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Telehealth Performance 2020
Rapid Telehealth Uptake Is a COVID Silver Lining
Author
Adam Cherrington
Author
Elizabeth Pew
Author
Dan Czech
COVID-19 revealed telehealth to be a sleeping giant, with visit volumes (previously at or below 1% for a majority of healthcare organizations) skyrocketing overnight. Some telehealth technology vendors have risen to meet the challenges of this rapid, exponential adoption, and others have struggled to deliver. This report seeks to provide insights into how well telehealth vendors have scaled their technology and supported customers during the pandemic, which deliver the best patient experience, and which are seen by customers as viable go-forward options.
The insights in this report are based on interviews with 277 provider, payer, and employer organizations (some of which rated multiple products) and are intended to help healthcare organizations as they begin to think about their post-COVID telehealth plans. While organizations often first consider the telehealth capabilities their core EMR vendor offers, the reality is that many organizations use a mix of different solution types to meet their various telehealth needs (i.e., scheduled virtual visits, on-demand/urgent care, telespecialty consultations, or remote patient monitoring†). In this report vendors are divided into three groups based on the type of technology they offer:
† While remote patient monitoring (RPM) is part of the broader telehealth landscape, it is not a focus of this report. For more information on RPM vendors, please see KLAS’ ongoing performance data and recent RPM report.
Note: The customer satisfaction details shared throughout this report are intended to help healthcare organizations as they make go-forward telehealth technology decisions. For a list of key questions to consider in the broader effort of building or expanding a complete telehealth strategy, please refer to KLAS’ COVID-19 Telehealth Guide.
No one could have predicted COVID-19, so it is no surprise that all vendors initially struggled to manage the rapid increase in telehealth adoption. Most vendors were able to eventually right the ship, and while the situation was unique, vendors’ responses provide insight into their ability to react to factors outside of their control and continue to help customers be successful moving forward.
Virtual Care Platforms (Non-EMR)
Typically healthcare focused; enable multiple visit types and offer multiple healthcare workflows (e.g., virtual waiting rooms, patient check-in, and scheduling). May include physician network services and proprietary equipment. KLAS ratings come from provider, payer, and employer organizations.
Amwell Has Struggled to Scale amid Multi-Year Growth; Teladoc Health (InTouch) Continues to Meet Needs after Early COVID Missteps
Despite Amwell and Teladoc Health (InTouch) offering some of the broadest solutions on the market, few customers plan to use their solutions to meet all telehealth needs going forward. Customer satisfaction with Amwell, who recently announced a partnership with Google Cloud, has steadily declined since 2018 as Amwell has struggled to scale to growth and maintain adequate support. The physician and patient experience is generally positive; outcomes can be hard to realize—needed data is difficult to access, and EMR integration is a common struggle. In response to COVID-19, Amwell quickly developed and released Amwell Now, which enables patient access via a link and has received positive early feedback. Two solutions from Teladoc Health are rated in this report. The multi-year Best in KLAS winner that Teladoc acquired from InTouch Health prior to Teladoc’s recent merger with Livongo has recovered from some early COVID hiccups, including strained support and out-of-stock hardware. The solution is easy for patients and clinicians to use, and customers are particularly pleased with the telestroke capabilities. Customers report strong outcomes; for some, these offset qualms about the solution’s cost. However, most plan to supplement the InTouch solution with other products rather than incurring the high cost of going all in with Teladoc. (See next page for insights on Teladoc’s other solution.)
High Satisfaction Prevails for Most Focused Solutions; MDLIVE and Teladoc Met Demand after Early COVID Struggles
Primarily validated for on-demand physician network services, MDLIVE and Teladoc Health Licensed Platform (a separate product from the acquired InTouch solution) struggled at the outset of the COVID-19 pandemic to scale to significantly increased volumes, leaving customers frustrated. MDLIVE’s patient experience was hampered by longer wait times, though no customers reported bandwidth/quality issues and customers report MDLIVE recovered quickly. The biggest reported struggle for MDLIVE customers is the lack of integration for both provider and payer/employer organizations, which leads to users missing some patient information or having to document in multiple locations. Some Teladoc customers want a more integrated experience and question Teladoc’s ability to deliver through multiple acquisitions and mergers. Most plan to continue using Teladoc’s services as a backup to their own physicians. Some feel Teladoc’s offering wasn’t created for the provider environment or workflow and at times delivers a clunky patient experience.
Note: Trend data is shown only for vendors who were fully rated (15+ surveys) in both 2019 and 2020. Because growth in this market has been so recent, KLAS does not have 2019 data for many of the vendors in this chart.
Note: Mend and swyMed not charted due to insufficient data.
Note: Adoption of visit types and healthcare workflows was self-reported by interviewed organizations and may not represent a vendor’s complete capabilities. For definitions of visit types, see Expanded Insights section.
Note: Please see Expanded Insights section for preliminary insights on Updox.
Video Conferencing Platforms
Often cross-industry; offer basic healthcare workflows. Typically used primarily to enable video conferencing. Sometimes used for general business functions, though KLAS examines clinical use cases only.
