Most people had heard of telemedicine before the Covid-19 pandemic because it had been used sporadically. However, over the past couple of years, it’s come into widespread use for doctors to “see” patients without the risk of spreading the virus. Does this mean that telemedicine is the way of the future? Do you get the same level of care that you do when you see the doctor in person?
Telemedicine (or telehealth, e-health, or m-health—short for mobile health) allows healthcare providers to deliver care to individuals without needing an in-person office visit. It can be done in various ways, like live over the phone/video chat or sending/receiving messages from your doctor using secure messaging, email, secure messaging, and secure file exchange.
It makes healthcare services more readily available or convenient for people with limited mobility, time, or transportation options, such as those who live in rural or isolated communities. It’s beneficial to monitor and improve ongoing health issues, like medication changes, chronic health conditions, lab test/x-ray results, urgent care issues (ex. colds, coughs, and stomach aches), post-surgical follow-up, and therapy/online counseling.
In addition, it allows people to have access to medical specialists that they might not be able to connect with otherwise. It also can use wearable, digital technologies with remote monitoring tools, including mobility trackers, blood pressure monitors, and glucometers. Patients can engage with smartphone health apps that can keep track of other aspects of daily living that affect their health, like nutrition data. The detailed and long-term monitoring that these tools provide can identify early signs of disease, improve preventative care, and provide more personalized care.
Virtual appointments are when you get to see your doctor or a nurse via online videoconferencing. These appointments allow you to receive ongoing care when an in-person visit isn’t required or possible. These services are generally for routine care or minor illnesses. During the “visit,” you’re guided through a series of questions to help determine the best way the practitioner can help you.
You might need to relay information, like your weight, blood pressure, blood sugar, images of a wound, a list of your symptoms, or medical records from another doctor to provide the whole picture. Next, the practitioner can prescribe medications, suggest home care strategies, or recommend additional medical care. This is different from a nursing call center, which is staffed with nurses who use a question-and-answer format to provide advice for care at home. They aren’t allowed to diagnose an illness or prescribe medications.
Your primary doctor may have an online patient portal, which is a way to communicate sensitive medical information securely. Typically, you can communicate with your doctor or nurse, request prescription refills, review test results and summaries of previous visits, and schedule appointments or request appointment reminders. Also, doctors can send you notifications or reminders to do rehabilitation exercises or take medication, provide new suggestions for improving diet, mobility, or stress management, and offer encouragement to stick with your treatment plan. If your doctor is part of a large healthcare system, the portal also may provide a single point of communication for any specialists you have.
Personal health apps
Many apps have been created to help consumers better organize their medical information in one secure place. These are known as electronic personal health records (or PHR systems). This is a collection of information about your health that you control and maintain. It can include storing your personal health information, recording vital signs, listing allergies, providing emergency contact information, scheduling reminders for taking medicine, calculating/tracking caloric intake, and logging physical activity. In an emergency, it can quickly give healthcare personnel vital information.
There are a variety of technologies that enable your doctor or healthcare team to monitor your health remotely. One example is web-based or mobile apps for uploading information, such as blood glucose readings. Another type is wearable devices that measure and wirelessly transmit data, like blood pressure, heart rate, lung function, gait, posture control, tremors, physical activity, or sleep patterns. One type that is becoming more common is home monitoring devices for older people or people with dementia that detect changes in normal activities, like falls.
Doctors talking to doctors
Doctors can use telemedicine to provide better care to their patients. One instance is a virtual consultation that allows primary care doctors to get input from specialists when they have questions about a diagnosis or treatment. The primary care doctor can send exam notes, history, test results, or X-rays/other images to the specialist for review. The specialist can respond electronically to the doctor, conduct a virtual appointment with you at your doctor’s office, or request a face-to-face meeting. This process may prevent unnecessary in-person referrals to a specialist, reduce wait times for specialist input and reduce unnecessary travel.
While telemedicine has been around for a while, the Covid-19 pandemic has caused it to gain popularity recently. To “see” patients despite the concerns of spreading the virus, many doctors turned to Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype. To facilitate this transition, in March 2020, the federal government stepped in to lower barriers to the use of telemedicine, including removing geographical restrictions, expanding the types of services that could be provided, and providing reimbursement for virtual visits equivalent to that for in-office visits.
For comparison sake, looking at data from Medicare, in January 2020, less than 1% of primary care visits occurred virtually; by April, almost 50% did. According to FAIR Health, a nonprofit group that analyzes private health insurance claims, federal spending through Medicare was nearly $4 billion for telehealth visits during March and April 2020, compared to less than $60 million for the same two months of 2019. According to the health insurer, UnitedHealth Group, the number of covered telemedicine visits rose from 1.2 million visits in 2019 to 34 million in 2020. Other insurers reported as much as an eightyfold increase.
