Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.
Telehealth — healthcare delivered remotely — has been offered for decades, yet only 11% of Americans used it in 2019. Not surprisingly, as Covid-19 changes the way we interact in all aspects of life, many patients are swiftly embracing virtual healthcare, with 46% of U.S. consumers now using telehealth. At a New England academic medical center, the telehealth utilization rate for routine health visits jumped from 1% before Covid-19 to 85% today. Meanwhile, more than 75% of Baylor Scott & White Health’s clinic visits are now virtual.
What will this mean for the future of healthcare? Below we look at the current telehealth landscape and how it will transform the physical design of clinics and other healthcare spaces.
Telehealth is particularly helpful for chronic disease management, post-hospitalization care, preliminary evaluation, follow-up visits and preventative care. There are three key types of care available: 1) Live telehealth allows physicians and patients to communicate in real-time, typically through video or phone. 2) Remote monitoring enables providers to monitor patients’ health data, such as blood sugar and blood pressure, via mobile medical equipment. 3) “Store-and-forward” telehealth is the electronic transmission of medical data and information, such as documents and x-rays, through a secure messaging portal to a provider or specialist.
Telehealth can keep patients out of the emergency room who aren’t sick and do not need to be there — those referred to as the “walking worried” or the “walking well.” This is critical to alleviate surges from the coronavirus pandemic. Telehealth can also “pre-sort and triage” patients, allowing doctors, specialists and other healthcare professionals to virtually prepare before they arrive at the hospital. It also allows healthcare systems to divert those who should not be seen at an emergency department to an appropriate venue such as an urgent care center — saving costs and provider capacity, and reducing the overall length of stay for all emergency department visits.
Telehealth services show key benefits for patients. The first being cost savings: Research shows access to telehealth can decrease emergency room trips. The average emergency room visit costs $1,734 and the average doctor’s visit is $149, while the average telehealth visit costs $79. Care is also much faster. Since there’s no travel required and shorter wait times, consultations are streamlined. Patients can take less time away from work or home duties and are not as exposed to delays. This is also a cost savings to employers as employees do not have to take hours off for a clinic visit.
These factors also translate to a convenience for patients who live a long way from the nearest healthcare center, and enables older adults and people with disabilities to receive improved access to care. The final benefit is improved health outcomes: with telehealth, there is no exposure to contagious illnesses in the waiting or patient room, and these services also translate into fewer missed appointments, better access and better patient follow-through. All of these can increase patient wellness, especially for chronic conditions.
In addition to providing benefits for patients, telehealth visits also make life easier for healthcare providers. Telehealth consultations are typically 20% shorter than traditional in-person appointments, which can allow providers to see additional patients. Unused exam rooms can be converted to support higher revenue generating procedural care, and telehealth also lowers caregivers’ exposure to illnesses. The combination of these means that providers can boost revenues and expand their patient base while providing higher levels of care.
The impact of telehealth on the design of clinics and hospitals
The increased use of telehealth services can change how healthcare providers design and use their spaces. Here’s a few different ways this can be realized:
More efficient use of space
With an increased demand for telehealth, clinics can reduce the number of exam rooms and apply the square footage to higher-value areas like procedure rooms or multi-purpose rooms that can be used for different procedures. For example, the standard clinic exam room is 100 to 120 square feet dependent on specialty, while a telehealth room for a provider can be smaller, at around 80 square feet. Without exam room equipment, a telehealth room only requires a desk with a computer monitor and camera, appropriate lighting and audio equipment, and enough space for a provider and possibly support staff. An increase in telehealth and decrease in exam room numbers could also result in a reduction in support space needs and staff for reception, patient check-ins and check-outs, the size of medical rooms, nursing stations and waiting areas.
Bringing doctor’s offices back into communities
In recent years, many doctors’ offices have been moved off-site or eliminated altogether. However with the emergence of telehealth, the doctor’s office may have a resurgence, in the form of a space that is part office, part exam room. Going forward, a doctor who spends a day in the clinic may spend half the time seeing patients in person and the other half seeing patients remotely.
Reinventing the waiting room
With the use of smart phone apps, the traditional waiting room could be transformed. In non-urban settings, the parking lot can serve as a waiting room for many patients. In urban settings, appropriate waiting areas could have limited seating capacity and organized so each patient has their own personal space. While some clinics have responded now by introducing plexi-glass partitions between chairs, and an abundance of hand-hygiene stations — this is a temporary solution.
These could be replaced in due time with solutions that use furniture and screening mechanisms designed for privacy and separation, with patients organized in small groupings of one to three people. Mechanically, we could see requirements for clinic and doctor’s office waiting rooms match those of emergency and radiology departments with negative pressure and increased air changes per hour exhausted outdoors.
Adding telehealth to the workplace
For many patients who worry about exposure to Covid-19, telehealth consultations at home can provide safe alternatives to in-person visits. Even when the pandemic retreats, these telehealth consultations could also take place in specialized places outside the home, such as offices and higher education campuses.
Dedicated rooms for virtual health visits on a corporate campus, for example, would provide patient convenience, privacy and time savings, and require less square footage than a more traditional health clinic. A wellness room within an office can easily be converted into a telehealth room with modest financial investment, requiring nothing more than good lighting, acoustical separation, a computer with a decent sized monitor and an internet and phone connection.
Barriers to telehealth utilization
Despite the benefits of telemedicine, there are a few things that are preventing it from being more widely adopted. First is the perception that telehealth is less effective than in-person care. This perception has kept some people from utilizing these services, but this should change as more people use it. A 2019 study shows satisfaction with telehealth has increased, with 62% saying the quality of care was the same as an in-person visit.
Another challenge is in the regulatory landscape. While some health insurance companies, as well as Medicare and Medicaid, may cover or reimburse telehealth visits, telehealth coverage laws vary between states. Moreover, people who are uninsured may not have access to the technology needed for telehealth appointments. This is something that needs to be addressed. If not, those under- or uninsured — who may benefit greatly from telehealth — will continue to be excluded.
Telehealth services have been critical during the coronavirus pandemic and a crucial supplement to in-person medical care. As more patients and providers become comfortable with remote care for some services, it is important to consider its impact on healthcare real estate and the overall patient experience.
Telehealth used to be the “on ramp” of the healthcare freeway system. Now it’s in the “passing lane,” overtaking some long-established traditional modes of care delivery. Telehealth is here to stay, and we need to plan for it.
How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at firstname.lastname@example.org.
Banner image courtesy Tim Griffith.Follow nbbX