Telemedicine adoption amidst a pandemic - can we overcome the barriers?

Neil Raden Profile picture for user Neil Raden June 3, 2020
Far from being a cure-all, telemedicine brings a whole new set of pros and cons. The barriers are not insignificant. However, a review of telemedicine adoption in the U.S. and beyond provides a good incentive to press forward.

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(via Adobe Stock)

The basic premise of telemedicine is that the patient can avoid travel to the doctor's office and waiting time at the office. The physician can see more patients for routine visits and, potentially, choose a remote, comfortable location. While not actually going to work seemed inconceivable just a few months ago, telemedicine is getting a serious look.

In part one, Will telemedicine finally disrupt the health care industry?, I discussed some of the barriers to telemedicine, which are numerous. Some barriers relate to tactual care a physician can provide, and others are purely regulatory and disruption of practices. First, among them is: can a physician actually care for a patient without making eye-to-to-eye and physical contact? Much of that has to do with the type of practice.

Someone with a rare disease, recovering from trauma or suffering from any number of ailments that don't present visually, may be a poor candidate. However, there is another aspect of telemedicine that is not often discussed. Your physician may use telemedicine to confer a specialist, who instantly has scans, abs, X-rays at his/her fingertips. 

Two other non-medical issues holding telemedicine back are regulations and technology. Medical practice is regulated by each state Medical Board; their outlook toward telemedicine is far from uniform. Some states, California in particular, require the physicians to see the patient once every twelve months physically. There are also issues about practicing medicine across jurisdictions where one is not licensed.

Some of these barriers may seem intractable. I'll describe what some other countries doing that are more creative. In the U.S., there is an element that can make telemedicine 1000% more effective - mobile devices.

When you see your doctor for either a check-up or not severe issues, the protocol is the same everywhere. They take your temperature, your pulse, your blood pressure, and listen to your heart sounds. Maybe they check your reflexes. I saw Dr. Eric Topol demonstrate a functioning EKG monitor no larger than a credit card that communicated with your smartphone. There are personal devices to measure every one of those things at home, skipping that ritual. Even glucose level, A1C, and cholesterol panel can be measured from a finger stick.

And one other thing: the doctor's EMR not only records all of this, but runs inferencing algorithms, making suggestions to the doctor, or warning about drug interactions.

If you think about all the things the physicians can infer from those five or six tests, it can shorten the appointment to just a few minutes. "Are you taking the meds I prescribe? Have you kept a log of your diet and exercise and pleas' transmit it to me."

Grappling with the costs of telemedicine

As with all things in healthcare, the cost is a factor. As per

One provider, GlobalMedwith their Cost Simplified Solution, Telehealth hardware, and software, will be available for a flat fee starting at $799 a month. This allows healthcare organizations to enable telemedicine as an operating cost versus traditional capital expenditure purchase models that start at around $42,000. 

Telehealth can lead to cost-savings for both patients and providers. The studies we reviewed showed that telemedicine has several financial benefits for providers, such as patient retention, time optimization, improved appointment compliance, and lower overhead costs and liability.

There are some barriers. Connectivity is still a problem in the U.S. Having sessions drop, poor resolutions, and choppy dialogue dilute the value quickly. We found in our own experiment that elderly patients have trouble with the technology. As per 2016 data from the National Ambulatory Medical Care survey, elderly patients account for 500 annual office visits per 100 population (not a typo), only exceeded by pediatrician visits (736 per 100).

The Coronavirus pandemic is showing signs of easing in some areas, but as of May 12, 2020, there were 1,242,594 confirmed cases and 80,820 deaths. The outbreak has generated a frenzy of activity related to telehealth. Payors are increasingly extending coverage; health systems are mobilizing quickly to expand programs, and telehealth companies are seeing rapid increases in demand.

Following the enactment of coronavirus emergency supplemental legislation that expands Medicare coverage of telehealth, reliance on telehealth services for Medicare beneficiaries will improve. The virus spreads rapidly in health care settings. Telemedicine offers a unique capacity for remote screening, triage, and treatment. It could be a powerful tool for reducing transmission of the disease to and among health care workers and patients who are not infected.   

Ideas from China's experience

An examination of telehealth use in mainland China, which has been grappling with the Coronavirus outbreak since December, offers some ideas for expanding telehealth in the United States. A recent article in The Economist noted that Chinese telemedicine services such as Ali Health (part of Alibaba), J.D. Health, and WeDoctor (backed by Tencent) quickly launched online coronavirus clinics to triage and treat patients across the country.

J.D. Health is now conducting about millions of online consultations per month, up a thousandfold since the outbreak. These new telehealth platforms have enabled patients in China to access care without having to travel, thereby reducing the risks of exposure and spread. West China Hospital of Sichuan University partnered with ZTE and China Telecom to rapidly deploy indoor and outdoor 5G networks to connect doctors with patients remotely. This reduced providers' risk of exposure and making it possible to treat more patients across disparate locations without having to travel.

Opportunities in the U.S.

U.S.-based companies such as TeladocAmWell, and Buoy are quickly following China's lead, and are offering similar screening and video visit services. AmWell noted that its patient traffic increased by more than 211% in the early days of the U.S. outbreak. As the virus has spread across the country, the number of online visits has surged.  

Telehealth could be a critical component of our nation's strategy to ramp up capacity to combat Coronavirus while keeping health care facilities safe. Telemedicine can also be an effective alternative to in-person visits for patients with other health care needs, and thus can help preserve critical provider capacity for those in greatest need of in-person care. Providers, states, and payers each can play an essential role in realizing the potential of telehealth

My take

In the U.S., telemedicine faces a range of daunting problems. Broadband connectivity to homes is far from universal. Only 60% of those 65 and older have broadband, and the definition of broadband is a little murky. DSL, for example, may advertise 25mbps service, but the upload speed may be less than 10% of that, which is inadequate for a video connection. Thee is no question that telemedicine will be disruptive to traditional physician practice. Reimbursement rates from payers may be too low. And one single incident where a doctor misses something that would have been detected I an office visit will create a crisis. 

With the rapidly rising cost of healthcare, and the fact that's it non-existent in some places, the need for telemedicine continues to grow. It may not be the option for everyone, but the pros seem to outweigh the cons. Being able to treat patients from their homes, give valuable medical support and information, and provide service to less developed areas makes it hard to pass up.

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