In a recent nationwide Harris Poll, 8 in 10 Americans who had used telemedicine said they “liked it” or “loved it” and said they were likely to continue using it after the pandemic. So, it’s not surprising that commercial interest in telemedicine has boomed, with both start-ups and established companies providing virtual care services. Officials added 140 services to the list of what Medicare would pay for during the pandemic, including emergency visits, eye exams, speech and hearing therapy, and nursing home care. This has had a significant impact.
One area of particular activity has been behavioral and mental health. A notable example is the city of Reno, Nevada, which instituted a $1.3 million experimental program where the city paid for virtual therapy of residents through the smartphone app Talkspace. Per a recent study, the first half of 2021 saw $14.7 billion invested in digital health. This was slightly more than the investment in all of 2020 ($14.6 billion) and almost double the investment numbers from 2019 ($7.7 billion).
Retail giants, such as CVS, Walmart, and Amazon, are driving these changes as they get in on the increasing market. This only underscores the importance of offering a compelling patient and provider experience. Many companies are offering remote urgent care, virtual primary care, and new wearable health technologies. According to the research company PitchBook, the annual global telehealth market is expected to top $300 billion by 2026, which is up nearly fivefold from 2019.
Despite the increase in popularity, the federal measures enacted at the beginning of the pandemic to facilitate access to telemedicine will expire once the Covid-19 pandemic has ended unless federal legislation is enacted to make the changes permanent. Several federal bills are under consideration that have bipartisan support.
The CONNECT for Health Act and the Telehealth Modernization Act would permanently remove geographic restrictions on telehealth and expand the types of services that can be provided. It’s vital to note that it doesn’t allow doctors to practice in states where they are not licensed. Per the Alliance for Connected Care, a telehealth lobbying coalition, more than 650 bills have been introduced in statehouses that advocate for expanding telemedicine permanently.
Another vital aspect is whether the government will continue to reimburse telehealth visits at the same rate as in-person visits. Medicare raised fees for virtual visits to match those for in-office exams. This was followed by state Medicaid programs and many commercial insurers. However, insurance reimbursement for telemedicine still varies by state and type of insurance. As of September 2021, some private insurance companies have begun to roll back their pandemic-era coverage policies or now only extend coverage for only a few months at a time.
The uncertainty of how they’ll be compensated for virtual visits has led to some health systems charging for telemedicine services, regardless of insurance coverage. Major physician groups are advocating for maintaining equal reimbursement. The American Medical Association said Medicare should continue to allow patients to receive virtual care in all areas of the country. The association is also pushing to keep reimbursing doctors for consulting with patients by phone because it would guarantee that patients without broadband internet aren’t left behind. It’s essential to point out that new Medicare policies are crucial when it comes to what will happen with private insurance since Medicare often sets the tone.
While there’s widespread bipartisan support for telemedicine coverage, lawmakers are reluctant to pass any bill that would significantly add to Medicare’s budget; the government already spends about $750 billion a year on the program. Private insurers see telemedicine as a way to save money. Many carriers will try to reimburse less for a telemedicine visit than an in-person one unless they are required to.
Some are also concerned that telemedicine might fragment healthcare by leading to gaps in care, overuse of medical care, inappropriate use of medications, or unnecessary or overlapping care. Further study is needed to determine which conditions and treatments telemedicine is effective for.
Others are concerned about equity. To use telemedicine, one needs access to a smartphone or computer with internet services. This isn’t universal. A recent study found that communities with higher poverty rates utilize telemedicine far less than others. Expanding high-speed broadband internet access to underserved communities and outreach efforts are needed to address this problem. When it comes to patient privacy and data security, this has to be tackled for telemedicine to be viable.
To make telemedicine successful, doctors and medical groups need to invest in technology and train staff on how to use it. There are three things to focus on when creating and launching a telehealth service. The first is making patient feedback a priority. The digital experience must be easy and enjoyable to use. Ask patients what they want from a telehealth service, such as what they want to be able to accomplish, on what devices they want the interactions to take place, and the kinds of instructions that are most valuable to make the process a smooth one.
The second consideration is ensuring that the platforms are easily accessible. Since about 15% of the population has a disability, building accessible digital experiences is vital. Healthcare providers should test their experiences against assistive technology to ensure. The third component is to remember the internal users. Healthcare workers are crucial to the telemedicine experience from the provider perspective. It’s essential to focus on the usability of the service.
While not everything can be done virtually, telemedicine is particularly valuable. It’s convenient for the patient and convenient for the doctor. Telehealth plays a critical role in maintaining relationships with healthcare consumers. It’s imperative to transform and modernize care models and settings, where a hybrid approach to delivering care in-person and virtually is the future. Part of this is developing a system that can handle day-to-day demands but also is prepared for disruptions like the Covid-19 pandemic. We need to make telemedicine sustainable and enduring.