehealth services at the same payment rate as they would receive for in-person services.  In August of 2020, CMS proposed to expand telehealth permanently, strongly suggesting that telemedicine has come into its own. 
Creating practical, private and flexible solutions for various types telehealth delivery: Usability is paramount for providers and consumers. With so many platforms and modalities now in the mix—21% of physicians used three or more platforms in 2020—healthcare organizations need a cohesive telehealth strategy that emphasizes ease of use, interoperability, and flexible enterprise solutions. Three-quarters of health-system providers say that technology challenges are barriers to video visits at their institution. 
Provider Spaces: Flexibility Without Compromise
“Everyone who is in the health design world needs to be at the table, to help think through new hybrid models. There’s a lot of careful thought being given to these design issues. A number of CEOs are giving serious thought to what kind of physical plants they will need. Fifty- to 100-year leases have been signed. But how much more needs to be built? Will doctors continue to work from home, as they started to during the early days of the pandemic?”
Susan Dentzer, speaking at a day-long telehealth design webinar sponsored by the Center for Health Design in September 2020, predicts healthcare designers will play a proactive role as these services become a bigger part of the overall healthcare mix. Dentzer, an American health care and health policy analyst, commentator, and journalist, is also a Senior Policy Fellow at the Robert J. Margolis Center for Health Policy at Duke University.
“Things are changing very fast. One of the biggest concerns is, will providers be paid at parity [with in-person visits], and will the patients come back to the old system after all of this. And as this unfolds, how can providers make better use of their existing facilities? How does the built environment need to respond? Will doctors have a nook in their exam room, or an established private space? No one answer fits every organization.”
You see a lot of question marks in Dentzer’s quotes. The event, entitled “Telemedicine Virtual Workshop: The Genie’s Out of the Bottle,” which included doctors, designers, architects, facilities designers, researchers, technology specialists and several breakout discussions, ended with unanimous agreement on one thing: no one is really sure what the future holds for telemedicine design. Given the barriers discussed earlier, healthcare companies—who are notoriously conservative – are reluctant to commit to dedicated space for telehealth delivery, and yet know they need to accommodate growing demand for this proven model.
Understand your healthcare clients immediate and long-term telehealth strategies, stay current on case-studies highlighting telehealth, follow your healthcare clients press postings, understand who are the decision makers for the organization’s telehealth plans, ask to be involved in the process as it is developing and evolving.
Perspective: Elsa Jacobson, UW Health, University of Wisconsin, Madison
“For now we’re looking for ways to create a really good experience without a huge investment in physical structure that could potentially not be useable,” says Elsa Jacobson, Senior Director of Ambulatory Access & Telehealth for UW Health at the University of Wisconsin in Madison. “Flexibility is most important. You don’t want to build a bunch of space for telemedicine and then have all of the reimbursement payments stop.”
Jacobson, with her colleague Thomas Brazelton, MD, MPH, Professor/Physician, University of Wisconsin School of Medicine, delivered a presentation at the event: “Health System Strategy: Are We There Yet? Yes, Virtually? How COVID-19 has Jump-started Digital Care.”
Jacobson designed UW Health’s new scheduling call center and was working on a new clinic facility that would also house telehealth when COVID hit.
“In May 2019, we thought we were planning aggressively for delivering 6.86% of our ambulatory health digitally. We were very wrong. At the peak, 72% of ambulatory health was done remotely. It’s remarkable how much can be done in a pinch. By May 8th, we had 1,000 providers doing more than 4,000 video visits per week, including pharmacists and nutritionists. It has settled back to about 25%, which feels sustainable to us.
“We still haven’t fully optimized it for the long term,” Jacobson told the audience. “In 2019 we did a ton of work to figure out what our built environment should look like to have an ideal telehealth visit. What does the provider setup look like, what’s the audio privacy solution? Are we building a set? Where is the boundary between digital technology and in-person visits?”
