Your usual healthcare visits include driving to a clinic or office, filling out some paperwork, and waiting for someone to call you when the provider is ready for you.
Then, the coronavirus infection. Suddenly, many people are attending appointments on the computer or over the phone, and telemedicine has become a household name.
Although telemedicine appointments are decades old, they are still on the fringe of the healthcare system. After the pandemic made it impossible to provide medical services as before, telemedicine became necessary, and barriers to reimbursement, technology, and licenses began to decrease. Certain medical systems must transition from small telemedicine implementations to 100% virtual encounters overnight. The patient soon began to see a doctor at home. Even in the hospital environment, they are increasingly interacting with healthcare providers via iPad. Harlan Krumholz, a professor of medicine at Yale University School of Medicine, said the latest developments in telemedicine are “unimaginable to most people.”
Before the pandemic, healthcare providers had realized that telemedicine was inevitable. However, due to various reasons, including the reimbursement system, tradition and patient preferences, the hospital system is still unable to extricate itself. Previously, most telemedicine was done through a network of healthcare systems and clinics called the “hub” model, in which experts (“hubs”) would provide for smaller health centers and hospitals (“spokes”) Virtual consultation. . For example, a patient may go to a community health center to see a psychiatrist hundreds of miles away. In the pandemic, this model has been largely replaced by a more decentralized direct-to-consumer model, but in areas with limited Internet bandwidth (people may need to go to community clinics) and remote locations that require more specialized equipment Except in the medical field, for example for patients who need to be evaluated for stroke or heart disease.
To many people’s surprise, this large-scale transition to telemedicine and video conferencing access works well. Health care organizations have been able to provide safe and arguably more efficient and cost-effective care for patients at home. This also means more opportunities to work from home, benefiting many healthcare workers (for example, parents with children). In addition, the provider can see the inside of the patient’s house, which may help to better understand the patient’s life.
Lauren Eberly, a clinical researcher in cardiovascular medicine at the Perelman School of Medicine at the University of Pennsylvania, cited an example during a telemedicine visit when her patients were talking about her medication. When Eberly asked about taking a certain medicine, the patient thought she was taking it-but then she showed Eberly her medicine cabinet, which did not contain the prescription. The patient thought she had all the medicines she needed, but in fact she lacked one medicine, which could have devastating consequences.
“In many ways, [the use of telemedicine] will be one of the positive factors in the pandemic,” said David Bates, director of internal medicine at Brigham and Women’s Hospital and professor of health policy and management at Harvard University. Chen Chen School of Public Health.
A powerful, permanent telemedicine system can reduce the congestion in the hospital, allowing more patients to receive care at home and outside the hospital. This may help allow Bates to predict that in the future, more hospital beds can be set up, so they can also become intensive care units or general care units instead of just one or more. In this way, hospitals will be able to “cheer up” during periods of high demand, just as California hospitals experienced during the pandemic.
However, the rapid development of telemedicine is not perfect. Both providers and patients need to quickly become familiar with the new technology platform, and it is difficult for people to manage video access, figure out how to use video conferencing applications or maintain a stable Internet connection. Providers may miss non-verbal cues and other subtle aspects of patient visits, or fail to show empathy in traditional face-to-face ways, such as providing comforting hands. Some platforms do not have the best security measures. Moreover, if the patient needs to undergo certain examinations, they cannot just be carried out on-site.
Broadly speaking, the pandemic has provided trials for many health systems to adopt telemedicine more widely. However, like any beta version, an improved version. In order for telemedicine to reach its full potential, it will require better forms of patient participation, such as remote monitoring, for example, a way for people to obtain blood pressure and other vital signs at home. Health care providers are still learning even the smallest things, such as not meeting as usual during virtual visits. The telemedicine platform will continue to be improved in terms of usability, privacy and security.
