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Telemedicine extends its benefits beyond its initial purpose to cater to individuals seeking healthcare services. Telemedicine has bridged ...
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| Telemedicine extends its benefits beyond its initial purpose to cater to individuals seeking healthcare services. |
Telemedicine is also known as "video visits," "online doctor visits," and "doctors on demand," and it can be implemented via smartphone, tablet, or computer. The field has shown great promise, particularly in recent years. But like many groundbreaking innovations, progress has been slower than many had expected.
Video conferencing means that patients with cancer who are frail don't have to come into the office. They can also use asynchronous chat rooms to get questions answered or engage in remote patient monitoring to check for changes in their conditions. Studies have shown that most patients with cancer enjoy these services and that they have helped reduce mortality rates.
Although many patients are receptive, implementation remains hobbled by misconceptions about the technology by physicians; confusing state regulations; and spotty reimbursement policies, which are a challenge for clinicians navigating Medicaid, Medicare, and commercial insurance.
Defining "Telemedicine"
Telemedicine involves the diagnosis and treatment of patients through telecommunications technology. It is a subset of telehealth, which includes other types of technology-enabled care, such as promoting health and wellness, remote patient monitoring, provider-to-provider remote communication, and mobile health.
There are essentially two types of telemedicine. The first involves real-time audiovisual encounters, also known as "synchronous telemedicine." The patient can be on a laptop, tablet, or desktop computer that has a camera, or even on a smartphone with a camera.
Elderly patients. These patients' mobility issues, making it hard to get to the doctor's office, would seem to make them good candidates for telemedicine.
Or the real-time audiovisual encounter can take place in a physician's office. This may be required by the payer or state regulation. Also, this arrangement allows for more robust care. When the patient comes to an office, an assistant—known as a "telepresenter"—can help with a hands-on physical exam measuring blood pressure, placing a stethoscope, and use of other ancillary medical devices.
Telemedicine is catching on. It has long been essential in rural areas, and now it is gaining traction in hospital systems and large practices in urban areas. Telemedicine companies are thriving. However this trend has yet to penetrate most small and medium-sized practices outside of hospital systems.
The second type of telemedicine is known as asynchronous, or "store-it-forward" visits. In this case, encounters are not in real-time and function like emails, where the response comes sometime after sending. Like emails, this can be more useful for busy patients and clinicians than a real-time session. In addition to text, asynchronous telemedicine may include lab results, images, videos, and medical records. It is commonly used in such specialties as dermatology, pathology, and radiology.
Trends in Telemedicine
Many companies offer online-only telemedicine, employing physicians who will never meet the patient face-to-face. But increasingly, physicians are offering telemedicine in their practices, where the technology can supplement face-to-face care.
Accurate statistics on physicians' use of telemedicine are hard to come by. In 2016, 15.4% of physicians worked in practices that used telemedicine, according to a survey by the American Medical Association. Since then, physicians' use has grown. The number of physicians self-reporting telemedicine as a skill doubled from 2015 to 2018, according to a survey released in 2019.
These statistics suggest that roughly 30% of doctors at least have access to telemedicine. That's much less than the hospital rate, which is estimated at more than half of all US hospitals. Still, both of these rates are much lower than the potential demand. According to a 2019 survey, 66% of consumers said they were willing to use telemedicine, but only 8% had tried it. And in another survey, 70% of employers said they were currently offering or planning to offer telehealth coverage for employees.
Why Physicians Like Telemedicine
Convenient for patients. Telemedicine can be a good fit for busy people, who don't always have the time to go to the doctor's office, as well as older patients and patients with chronic conditions, who aren't mobile. In addition, patients living in rural areas may have to drive long distances to receive face-to-face care. Parents of young children also appreciate not having to bring their kids along for a doctor's visit.
Competitive advantages. The convenience that telemedicine offers can make a doctor's office more competitive with local practices, retail clinics, urgent care centers, and online-only telehealth services.
Reduces subspecialists' travel time. Doctors in subspecialties often have to engage in "circuit riding" so they can offer their services at many different sites. Telehealth can save a lot of car time. Specialists can also offer telemedicine services to patients well outside of their area.
Easier to provide follow-up care. Telemedicine can make it easier for doctors to follow up with patients and make sure everything is going well. This can improve communication and care between in-person visits.