Jacobson says she’d like to have the telehealth space to be close to the in-person exam rooms, but distinct. Having a provider use their own exam room for virtual visits is not an optimal use of space. But separate areas add space, and therefore costs.
Providers prefer to do their remote clinics in one-time block, perhaps four hours, and in-person visits in another block so they’re not having to switch back and forth.
“To the extent that we can deliver telemedicine care from a dedicated telemedicine space, we can reduce a little bit of our physical footprint and our cost per square foot.”
Jacobson says UW Health is working to create spaces that look professional to patients, are uniform from provider to provider and reflect the organization’s brand. It’s also important that patients are aware that the visit is private through carefully controlled audio and visual cues.
“I shadowed a provider who did a great job at the beginning of the visit letting patients know where he was calling from, that he was alone with the door closed, and asked if they had any questions about his environment. He then asked the patient about their environment, do they have audio privacy, are they comfortable with the people near them, is their door closed.” This protocol helps establish trust and a high level of comfort for a productive visit.
“The biggest thing is orienting for the comfort of the provider while still keeping the space professional,” says Jacobson. “Multiple providers will use the same station throughout the day, so we need all the elements to be adjustable. The setup is a sit/stand desk with two large monitors on adjustable arms, one showing the patient nearest the camera, the other for patient records or other information. We also need room for a desk phone in case we need to conference in an interpreter.
“Ergonomics is obviously important if someone is going to be in one spot for up to four hours, versus seeing patients in person. Some of our behavioral health providers do virtual visits for their entire day, so we need to give them all the elements they need to be comfortable and stay alert.”
Questions to ask…
- What type of telehealth mode does the space need to support?
- What does the provider setup need to look like?
- Is it one space for one provider or one space leveraged by many providers?
- What are the technology and lighting needs?
- What are the audio and visual privacy solution?
- Are we building a set? What type of branding should we consider?
- Where is the boundary between digital technology and in-person visits?
Perspective: Susan Suhar, HDR
“Camera angle is critical,” says Susah Suhar, Design Principal for HDR, an international architecture firm that has done its fair share major healthcare projects. “I recently had a telehealth appointment where it felt like my provider was looking down on me. It’s disconcerting.
“It’s also important to patients that they are familiar with the doctor’s setting, that it never changes. That familiarity adds a lot of emotional security, knowing that they’re always working from the same space. Minimizing background clutter also helps patients stay focused on what the provider is trying to communicate. I’ve been on video calls where there are too many random things in the frame; it’s distracting.
“We’re workshopping a programming a tower expansion right now for a health provider, and to be honest telehealth hasn’t yet been a big part of the conversation,” Suhar says. “This is an acute facility, and we’re still trying to understand which departments would be doing telehealth. It’s different than a clinic, where it’s more obvious what’s going on. We are seeing a lot of telehealth visits for follow-up appointments, which are often more just a conversation and check-in.”
Suhar says space is always at a premium, so if private telehealth rooms or pods are the answer, they may also serve as respite spaces, or online training rooms, or stations for recording videos and presentations for patients.
Flexibility with familiarity is critical when designing for telehealth: telehealth rooms or suites may also be used for respite spaces, training for providers and patients but ultimately must bring comfort to the patients.
Understanding The Impact Of Telehealth On Medical Real Estate Trends
Podcast Building Places| People, Cities and the Future of Real Estate: How Will Telehealth Impact Medical Property
JLL: Healthcare Real Estate Outlook
Globest.com: Telehealth Adoption to Reshape Healthcare Real Estate
In the Post-Pandemic Era—the ease, efficiency and convenience of telehealth care will:
- Increase patient commitment & retention
- Lead to more in-person appointments and follow-up care
- Improve compliance with prescribe treatment plans
- Enable patients in remote or underserved locations access to care
- Well-suited for remote management of chronic conditions Help monitor treatments such as infusions and pacemakers
Although telehealth usage has grown dramatically, its role today within the healthcare service delivery spectrum continues to be secondary. However, long-term outlook for telehealth will allow healthcare providers to drive down costs while boosting revenue through an expand “reimbursement” model. Through this evolving model, providers will need to reconsider and reconfigure their facilities to provide for private, technology enabled spaces for the provision of virtual scheduling as well as telehealth and remote monitoring services.