Relationship Challenges Cloud Positive Technology Experiences and Create Vulnerability for Doxy.me, Zoom
The solutions from Doxy.me and Zoom are easy to stand up and roll out to physicians and staff. Healthcare-specific Doxy.me is unique in giving each participating provider a simple, unique link to share with patients. Customers appreciate the low cost and report that Doxy.me recovered well following some initial scalability problems. Both ambulatory and acute care customers say that Doxy.me’s onboarding, guidance, support, and executive involvement fall short of their expectations. One customer reports being part of a new CSM program. Zoom customers are nearly unanimous in praising the solution’s stability and scalability. Despite high consumer familiarity with Zoom, the patient experience can be a challenge since users must download an app, or sometimes two if using in conjunction with Epic. Customers see Zoom as transactional, and some were disappointed by a lack of help during COVID, especially in terms of executive involvement. Almost 30% of Zoom’s and Doxy.me’s healthcare customers say the solutions will not be kept long term. Hoping for better integration and a simplified clinician experience, many plan to switch to their EMR vendor’s offering once it is sufficiently mature.
†Relationship scores are based on customer ratings for the following standard KLAS metrics: quality of phone/web support and executive involvement.
Microsoft Teams Stands Out among Technology-Focused Vendors; Vidyo’s Healthcare Presence on Shaky Ground
Already deeply embedded in many organizations, Microsoft has developed clinical and other healthcare-specific capabilities for Teams, which is used for the broadest number of visit types among video-conferencing platforms. Teams has scaled well, thanks to Microsoft’s preexisting infrastructure; customers would have liked more handholding with training. The patient experience lags behind that of other solutions and is sometimes hampered by the user interface and the need to download a separate application. Rating their vendor at or near the bottom in every indicator measured, Vidyo customers are the most frustrated in this report. Over half say they will not keep the product long term, and just over half would not buy it again. Clients view the licensing structure as expensive and feel healthcare is an afterthought. Satisfaction has declined since the acquisition by Enghouse Systems, with customers reporting significant support struggles and unstable technology. As Epic has recently developed their own video layer on top of Twilio, many customers no longer see the need for Vidyo, reporting plans to drop it entirely or use it only for specific use cases, such as group video or therapy sessions.
Note: Adoption of visit types and healthcare workflows was self-reported by interviewed organizations and may not represent a vendor’s complete capabilities. For definitions of visit types, see Expanded Insights section.
Note: Please see Expanded Insights section for preliminary insights on BlueJeans, Cisco, and Doximity.
EMR-Centric Virtual Care Platforms
EMR-centric telehealth tools; may be driven through a patient portal. Typically allow for scheduling, documentation, and billing, either natively or through integration with an EMR. Video capabilities may be facilitated via third-party technology.
Patient Experience Inconsistent for Epic Customers; NextGen Healthcare Minimizes Disruption
Overall satisfaction with the telehealth solutions from Epic and NextGen Healthcare is high (partly due to the positive clinician experience created by strong EMR integration), and all interviewed customers view the solutions as part of their long-term plans. Epic customers tend to have more complex needs, and less than half of respondents say Epic will be their sole telehealth solution; however, all respondents say Epic will be core to their telehealth strategy, with niche solutions used to fill specialized needs. Feedback about the patient experience is mixed; tech-savvy patients who have adopted MyChart are more likely to report a positive experience. However, patient mishaps can be challenging for organizations to troubleshoot since patients must enroll in MyChart and download multiple applications (for the portal and the Vidyo/Zoom video layer). The initial feedback from a few organizations that have deployed Epic’s embedded solution suggests a slightly more positive patient experience, and KLAS has validated very early use of Epic’s new link-based telehealth tool, which allows patients to circumvent MyChart. 83% of NextGen Healthcare customers—whose telehealth needs tend to revolve around straightforward scheduled visits—say they will use NextGen’s Virtual Visits solution (acquired from OTTO Health) as their sole source of telehealth technology. NextGen customers report consistently positive patient experiences—links are sent directly via email and text, allowing patients to easily launch a visit.
A Note on Other EMR Vendors
Allscripts, athenahealth, eClinicalWorks, Greenway Health, and MEDITECH all quickly released telehealth capabilities in response to the COVID-19 pandemic. Cerner has a partnership with Amwell that predates the pandemic, and they encourage most customers to use the embedded Amwell solution for their telehealth needs. KLAS is early in the process of validating the customer experience for these vendors and intends to release a future study specifically on EMR telehealth solutions.
Note: Adoption of visit types and healthcare workflows was self-reported by interviewed organizations and may not represent a vendor’s complete capabilities. For definitions of visit types, see Expanded Insights section.
Note: Please see Expanded Insights section for preliminary insights on Allscripts, athenahealth, Cerner, eClinicalWorks, Greenway Health, and MEDITECH.