Reinforces treatment adherence. Telemedicine can help physicians check in on patients more frequently, which helps to reinforce treatment adherence. These visits can involve follow-up work, lifestyle coaching, or medication management.
Flexible hours. Telemedicine helps physicians set their own work hours. They can work from home or part-time, or even while traveling, knowing that they are still accessible. They still need to meet all practice regulations, which will be discussed later in the course.
Misconceptions About Telemedicine
One reason for the slower adoption of telemedicine has to do with physicians' beliefs about this way of providing treatment. However, some of those preconceptions are not fully valid.
Patients don't have the technology. Computers with cameras are essential for telemedicine, but they are now commonplace. In 2019, only 10% of Americans did not use the Internet, down from 15% in 2015. Adoption rates are rising even among older people. In addition, 79% of laptops now have webcams, and many people now have smartphones with cameras.
Patients can usually get telemedicine in the home. In fact, Medicare and some Medicaid programs require patients to go to a hospital, doctor's office, or other healthcare facility for a televisit, rather than do it in the home. The thinking is that telemedicine can be used more effectively at a healthcare facility, because staff can assist in the physical examination and use stethoscopes and other equipment.
It harms continuity of care. Continuity of care may be disrupted when patients use online-only telehealth services. But when telemedicine is used for your existing patients, it actually improves continuity of care by providing more opportunities to interact with them.
It doesn't apply to some specialties. Psychiatry, radiology, and pediatrics were early adopters, and many internists, family physicians, and neurologists use telemedicine. However, anesthesiologists, general surgeons, orthopedic surgeons, ob/gyns, and oncologists have been less interested, according to one survey. But many of these specialties can benefit from telemedicine. In surgery, for example, it can used for preoperative and postoperative visits.
Telemedicine visits are impersonal. Some patients believe telemedicine will be too impersonal, but there are many ways for remote physicians to help put patients at ease, which will be discussed later. Also, when patients can use telemedicine in their homes, they usually feel much more comfortable than in a doctor's office.
Telemedicine can't be used to prescribe. Many states don't require a face-to-face visit to prescribe everyday medications and refills. The main problem is with prescribing controlled substances, but that is becoming easier. Eight states now allow prescribing of controlled substances through telemedicine, and a new federal law will allow this, but it has not yet been implemented. On the other hand, physicians who are enthusiastic about telemedicine may have misconceptions about how to implement it and which patients it applies to.
If you build it, they will come. Being successful with telemedicine is not just a matter of offering a new service. You have to figure out how your patients want the service delivered. Do they want it for off-hours care, follow-up visits, prescription refills, or something else? Then you have to reach out to them and explain the service.
Visits will be shorter. You may still have to spend the same amount of time with the patient. However, many of the visits using telemedicine—such as simple care and follow-up visits—tend to be relatively short.
You just plug it in and start. First, you have to make sure that the transmission is secure and provide a simple way for your patients to use the service. Your office needs to be set up so that it is secure and inviting. That said, basic telemedicine connections involving the patient's mobile device or laptop can be quite simple.
It's useful for any patient. You will still want to see many patients in person, owing to their condition or your lack of familiarity with them. State regulations and insurance rules further limit whom you can treat. But once you understand these limitations, you will be able to quickly pick the right candidates for telemedicine.
Telemedicine will reduce no-shows. It's been said that because telemedicine is more convenient, it will reduce missed appointments, but often the opposite is true. No-show rates for telehealth are often 30% or more, according to one report. However, the rate is lower when patients are seeing their regular doctor. Patients can miss an appointment when they don't understand the technology or believe it is not as real as an in-person appointment.
Conclusion
Telemedicine shows great promise in improving patient care by helping patients make their appointments, adhere to doctors' advice, and refill their prescriptions, to name a few benefits.
It is also a way of retaining patients and finding new ones. Patients like the convenience of not having to come to the doctor's office for more minor visits. However, implementing telemedicine is not a slam dunk. Patients still have to be convinced to try it.
Overall, the promise of telemedicine has not materialized as fast as expected, owing to misconceptions about its use, confusing state regulations, and spotty reimbursement policies. However, physicians can deal with these issues. They will be covered later in this course.