Waiting on Virtual Physician Appointments

Obstacles to surmount before telemedicine becomes reality.

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Loads of people have smartphones filled with apps. Loads of people see physicians and other healthcare providers for medical treatment. But why are options to visit with a physician using a smartphone app limited?

Although we have the audiovisual technology—including high-quality cameras and stable broadband Internet connections—to deploy telemedicine and make virtual office visits and medical consults a reality, we still have numerous obstacles to surmount before virtual patient visits become commonplace and this innovation becomes disruptive thus changing the way that medicine is practiced.


What Is Telemedicine?

Using technology, telemedicine allows two-way communication between a practitioner and patient in real time. From a distant or hub site, a physician or other licensed health care provider serves a patient located in an originating or spoke site. For example, a cardiologist at a regional center could direct the care of a patient with heart disease in a rural hospital using telemedicine technology.

Although real-time clinical interactions are a recent development, telemedicine has been around for more than 30 years. Using "store-and-forward" technology, pathologists and radiologists have long reviewed digital images and recordings that have been transferred from one site to another.

By 2012, nearly half of all U.S. hospitals proffered telemedicine in some capacity. Moreover, the federal government is heavily invested in telemedicine, and the U.S. Department Veterans Affairs has rolled out VA Telehealth Services for veterans.

In 2014, an estimated 28,000 veterans were served by physicians in remote locations using telemedicine services.

Institutional and government interest in telemedicine is fueled by worries concerning the rising costs of health care. Many believe that by offering telemedicine services, the price of health care will decrease.

However, it's unclear whether telemedicine will actually save money, and research on the subject is scant and inconclusive

Telemedicine Barriers

Sure, there are theoretical cost-efficiencies of telemedicine. These projected benefits include decreased brick-and-mortar overhead, decreased the cost of reimbursement by insurers, and decreased opportunity costs experienced by the patient including limited travel expense and lost time from work. However, in an empirical sense, these efficiencies have yet to be realized. Specifically, no study has proven that telemedicine decreases the cost of health care.

Moreover, telemedicine will likely come with its own distinct expenses including the cost of having nurses or others trained to take orders via telemedicine, and the possibility that easier access to referrals will actually increase the frequency of primary care and specialist visits.

With respect to improvements in health, it's also unclear whether telemedicine will benefit patients.  Some evidence suggests that telemedicine measures may reduce the length of hospital stay in people with respiratory problems, diabetes and heart failure.

Moreover, mortality benefit has been associated with telemedicine measures provided to patients with heart failure. However, other studies show no health benefit of telemedicine, and we're unsure whether virtual consults will improve the quality of care outside of acute or intensive care environments. No long-term studies have been done examining health quality outcomes.

One of the biggest problems with telemedicine has to do with licensing and regulation. Medical state boards license physicians, and things can get hairy when a health care provider from another state or country directs care. In order for telemedicine to go mainstream, physicians providing remote care must be allowed to do so.

Virtual office visits and consults will undoubtedly change the therapeutic relationship between physician and patient. For example, with virtual encounters, it's impossible for a provider to lay hands and physically examine the patient. Many patients find face-to-face interactions with physicians comforting and may be reluctant to visit with a physician via digital means.

On a related note, telemedicine will change the dynamics of teamwork among health care professionals. Currently, most medical care is provided by professionals who directly interact with each other. What happens when some members of the team function remotely?

Bottom Line

As patients become more tech savvy and increasing focused on convenience and insurers become more value-oriented, the draw of telemedicine and virtual consults will likely prove irresistible. However, we're still far from a tipping point, and in order for telemedicine to go mainstream, we need to understand the implications of such technology on patient-centered outcomes. Moreover, insurers and other accountable care organizations must figure out how to make telemedicine work in a financial sense.

Selected Sources 

Article titled "Virtual Visits--Confronting the Challenges of Telemedicine" by JM Kahn from NEJM published in 2015.  Accessed on 7/13/2015.

Article titled "The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview" by S. McLean and co-authors from PLoS One published in 2013.

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