Most people are aware of the evolving state of healthcare today—whether they’ve personally experienced the plethora of issues that healthcare presents or have read the many news reports covering the industry. As a service designer who is constantly identifying and solving problems, I have always been fascinated with the truly wicked problem that healthcare presents. Considering the broad scope of healthcare and its many stakeholders—including the government, healthcare providers, payers, pharmaceutical companies, and pharmacies—the problem seems almost impossible to address.
But patient demand is driving big changes. People’s experiences across industries are elevating their expectations of the healthcare industry. As a consequence, companies are reinventing themselves through acquisitions and partnerships to address the healthcare system’s legacy issues. Examples include CVS’s acquisition of Aetna and JP Morgan Chase, Amazon, and Berkshire Hathaway partnering to create Haven. Plus, people are taking more ownership of their health and are adopting digital health technology such as wearables and remote tracking to support their expectations and behaviors.
With such significant changes happening in healthcare, it’s both exciting and overwhelming to consider what they really mean for the patient—particularly the core of the healthcare experience: the interactions between patient and physician. One digital health technology whose purpose is to improve access to care is telehealth, through which patients can have remote consultations with their physicians. While the use of telehealth is rising rapidly, its successful adoption by both patients and physicians relies on the expertise of experience designers—who not only create intuitive technology experiences that enable trust and relationship building but also consider the broader, more complex healthcare-service context of which telehealth is a part.
The Rise of Telehealth
Telehealth enables remote care outside traditional office or clinic locations through a variety of technologies, including video chat, remote-monitoring tools, and health mobile apps. Through telehealth, patients can conveniently maintain relationships with their healthcare providers from their home or another remote location. Plus, healthcare providers’ access to patient health data lets them work with meaningful, real-time data that enables better care and intervention.  The telehealth market is expected to grow almost 30% between 2017 and 2023 because of a variety of factors,  including the following:
interest by patients—Patients have long complained about waiting times and access to physicians. Moreover, for people who are living in rural areas, are older, or have chronic diseases, getting to an appointment can be difficult. Telehealth removes those barriers, so interest in using it is high. In a 2016 study, two-thirds of the surveyed patients indicated that they were willing to have a video call with their doctors; and one-fifth would switch to another primary-care physician if they offered video calls. 
coverage by insurers—All but two US states provide Medicare coverage for telehealth services; and 32 have a private-payer policy that allows provider reimbursement.  Moreover, between 2016 and 2017, “telehealth usage as measured by claim lines grew 53 percent—a rate greater than for any of the other venues of care we studied for that variable.” 
evolving provider workforce—There is a shortage of healthcare practitioners (HCPs) due to a retiring baby-boomer generation of HCPs. This is adding stress to an already burned-out workforce. Telehealth allows flexibility that lets active physicians care for patients more efficiently and accommodate their schedule.  Adoption rates of telehealth by HCPs has skyrocketed to 340% between 2015 and 2018. 
diagnoses and reasons for use—In 2016, mental healthcare was the primary reason for using telehealth, but by 2017, mental health was fifth—behind injury, respiratory infections, digestive issues, and general symptoms such as headache and fever.  This shift shows the broadening use of telehealth for more diverse health issues.
The infographic in Figure 1 shows healthcare-quality outcomes for telemedicine.
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.
Director of Strategy & Experience Design at NTT Data
Woodbridge, New Jersey, USA
Laura’s 10 years of experience have focused on representing the human element in any interaction with a brand through actionable, business-impacting insight gathering and design. At NTT Data, Laura leads cross-channel experience design strategy engagements for clients. Clients have included AstraZeneca, Hachette Book Group, GlaxoSmithKline, Prostate Cancer Foundation, Honeywell, and the NBA. In addition to her Service Design column for UXmatters, Laura has written articles for the Service Design Network’s Touchpoint: The Journal of Service Design, User Experience Magazine, Communication Arts, and Johnny Holland. She has presented on service design at SDN’s Global Service Design Conference, the Usability Professionals’ Association International Conference, IxDA New York City, and IxDA New Jersey. Read More