In order for telemedicine to reach its potential, we also need to pay attention to who will be left behind. Smartphones can help bridge the digital divide, but for many groups, there are always barriers to access to technology. For example, people from ethnic minorities are characterized by low broadband adoption rates and low computer and Internet usage rates. Elderly patients may only have a landline and cannot access video.
A recent study of patients who plan to undergo telemedicine visits in the first few months of the coronavirus pandemic shows that there are significant inequalities in the use of telemedicine. In general, the use of telemedicine (including telephone and video) is lower among older, Asian or non-English speaking patients. Similarly, older, female, black or Latino, people with lower socioeconomic status use video access less frequently.
“We are building a new telemedicine system, which gives us the opportunity to solve the problem,” Eberly said. “When implementing it, whether it is more technology or more innovation, we must use a framework so that we can continue to evaluate structural inequalities in telemedicine.”
Telemedicine will require more investment. The Mercy Virtual Care Center, a large virtual medical institution, has been a leader in helping organizations consider virtual care. According to Bates, Mercy spends about 5% of its revenue on telemedicine, which is much higher than other hospital systems’ expenditures on telemedicine (approximately 0.1% to 0.2% of its revenue).
Bates said: “We are seriously underinvesting in (telemedicine).” “There will be changes in the future, but it will take some time.”
Improving telemedicine also requires long-term policy and regulatory reforms. Before the coronavirus pandemic, although telemedicine had been effectively implemented in many professional fields, there was almost no reimbursement for telemedicine expenses. After the pandemic was declared a public health emergency, insurance companies, as well as Medicare and Medicaid, provided expanded telemedicine coverage. Congress, the federal government and state governments have also relaxed patient confidentiality and telemedicine regulations. However, most of these reforms were issued temporarily during public health emergencies, and although the epidemic is not over, they have already begun to roll back.
Ideally, the reimbursement rate for all forms of healthcare (face-to-face, video and phone) should be the same, not just temporary. Without this parity, providers that provide telemedicine (such as telephone visits to marginalized people) will be punished substantially because their reimbursement prices are lower. However, there are some reasons for optimism. For example, with the support of the two parties, the 2021 Telemedicine Protection Act after COVID-19 and the Telemedicine Modernization Act of 2021 were proposed to Congress recently. The governor of Massachusetts, Charlie Baker, recently signed a health care reform bill, which requires that the cost of behavioral telemedicine visits should be the same as the cost of face-to-face visits for a period of two years. Without such regulations, there will be at most one telemedicine coverage in the country. But stakeholders do not want to conduct telemedicine visits without providing value to patients.
“People will seek accountability,” Krumholz said. He also pointed out that since patients like telemedicine usually visit a doctor, insurance companies will continue to underwrite the pressure of telemedicine.
Joseph Kvedar, professor of dermatology at Harvard Medical School and chairman of the American Telemedicine Association, said that a simple reimbursement policy is as important as payment. If it is complicated, the insurance company may sometimes reject a bill, or the patient may receive an unexpected bill.
In addition to the reimbursement mechanism, there are other policy areas that need to be updated. For example, there are some restrictions on accessing patients across states through telemedicine. Although this restriction is meaningful for the first visit, it may be necessary to relax the requirements for state permits so that follow-ups can be optimally performed virtually. General broadband service is also required.
One of the main questions driving telemedicine is: When does it make sense for providers to see patients in person rather than on video? Depending on the needs of the patient, certain areas such as psychiatry may be very suitable for virtual follow-up. However, due to the need for specialized equipment, other people (for example, seeing a doctor for sight or hearing) are gone.
Overall, health care organizations still have unresolved problems, including how to best use their physical structure and how to classify patients. But these problems can be solved. The important thing is that telemedicine has and will continue to provide people with great value.
“We will only see its growth. There is still a lot to learn, but this is an exciting time.” Krumholz said.
Update March 1, 2021: This article has been updated to reflect that Joseph Kovdal is currently the chairman of the American Telemedicine Association.
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