Following are multiple options healthcare occupiers, owners and investors will consider for the future of their facilities:
Develop telehealth care provider suites. Although patients will be able to participate in telehealth calls and remote health monitoring at home, practitioners will still need space for calls or electronic communications, as well as for remote monitoring and diagnostic equipment. Medical office buildings could provide suites for technicians and nurses to virtually manage intensive care, emergency and home care patients, for example. These spaces would require internet redundancy, appropriate lighting, screens and acoustics, ergonomic furniture/solutions and assured patient-caregiver privacy for HIPAA regulatory compliance.
Reconfigure public spaces. Even as healthcare providers transition more basic care and monitoring services to online delivery, patients will still need office visits for advanced treatments, extensive physical evaluations and for use of advanced diagnostic equipment. However, the pandemic already has led healthcare providers to rethink their waiting room management to allow for social distancing. For instance, some providers ask patients to wait in their cars rather than in the waiting room and use text messaging to alert patients of their appointments.
Reconfigure and repurpose healthcare delivery spaces. Many facilities will require interior reconfigurations, renovations and buildouts to support the transition to telehealth services. The adoption of telehealth care delivery will likely reduce the number of physical exam rooms needed in a healthcare facility and will free up square footage for other purposes. With less space required for physical exams, facilities can prioritize space for high-value imaging, diagnostics, injectables, wound care, advanced and acute treatments, obstetrics and laboratory services.
Reimagine the potential for live practice. Though there is a core group of vulnerable and less-mobile patients who greatly benefit from telehealth availability, preserving and rethinking the option of in-person visits is valuable to a large segment of the population. There is a benefit to preserving and rethinking the option of in-person visits, even as the trend toward telehealth rises. The JLL Advisory Board estimates that between 20 percent and 80 percent of practitioners could potentially work from home as providers continue to reactivate services. However, this statistical analysis does not incorporate a critical component that advances quality outcomes: establishing a personal relationship with a patient. Providers have an opportunity to carefully consider how their real estate can facilitate in-person visits and how they communicate safety measures to patients; this can vary based on specialty as well as ease and applicability of virtual care. Behavioral health poses an interesting example. Although they can easily see patients virtually, many specialists in this segment are largely resistant to doing so, given that so much of their diagnostic protocols are captured in nonverbal cues.
Telehealth increases overall care demand, enhancing the need to rethink healthcare real estate
Telehealth Spaces—Evolving, Adapting & Adjusting
The surge in telehealth usage over the past year has been remarkable, but it isn’t the biggest takeaway. As unprecedented as it is, the number of physicians and consumers using telehealth now is less important than how they are using it. They’re using it for urgent, primary, and specialty care, on a range of devices, in a variety of settings, and with people they already know. Rather than being confined to certain situations or certain types of care, telehealth has quickly become embedded across the full continuum of care. It hasn’t just grown; it is diversifying and blending in. The spaces to support Telehealth services are just as important and diverse.
In healthcare, the emerging hybrid care model combines virtual and in-person experiences across the full continuum of care. As patients go through treatment care pathways, there are in-person elements—procedures, labs, imaging, immunizations—and virtual elements, which might include remote monitoring and checking in with a Primary Care Provider or a specialist from home. It’s not that physical encounters don’t matter anymore, but with hybrid care, the physical joins the digital to create a cohesive experience for providers and patients alike. 
