Health care in the United States is often compromised by fragmentation in its delivery, limited patient access due to a shortage of primary care doctors, long wait times (even for patients who have appointments), and spiraling costs. As a result, innovative approaches to delivering health care are becoming increasingly important in America’s continued pursuit of improved outcomes and reduced cost of care.
Health care delivery models such as telemedicine aim to address the long wait times and high administrative costs associated with traditional care and offer important insights for improving the healthcare process.
By definition, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Although telemedicine is rapidly expanding, it is a concept that has existed for more than half a century. At its basic level, telemedicine is a physician talking on the phone to a patient or another physician. Today, the term telemedicine includes remote physician consultations through channels such as texting, video, e-mail, and other wireless tools. Ultimately, the goal is to connect a physician with a patient to provide a diagnosis and recommend treatment options.
The U.S. population is getting older and more patients are dealing with chronic conditions. The result is an increasing demand for care. Unfortunately, communities across the country are simultaneously experiencing physician shortages. The Association of American Medical Colleges estimates that the U.S. will face a shortage of more than 130,600 physicians by 2025. The use of telemedicine has the potential to provide some relief from this shortage, which is expected to be equally distributed among primary care and medical specialties such as general surgery, cardiology, and oncology.
Although telemedicine has a lot to offer America’s health system, physicians must carefully consider when to incorporate it into the continuum of care. According to The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, the following are some potential risks providers should be aware of:
1. Telemedicine can pose challenges for the traditional physician-patient relationship. Office visits allow time for conversations that build relationships and have a positive impact on care. Personal relationships matter in healthcare, and patients need engaged care providers to become engaged themselves. Done properly, telemedicine provides connection, communication, and continuity that can enhance patient care and the physician-patient relationship. Consider developing strategies to ensure patients understand how telemedicine improves their medical care.
2. A physician cannot perform the onsite portions of a physical exam. Not having a physician on-site to perform a physical examination can mean inaccuracies from patient self-reporting and missing additional findings that may only be caught in person. These risks should be communicated to the patient and documented very clearly in the medical record. In some settings, local onsite support personnel can be part of a complete telemedicine program. The literature increasingly supports inclusion of telemedicine in many practice settings.
3. Telemedicine is very dependent on technology. It relies on equipment like examination cameras, remote monitoring devices, and surgical robots. If the equipment is inoperable, patient safety and health are at risk. Faulty technology or equipment may cause a physician to act on inaccurate information or prevent the physician from facilitating adequate or continuous care.
4. Be aware of privacy, security, and patient confidentiality. It’s important to remain HIPAA-compliant. Physicians interested in integrating telemedicine into their practices should ensure patient data files are encrypted to prevent a data breach or cyberattack, clearly define proper protocol for webcams and web-based portals, and ensure there is a mechanism in place to protect the privacy of individuals — including staff members, other patients, or patients’ families—who do not want to be videotaped if sessions are being recorded.
Managing the social aspects of telemedicine can be challenging, but telemedicine has the potential to support a stressed delivery system by increasing patient access to care, improving outcomes, and reducing health care costs.
B. Tilman Jolly is chief medical officer, Specialists On Call.