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What will hybrid healthcare look like in the post-COVID recovery?



Vimal Mishra, director, digital health, at the American Medical Association, assesses how technology will work alongside in-person care post-pandemic


COVID-19 has spurred a dramatic increase in the adoption of telehealth. While widening adoption was initially seen as a temporary solution to challenges faced during the pandemic, many physicians and patients have experienced the value of delivering and receiving medicine virtually. Health systems everywhere are entering a new era of digitally enabled care, or hybrid health care. 

Digitally enabled care is characterized by fully integrated in-person and virtually enabled care delivery models that will hybridize care delivery based primarily on clinical appropriateness and other factors such as care integration, convenience, and cost. Instead of focusing narrowly on whether a specific type of visit can be delivered virtually, the attention will shift to how to integrate the use of innovative digital solutions into care. Video visits, point-of-care home devices, sensors, remote care monitoring programs, and augmented intelligence (AI) tools are becoming integrated into in-person care delivery models to enhance overall episodes of care and enable the right care at the right time in the right setting. 

Vimal Mishra

When implemented effectively, virtual programs create a new venue of care that enhance clinical outcomes, improve quality of care, and increase patient safety. While every healthcare system is different, such care also can play a role in reducing barriers that delay patients’ access to timely care, while enhancing the overall care experience for patients, their families, and caregivers. The shift towards digitally enabled care also allows operational efficiencies and more flexible work schedules for clinicians and care teams and provides quick, easy access to care for patients. This form of care delivery also can be more cost-effective. 

Such technologies can improve access to quality care, but they also introduce new challenges such as elevated levels of digital literacy, integration into existing clinic operations and workflows, clinical workforce training and access to technology. The majority of patients have enjoyed the shift towards telehealth due to convenience, yet for some, emerging technologies can add stress to a situation that already can be fraught with anxiety. For clinicians and care teams, the flexibility of telehealth affordances is juxtaposed with some barriers such as the inability to perform full, physical examination and when necessary, bundling lab draws and radiology visits. 

What has become clear in recent months is the need for a model that allows for in-person services and telehealth services. The specific method of care delivery will be based on clinical appropriateness and other factors such as cost and convenience. These are measured differently for every health system, but a framework to measure their value has started to form. The integration of virtual solutions into new, digitally enabled models offers the potential to enhance patient experience, improve population health, and inject a greater balance into the work-life of clinicians. This integrated care model could break the iron triangle of cost, quality, and experience in healthcare systems worldwide. 

Throughout the pandemic, we have seen some health systems thrive and accelerate faster than others into telehealth, largely due to the availability of the technology and infrastructure needed to underpin its delivery.  Of course, tech investment and care design are key. A significant part of this investment often overlooked is the medical coding infrastructure which enables the interoperability of treatment regardless of care setting. This coding foundation can not only optimize the efficiency of the system itself, but also – as in the case of the NHS – contribute to data sets that are relevant, searchable, and sharable across the whole health ecosystem in the UK and beyond. 

A continuous move to digitally enabled care is needed to future proof our health systems.  More investment in technology and an optimal coding system to support these changes along with research into applying digital care delivery effectively must continue in earnest as we recover from the COVID-19 pandemic.  

About the author

Dr Vimal Mishra is an associate professor of medicine and health administration at Virginia Commonwealth University Health System, specializing in internal medicine and health informatics. As a physician providing hospital-based medical care, his work lies at the intersection of delivering high-quality clinical care and leading innovative clinical and digital transformation.

He serves as the medical director of telehealth and is responsible for providing the vision, strategy, thought, and clinical leadership to enterprise-wide virtual and digital health efforts. As a physician informaticist, he provides subject matter expertise in integrating the practice of medicine with computer/information science. He guides designing, planning, implementation, adoption, optimization of the electronic medical record and clinical decision tools to enable high quality, safe, effective and efficient patient care.

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