Healthcare systems will most likely need a variety of spaces to support their telehealth services including:
- Private Office
- Shared Telehealth Suites
- Flexible Exam Room (interchangeable in-person/virtual)
- Provider at home office
- Medical Scheduling/ Monitoring /Triage Centers
Responsive Furniture Solutions:
Telehealth is still in its infancy and that means it is a trend that has yet to be fully understood or adapted. Since it is still trying to be integrated into both existing and new facilities, it is important to have design and furniture that is responsive and adaptable to changing technologies and trends. Here are some tips to make the most of your furniture and surroundings.
Eye Contact, Camera Angle and Lighting
Forming a bond between the patient and provider requires recreating, as much as possible, a person-to-person visit, which means avoiding some common teleconferencing pitfalls:
- Minimize distracting clutter
- Looking “down” on the patient because the camera is too low
- Making “eye contact” by looking directly into the camera
- Poor lighting/back lighting, putting the provider in shadow
- Cluttered background or distracting elements
- Having a consistent “set” or background for every visit
- Acoustic controls to avoid echo or poor audio transmissions
Getting all the elements just right can take some training and coaching, according to an AmWell cast study on Southwest Medical Associates in Las Vegas. 
Ergonomic task and executive chairs are highly adjustable, allowing people of many different sizes, postures work habits to be comfortable and well supported, and to change their support profile throughout their shift if desired.
Adjustment options include:
- Tilt, tilt tension and tilt lock
- Seat height
- Seat depth
- Synchronized mechanisms that change seat and back geometry as you recline
- Lumbar support, tension and height
- Armrest height and width
Other seating options to consider:
- Swivel and roll
- Seat and back firmness
- Choice of materials
Sit-Stand Desks and Tables
- Heights from 22.6-48.7 inches from ground to work surface top, for maximum adaptability
- Work surfaces must be large enough to accommodate two monitors
- Button-controlled electric raise and lower
- Anti-collision sensors that stops (and retracts) the table when it makes contact with any object
- Smooth, sturdy operation
- Independently adjustable dual array, for two monitors
- 90-degree rotation limiters, for portrait orientation
- Cable management
- Integrated USB and power outlets for desktop power and charging
Power Modules/Keyboard/Wire Management
While it’s unlikely that telehealth stations will be in close proximity with each other, separation and privacy screens are always a concern when teleconferencing. These screens provide acoustic control as well as extra privacy from surround distractions. They come with multiple mounts so they are adaptable to various types of tables and settings.
Because we’re still in a healthcare setting and accommodating caregivers who are still interacting with patients for part of their day, cleanability is always a concern in shared spaces. With extra concerns about contamination and spreading of viruses, it is more important than ever to make sure the surfaces, fabrics, and furniture that is selected can be cleaned using the top ingredients recommended by the CDC – Bleach, Hydrogen Peroxide, Quaternary Ammonium, and Isopropyl Alcohol.
There are a variety of surfaces with many different types of cleaning recommendations, so it is important to always read and follow the directions on the cleaner/disinfectant label to ensure safe and effective use. Multiple furniture and fabric manufacturers offer guidelines and instructions on how best to clean their products – make sure to refer to these guides and work with the organizations infection control units to understand the providers goal for cleanability, sustainability, and design.
Telehealth was an emerging way of healthcare delivery prior to the onset of COVID-19. However, the pandemic has no doubt accelerated its use exponentially seemingly overnight, and promises to continue to alter the way we deliver healthcare.
As evidenced by this course, the benefits of telehealth can be numerous. By its nature, it provides additional safety to both the patient and provider. It allows for easier access to healthcare. In many cases, it has shown improved outcomes as well as being cost-effective for all parties. Finally, telehealth has grown to serve a wide range of healthcare needs – from on-demand virtual urgent care to virtual home health services such as physical therapy.
In addition to the benefits to patients and providers, telehealth offers new benefits for designers. Designers can help imagine these emerging spaces in the type of furniture being specified, set-up, overall environments, and in responsive furniture solutions.
It is up to all parties to move swiftly and effective to ensure a smooth transition into the emerging opportunities that telehealth affords.
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