Part I: Is Telemedicine Here to Stay?
COVID-19 has changed everything permanently. In the healthcare industry, it has made us look towards alternative methods of caregiving. Telemedicine might be THE method that allows us to continue to provide excellent care.
During the height of COVID-19 fears in the United States, tests were scarce and healthcare centers were shutting down due to the fear that in-person interactions with care providers might lead to someone becoming infected and causing an outbreak.
While understandable, this left those in need of immediate or cyclical care at risk. What if someone needed care, but it wasn’t life threatening? Medical professionals were advising that people stay away from hospitals and emergency care centers, since they were overwhelmed with providing care for existing patients, as well as those coming in with urgent care requirements. They didn’t want any more people there, since if someone with the virus were to be in the vicinity, its spreading could have led to a large-scale outbreak.
There was also the worry that some in need of cyclical care, like diabetes patients, who have weaker immune systems, might be more susceptible to being infected. The infection would affect them worse, leading to outcomes that could range from flu like symptoms, to permanent damage to the lungs and/or heart, or even death.
While they can’t be treated in person, they can’t just be left to fend for themselves, without care, since that could lead to long term damage or death. This scenario is what made the healthcare industry take a second look at telemedicine.
Zoom, Google Hangouts, FaceTime, Whatsapp Video Call, Facebook Video Call. In our goal to bring together our society by making instant communication easier, we had already created countless applications that could allow people to interact visually, without the need for in-person contact.
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This wasn’t anything new. In 2012, The National Academies of Science, Engineering and Medicine led a discussion on this topic, discussing “how telehealth can drive volume, increase the quality of healthcare, and reduce overall costs by reducing readmissions and avoidable emergency department visits for rural communities. Telehealth allows small rural hospitals to provide quality healthcare services at lower costs and in the local healthcare facility which benefits rural patients, since they are no longer required to travel long distances to access specialty care. Avoiding patient transfers when care can be provided locally is critical for both small hospital and provider viability in rural areas. It also helps tertiary care centers keep beds open for patients in need of critical care.”((Telehealth Use in Rural Healthcare Introduction – Rural Health))
The crisis that the worldwide community faced during the initial COVID-19 spread, could’ve been aided by the implementation of telehealth, on a much larger scale. With telehealth, several services can be provided, even if it’s not at its full potential, such as:
- Cardiology
- Psychiatry
- Oncology
- And more
Because of this, people at risk, like diabetes patients, don’t need to get a face to face appointment. The care they need can be taken care of remotely.
Even the diagnosis and treatment of COVID-19 is possible through this method. While the most thorough way of testing is an in-person diagnostic test, there are other signs that can be used to diagnose it. For instance: “red-purple, tender or itchy bumps that develop mostly on the toes, but also on the heels and fingers.”((COVID Toe and Other COVID-19 Skin Conditions : Accessed September 1, 2020)) This diagnosis doesn’t require an in-patient visit. A few pictures can be taken and sent to the dermatologist or treating physician, who can assess it and convey the results with the patient via telemedicine. For people with difficulty traveling or older patients who wish to stay home and avoid any risks, this is ideal.
Oftentimes the physician will likely just recommend quarantine, but in the case of a dermatologist, they might provide relief by digitally prescribing a treatment product, or by recommending an over the counter product.
The Centers for Medicare & Medicaid Services (CMS), as well as the President of the United States, have taken note of the usefulness of telemedicine as well and have pledged their support for it. The latter, on August 3rd, 2020, issued an executive order, which included.((CMS Releases Proposed Changes to Telehealth, Merit-based ….” Accessed September 1, 2020.))
- Announcing a new payment model for rural healthcare providers to allow for flexibilities from existing Medicare rules
- Developing and implementing a strategy to improve the physical and communications infrastructure to improve access to healthcare in rural communities;
- Submitting a report on upcoming initiatives to improve the availability of clinicians in rural communities
- Proposing a rule to extend telehealth Medicare flexibilities put in place during the PHE beyond the PHE.
But not all are on board with telemedicine. Author Trevor Royce, MD, MS, MPH, has brought up several questions and concerns, such as: “How will the safety and quality of care be impacted? How will we integrate essential components of the traditional doctor visit, including physical exam, lab work, scans and imaging? Will patients and doctors be more or less satisfied with their care? These are all potential downsides if we are not thoughtful with our adoption.”((Telehealth Could Have Long-Lasting, Unforeseen Effect on ….” Accessed September 2, 2020.))
Those are concerns that need to be addressed. One of those concerns can be alleviated by saying that the current work around, where lab work, scans and imaging done by a third party, is effective. But the question is whether it actually is.
Third party testing protects the provider, but the patient still has to be present in person. Then there is the concern that due to the complexity involved because of multiple parties, the information might be jeopardized or be privy to unwanted eyes.
Then there is the question of what about if a patient or doctor is unsatisfied with a consultation? For instance, a patient goes in with a pain in the back of the neck. The doctor assesses it remotely, sees a bulge.
Now with telemedicine, they can have the patient feel it and describe it, as well as explain how it affects them physically. But the patient is not a reliable narrator. Squishy is an amusing word and for some, it means how a teddy bear feels. For others, it means how green jello feels. If there is a miscommunication, it could mean a wrong hypothesis and unnecessary testing or treatment.
There is also worry about improper implementation. Providers and healthcare centers, in a hurry to open up and provide care again, as well as to start bringing in revenue to manage operations, might rush and that could lead to all the aforementioned concerning scenarios and possibilities.
So what is the takeaway here? Is telemedicine here to stay?