What Telehealth Got Right — and What We Need to Fix Before It's Permanent

In early 2020, my hospital went from 12 telehealth visits per month to 1,200 per week. We didn't have time to design workflows — we improvised them. Now, years later, many of those improvised workflows are still in place, held together by workarounds and tribal knowledge.

Telehealth is here to stay. It's time to build it right.

What We Got Right

Credit where it's due — the rapid telehealth expansion proved several things:

• Patients want it. Satisfaction scores for telehealth visits consistently match or exceed in-person visits for appropriate use cases. Patients appreciate not taking a half-day off work for a 15-minute follow-up.
• Clinical quality holds up. For chronic disease management, post-operative follow-ups, behavioral health, and medication management, the clinical evidence supports telehealth as equivalent to in-person care.
• Access improved. Patients in rural areas, patients with mobility limitations, and patients with transportation barriers got access to specialists they couldn't reach before.

What Needs Fixing

The problems are mostly operational and technical, not clinical:

The EHR workflow is fragmented. In most systems, telehealth visits use the same encounter type and documentation templates as in-person visits. But the workflow is fundamentally different. You can't do a hands-on physical exam. You need to document what you observed versus what you couldn't assess. The vital signs may come from a patient-reported source rather than a calibrated clinical device. Current templates don't accommodate these differences.

Scheduling is a mess. Many practices still use the same scheduling templates for telehealth and in-person visits. But visit durations are different, room requirements are different, and the staff support model is different. A dedicated telehealth scheduling template with appropriate time blocks, buffer time for technical issues, and different check-in workflows would solve problems that practices are currently handling manually.

The patient technology gap. We assumed everyone has a smartphone with a camera and reliable internet. They don't. Approximately 20% of our patient population struggles with the technology. We need permanent solutions: tech support hotlines, library and community center telehealth stations, and simplified interfaces for older adults.

Clinical triage for visit type. Which visits should be telehealth and which should be in-person? Most practices leave this to the patient's preference or the scheduler's judgment. We need clinical criteria — developed by clinicians, not administrators — for when virtual care is appropriate and when it's not.

Building Sustainable Telehealth Workflows

The organizations doing telehealth well share a few characteristics:

• Dedicated telehealth encounter types in the EHR with appropriate documentation templates
• Clinical triage protocols that match the visit type to the clinical need
• Technology support as a staffed function, not an afterthought
• Quality metrics specific to virtual care — not just "did the visit happen" but "was the clinical outcome equivalent"

We have an opportunity to design telehealth workflows intentionally rather than accepting the emergency-era improvisations as permanent. The technology works. The clinical evidence supports it. What we need now is the operational rigor to make it sustainable.