Telemedicine made a slow start, but Covid-19 has given it a boost. While many physicians and patients remain reluctant, despite compelling benefits, much of the hesitancy is due to false perceptions about its efficacy.
Health systems should embrace it.
Pre-2020, less than one percent of US primary care visits were remote. In April 2020, the pandemic increased this figure to nearly 30 percent. As normal life slowly returns the dilemma of whether telemedicine should continue to grow, or return to being niche is becoming apparent.
Some of telemedicine’s virtues are self-evident. It is convenient with no commuting to the clinic or wasting time in the waiting room required. It is easily accessible to people in remote areas or those with physical disabilities. Telemedicine decreases the need for sick people to be in the vicinity of other sick people, and frees up medical facilities for the treatment of other patients.
When the platform is embraced at an institutional and cultural level, physicians and patients can collaborate to leverage healthcare digitization further, offering more benefits.
Prior to a consultation, the patient will have monitored their own blood pressure, pulse, and other vitals using electronic devices, and this data is uploaded into the patient’s medical record. The patient will have also completed an automated triage questionnaire, and used approved online medical encyclopedias to learn more about their chronic conditions, allowing them to prepare pointed queries for the physician. These are all steps that are either absent or require a medical professional under traditional medicine.
During the consultation, the physician can use the same digital interface to enter notes for the patient, making it easier for the patient to understand their condition and to accurately adhere to instructions.
This empowerment also increases patient engagement, making them feel like an active contributor to the resolution of their health problems, rather than a passive charity case. It also increases the likelihood that patients diligently studying their medical records will spot a physician’s error.
Further down the line, fuller integration with home medical devices will mean that physicians can skip checking in style consultations, as the physician automatically receives the patient’s remote health data.
While many of these digital benefits are possible without telemedicine, in practice, they go together because they require the physician and patient to change their mindset and use digital assistance in a way that is much more difficult to encourage under traditional medicine.
This is also why many of the perceived risks associated with telemedicine reflect erroneous assumptions. There is a fear the absence of a physical examination increases the likelihood of a clinical error. However, this ignores the fact that many primary care consultations manifestly do not need an in-person consultation, and that a physician can call for one if necessary.
Physician and patient also have deeper neuroses. Doctors fear that by making it easy to get a consultation, patients will start pestering the doctor with low value consultations. Patients fear that unless the doctor looks them in the eyes face-to-face, they become the victims of a multi-tasking physician who is trying to maximize appointments and earnings.
Both are wrong. While we have all met hypochondriacs who run to the doctor for a paper cut, these are a small minority. In net terms, integrated telemedicine means higher efficiency by eliminating useless appointments and because the digitization supports better long-term outcomes. With time, skeptical patients come to appreciate that doctors are giving them superior care rather than exploiting remote consultations to shirk on the job.
Researchers have demonstrated the benefits of telemedicine. By looking at Israel’s experience during the pandemic Dr. Dan Zeltzer and his colleagues found that increased telemedicine usage during 2020 led to a slight increase in primary care visits, but considerably lower per-episode costs, meaning lower net usage of healthcare resources. Moreover, there was no evidence of missed diagnoses or adverse outcomes.
As proactive stakeholders make a push for the institutionalization of telemedicine, entrenched interests will erect barriers: physicians, triage nurses, receptionists and other healthcare workers may all fear losing their jobs due to the associated digitization, and physicians don’t like patients seeing their medical records and uncovering their errors. Yet our ultimate judgment must rest on the quality of health outcomes, where the economics are becoming compelling.
Omar Al-Ubaydli is a board member of medical records company Patients Know Best