Overall Market Trends & Insights
Unprecedented Adoption Rate Moves Industry from Telehealth 1.0 to Telehealth 2.0
COVID-19 revealed telehealth to be a sleeping giant. Prior to COVID, the majority of interviewed organizations had telehealth visit volumes of less than 1%, but not surprisingly, those rates increased exponentially in the days and weeks immediately following the outbreak. In a matter of days, organizations had implemented telehealth solutions and at their peak were delivering well over half—and often all—of their visits virtually. As organizations look to the future, the majority estimate that virtual visit volumes will level off to anywhere from one-tenth to one-third of total visits (as long as current reimbursement models remain intact). Interestingly, respondents’ predictions don’t vary much between different organization types (clinics vs. hospitals vs. health systems). However, some specialties, like behavioral health and primary care, are more likely to report higher future volumes.
“Before COVID-19, we were just on the cusp of starting our program. We had one department set up. Besides inpatient workflows, we just didn’t have in-house hospital-based functionality for our specialties. We were barely doing anything else. Thank goodness we were that far along because we had to scale our technology quickly with COVID-19. We went from one department to four hundred. We reformulated our entire strategy around telehealth when the pandemic hit.” —IT manager
“After COVID-19, we will probably have between 25% and 30% of our visits be virtual. Telehealth decreases barriers to care for a lot of people. For example, telehealth enables people to get care around their work schedules. Patients can do a telehealth visit from their work office or during lunchtime. They don’t have to necessarily drive back and forth from a health center. Telehealth increases the access to care and, for some people, the affordability of care.” —Practice administrator
“We had so much happening in terms of telemedicine. We reported on the visit percentages to our executives, and they were seeing huge increases in percentages, just like everybody in the country. Everybody flipped to telemedicine.” —VP of telehealth
Telehealth 3.0 Approaches: Post-Pandemic Vendor Consolidation and Replacement Forthcoming
Interviewed organizations unanimously proclaim that telehealth is here to stay. While changes to reimbursement policies may dampen some adoption, organizations report an appetite from both providers and patients to continue virtual care for many scenarios. As the market begins to stabilize and organizations look to the future, several themes arise:
- Almost one-quarter of organizations either are actively looking to replace their solution or are unsatisfied with their solution but feel stuck with it.
- Even organizations that are currently satisfied say they will continue to evaluate their EMR vendor’s tool and may make a change when the functionality is ready, especially since many EMR-agnostic tools struggle to deeply integrate.
- Video conferencing vendors are some of the most vulnerable because replacing them requires only a relatively small lift.
- Few tools exist today that organizations feel are robust enough to meet all of their telehealth needs going forward. This is especially true for inpatient organizations.
- Organizations often report that their ongoing strategies will center around virtual visits, with a focus on creating different strategies for different specialties. From there, organizations will expand to other visit types as needed.
- Remote patient monitoring also comes up often as a future expansion of today’s telehealth offerings.
Note: Other aspects reported by less than 10% of respondents include digital front door, direct-to-consumer care, help for underserved communities, ICU, patient concierge, surgery, and telestroke.
About This Report
Each year, KLAS interviews thousands of healthcare professionals about the IT products and services their organizations use. These interviews are conducted using a standard quantitative evaluation, and the scores and commentary collected are shared online in real time so that other providers and IT professionals can benefit from their peers’ experiences. To enable readers to more quickly understand high-level differences in vendor performance and give better context as to how each product compares to other offerings in the market, KLAS has organized the questions from the standard evaluation into six customer experience pillars—culture, loyalty, operations, product, relationship, and value.
To supplement the data gathered with this standard evaluation, KLAS also creates various supplemental evaluations that target a subset of KLAS’ overall sampling and delve deeper into the most pressing questions facing healthcare technology today.
The data in this report comes from both evaluation types and was collected over the last 12 months. The majority of standard evaluations and all supplemental evaluations were collected after the initial spike in telehealth adoption, from July to October 2020. Because expansion in this market has come so recently, this is the first time KLAS has measured some vendors in this report. Baseline performance data on these vendors is therefore not available. The number of unique responding organizations for each vendor and survey type is given in the chart below.
Note: Some organizations may have rated more than one product.
† KLAS encourages readers to consider that feedback on MDLIVE may be weighted toward the perspective of provider organizations (as opposed to payer and employer organizations, which make up the vast majority of MDLIVE’s customer base). For this research, 11 of MDLIVE’s 24 standard evaluations and 6 of their 16 supplemental evaluations came from provider organizations. MDLIVE reports that less than 5% of their total revenue is attributable to provider organizations.
‡ These solutions are used widely by healthcare organizations for business use cases. The estimates shown in the Estimated Healthcare Customer Base column are for clinical use cases.
What Does “Limited Data” Mean?
Some products are used in only a small number of facilities, some vendors are resistant to providing client lists, and some respondents choose not to answer particular questions. Thus a vendor’s sample size may vary from question to question and may not reach KLAS’ required threshold of 15 unique respondents. When a vendor’s sample size for a particular question is less than 15, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 6, no score is shown. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.
Overall scores are measured on a 100-point scale and represent the weighted average of several yes/no questions as well as other questions scored on a 9-point scale.
Writer
Elizabeth Pew
Project Manager
Natalie Jamison
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.