Does Telehealth Have a Trust Problem?

Trust:  A firm belief in the reliability, truth, ability, or strength of someone or something

I still recall my nascent days as a telehealth advocate, stretching back to the early 1990s.  I often heard that telehealth would be most appropriate for rural communities because “they couldn’t access an in-person doctor.”  I chafed at this point of view and often countered that telehealth was a legitimate care delivery model for both rural and urban citizens that could effectively compete with office-based care.  It was clear, even then, telehealth was considered a second-class mode of care delivery.  This mindset signals doubt, a seed that can and unfortunately has, grown into a lack of trust.

In March 2020, when telehealth became a household word, countless patients and providers experienced the power of telehealth as a care delivery tool.  Several past and current studies have shown that telehealth’s diagnostic accuracy and health outcomes are on par with care delivered face-to-face. And our highest-ranking healthcare agencies have declared telehealth to be a necessity. Yet, it seems we still have a trust problem with telehealth.

It doesn’t help matters when telehealth companies or remote care providers make headlines for possible fraudulent activity.   

While not exclusively, many of these company founders often come from the tech world, and their business plans mirror those of tech companies.  Backed by millions of investment dollars from venture capitalists, they face pressure to scale quickly.  While the mindset of traditional healthcare delivery is “build it and they will come,” the mindset of tech relies heavily on marketing dollars to generate revenue. As a result, some telehealth companies have made questionable decisions on how they present themselves to potential patients, particularly in the context of social media.  While this approach may lead to short-term growth, it inevitably tarnishes the company’s image – and that of the entire telehealth industry.

It’s also a well-known phenomenon that relationships on the Internet are more transactional and less intimate, including for care providers. Anecdotally, I’ve heard of care providers conducting telehealth visits from their car, and even one male provider conducting a virtual patient visit while shirtless on a tropical beach. Is there something about the lack of intimacy on the internet that leads people to think this lack of professionalism is somehow acceptable? Have we become too comfortable ‘Zooming’ from our homes, with our colleagues and our grandkids? The subtext here is, telehealth is not serious care – would that same provider show up at his office shirtless to see patients?

This type of conduct does not foster what, according to a Harvard Business Review paper, are the three elements of trust: Positive Relationships, Good Judgement/Expertise, and Consistency.  

Don’t get me wrong. I’m not defending any company or healthcare practitioner who has behaved unethically or inappropriately. My point here is that their behavior has serious implications for the relatively new and somewhat mysterious field of telehealth. They are not just harming their reputation. They are casting a long shadow over an entire industry. Our industry, that we have fought long and hard to build. 

So how do we establish or reestablish trust?

First and foremost, we must address the underlying issues that are raising concerns in the first place. Those companies in the crosshairs must do their part to engage in a productive dialogue, shore up quality control, re-evaluate marketing strategies, and ultimately deliver a quality healthcare experience to our patients. And they are.

The American Telemedicine Association, for which I am privileged to be the Immediate Past Chair, is again demonstrating its industry leadership, by launching several important initiatives to support its members and the telehealth community. The ATA has already adopted Policy Principles to ensure that federal and state health policy is technology, modality, and site neutral. In addition, the ATA’s Principles of Practice for Virtual Health Providers express the commitment of member organizations to deliver quality virtual healthcare and serve as valuable contributors to the public health and help guide ethical decision making.

The ATA is also creating two key work groups with respected thought leaders to address critical issues facing our industry: a Data Work Group to tackle cybersecurity, AI and privacy, and a second Clinician Work Group on rebuilding trust. You will hear much more about these initiatives and other efforts by the ATA, and we will encourage your input and participation.

But there may also be lessons to be learned from well-known examples of how organizations handled crises that affected their brand image.

In 2005, the American Red Cross faced criticism over how it handled donations made in response to Hurricane Katrina. They responded by launching a nationwide transparency and accountability campaign, which included providing detailed information about how they deployed these donations, setting up an independent panel to review its operations, and making significant changes to its organizational structure and governance. This swift and transparent response helped restore public trust in the Red Cross and reestablished its reputation as one of the world’s most reputable disaster relief organizations.

By contrast, the National Football League’s (NFL) handling of concussions and brain injuries sustained by its players had a different outcome. For years, the NFL denied the link between repeated head trauma and long-term cognitive problems, was criticized for not doing enough to protect players, and trying to influence scientific research on the topic. The NFL’s initial response to the crisis was slow and inadequate, and it was accused of prioritizing its image and financial interests over the health and safety of its players. The NFL’s reputation was damaged and led to significant public criticism and legal battles.

There are countless corporate examples too. The now-famous J&J Credo, crafted by Robert Wood Johnson in 1943, is more than just a moral compass, it’s a recipe for business success. All of these examples teach us that there is a reliable playbook for creating and rebuilding trust

We are at a critical juncture in the advancement of telehealth.  We must demonstrate it is a care model on equal footing to office-based care and one that all parties in healthcare must take seriously. Telehealth has a trust problem. It’s real and we all own it. Hence, we all must do our part to help fix it. Trust in the validity of telehealth doesn’t only create uncomfortable headlines. It could derail public opinion and sink any chance of permanent policy and reimbursement for virtual care services. 

If you’re provider organization, start by examining the ATA’s Principles of Practice and think about implementing these principles in your own organization.

Technology solution providers should ensure that platforms, systems and devices mitigate cybersecurity risk and provide for patient safety and confidentiality.  

All advertising and marketing should be truthful, appropriate and non-misleading.

What else is your organization doing to ensure patient safety and data security, and build trust in your telehealth services?