Evaluating Barriers to Online Therapy and Telehealth Implementation

As a medical provider, you care about offering your patients the highest level of service possible. As a therapist, this often means finding unique and innovative ways to meet your patients ‘where they are at.’ For many patients, coming into the office may be a challenge because of geographical limitations, transportation problems, health concerns, or just a need to build up the courage.

Because of this, many therapists have considered implementing telehealth or online therapy services. But as is the case with any major shift in treatment, it comes with some valid questions you need to get answered first.

  • How will online therapy affect the results I can give my patients?
  • What are the technical requirements needed to implement telehealth?
  • How will this affect my bottom line or my relationship with hospitals and insurers?
  • Is online therapy an all-or-none decision?
  • What are the steps I should take now if I am considering implementing telehealth?
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Many of these questions do a masterful job of identifying some of the perceived barriers to entry when it comes to implementing telehealth at your office or throughout your practice.

The bottom line good news upfront? Many of these barriers to entry are only in your mind. In this article, we’d like to look at the different barriers to online therapy and telehealth implementation that you may have or haven’t considered. We’ll look at which concerns are valid and which we can dismiss from our decision-making process.

The Quality of Your Patient Results

No therapist wants to implement a new medium of treatment unless it offers the same high-quality of service or better to their patients. One of the most significant barriers to entry that therapists face is not knowing whether the level of service they can offer through telehealth is going to be great.

Here’s some good news. Recently, a research study was conducted by Net Health compared functional rehab results, patient satisfaction, and the average number of visits for patients that used some, most, all, or no telehealth services. And while the study only focused on physical rehabilitation, the conclusions were groundbreaking and may be able to be extrapolated to other areas of online therapy.

The results showed that no matter the level of online therapy and telehealth that was used, the functional outcome results were the same. Additionally, the study showed that these results were reached in an average of two to three fewer visits. In other words, there was no loss of quality of care by using any degree of telehealth, and the study suggests that these results are attainable in fewer visits.

Again, it’s important to point out that this study was directed at physical therapy and rehab. But if the results were such in an area of therapy that many would think would require hands-on help, the conclusions could be extrapolated to other forms of online therapy like psychology and psychiatry.

Patient Satisfaction

Before we leave this study to move onto our next barrier to entry, we do want to point out two more important findings to consider. First, patient satisfaction with the functional outcome of the therapy was measured in the study. There were no changes in the satisfaction of the patients using telehealth therapy or not. This is an important checkmark in the win column for telehealth.

Additionally, the study looked at satisfaction with the results and not directly at things like satisfaction with convenience. And while we don’t want to speculate, it does beg the question if the studied patients were asked to include convenience in their satisfaction rating, would there be a big increase in satisfaction above the baseline?


Secondly, one of the most important questions asked is whether or not the benefits of online therapy and telehealth services require an all-or-none approach. According to this study, all of these benefits were evident, no matter the level of telehealth used. In other words, the study showed benefits present when telehealth was used exclusively and when it was used in conjunction with in-person treatment.

A unique idea for utilizing online therapy if you don’t want to completely utilize the medium with a patient could be conducting booster visits. You can have your normal in-person sessions but offer shorter booster sessions in-between for added results. Not only could this help drive better results, but it could be a great competitive advantage.

Cost and Technology Requirements

When it comes to barriers to entry for telehealth and online therapy, the first thing that comes to most people’s minds is cost. How expensive is this? Do I need to buy a studio? What equipment do I need? Again, all of these are incredibly valid questions that you should be asking.

The answer to the question depends on whether or not you’re going to build out your own solution or utilize an existing platform. The least expensive route is partnering with an online therapy company that already has the framework built. Generally, all you’ll need for this path is video and audio equipment that can be as simple as a webcam and the microphone on your computer.

You will be required to pay something to the company in return for their services. And while this might not seem ideal, it does spare you a lot of upfront infrastructure costs. Additionally, many of these services can help you to get more clients through their platform that may even be outside of your immediate geographical area. Many of the best online therapy providers also handle insurance claims for you, which is a real plus.

If you’re considering building an in-house solution, you can expect to have some significant expenses. You’ll need to look into security, bandwidth, servers, a website, and backup systems. Additionally, you may want to look into upgraded video and audio equipment. If this is something you want to do, what’s the first step? Reach out to video conferring companies who mention specializing in telehealth and telemedicine.

The legal landscape surrounding telehealth is changing rapidly. The good news is that many of the changes being released are in support of the new treatment medium. That being said, it’s extremely important that you take the time to research the laws in your particular state.

Currently, some areas are more receptive to the practice than other areas. Additionally, you may want to include in your research how the state looks at servicing clients that live in another state. Telehealth and online therapy give you the ability to reach patients all around the world. It’s important you take a little time to understand if that has any effect on how you should be conducting business.

Actionable Next Steps

If you’re ready to look deeper into implementing telehealth in your therapy practice, here are a few steps that can help get you started.

  1. Research the legal landscape of your state. Include a search into federal laws and how they’re applied in your state. The best course of action here is to reach out to an attorney familiar with the laws in your state.
  2. Decide if you want to use an outside service. The next decision you need to make is whether you want to utilize an online therapy provider that already has the groundwork set up or if you want to implement your own in-house solution. Smaller practices with smaller budgets may benefit from the cost savings of outsourcing. Larger practices that may have more in-place resources may or may not see benefits from outsourcing. A proper cost-benefit analysis is a must.
  3. Talk with your patients. If none of your patients are interested in online therapy, it might not be something you want to move forward with as quickly or at all. Ask your patients what their thoughts are about telehealth to gauge the interest levels in your area. Do make sure you phrase the question in a way that doesn’t make your patients think you’re trying to get out of having to see them.
  4. Try a session yourself. It might be a good idea to try out a session with a provider that you’re considering using. You may be able to get a free demo through the company, or it might be a good idea to invest a few dollars and do a real session from start to finish.
  5. Start small. Once you have everything in place, start with a few smaller trial runs. Instead of moving all of your patients over at once, start with a few. Or you could start by moving a few sessions a week. Or you could start with just booster session. Remember, the benefits of telehealth may be present with any level of implementation, so there’s no need to push forward 100 mph if it’s not completely necessary.

Written By: Jason Lee

Jason Lee is a journalist and data analyst with a passion for studying online dating, relationships, personal growth, healthcare, and finance. In 2008, Jason earned a Bachelors of Science from the University of Florida, where he studied business and finance and taught interpersonal communication.

His work has been featured in the likes of The USA Today, MSN, The Motley Fool, Net Health, and The Simple Dollar. As a business owner, relationship strategist, dating coach, and officer in the U.S. military, Jason enjoys sharing his unique knowledge base with the rest of the world.