Are the best days of telemedicine already behind us? We don’t think they are, although the concern is understandable given that the end of the public health emergency sunsetted many pandemic-related telemedicine regulations. But we believe that the next level of virtual care can only be reached if we bring more elements of the clinic to the patient.
At the start of the Covid-19 pandemic, amidst unprecedented rates of telemedicine use, some contemplated whether it was the beginning of a new normal — one with telemedicine as a core component of how patients receive care. To date, the result has been more of a modest change than a paradigm shift. The number of telemedicine visits per month in the United States has fallen substantially since its peak in April 2020 and today represents roughly 5% of all outpatient visits. Patients and physicians have largely shifted back to in-person visits, in many cases because they question the quality of care in a telemedicine visit and specifically the inability to conduct a physical exam and key tests (e.g., electrocardiograms).
The remedy is to bring key aspects of the doctor’s office to the patient. An emerging industry aims to fill this gap. Already patients can use connected devices to check their blood pressure, blood sugars, and other physiological measurements at home and share them remotely with their doctor. There has also been movement to obtain this data through consumer wearables such as Apple Watches. Lab testing providers such as LabCorp and Quest offer an extensive network of “patient service centers” for sample collection outside doctor’s offices, as well as a growing array of at-home mail-in test kits. Portable diagnostic service providers can come directly to a patient’s home to take X-rays and ultrasounds or blood draws for lab tests.
These changes are only the tip of the iceberg. This future need not stop at simply recreating a standard doctor’s visit but can go far beyond it through use of new devices such as digital stethoscopes or ultrasounds. Looking at a child’s ear in the doctor’s office is difficult. Often the doctor gets only a fleeting look of the eardrum. TytoCare’s Home Smart Clinic and other similar devices could in theory result in better exams than what is available in-office by helping the parent get a comprehensive video of their child’s eardrum that can be sent to the doctor and rewatched as needed.
New technologies can even collect data that was never available in a doctor’s office. Though it sounds futuristic, increasingly many of the sickest patients have devices implanted in their body for management of their conditions. Millions of heart failure patients in the United States have an implanted pacemaker, defibrillator, or other device. These devices are continuously recording a variety of data whose scale eclipses anything that is collected in clinic. Researchers are working to identify novel ways to leverage this wealth of data to improve chronic disease management.
These emerging technologies also have the potential to dramatically alter the way patients interact with their providers. While previously patients might have had a visit with their physician every few months, these new offerings allow for more frequent, and sometimes 24/7, monitoring. The result is a richer sense of a patient’s health status and progression. In the traditional care model, the onus is on the patient to initiate care. In this new model, physicians can immediately observe when things are awry and preemptively contact their patient, engaging patients when the need is greatest. Additionally, by separating data collection from the visit itself, the patient-doctor interactions that do occur can be maximally productive, focusing on treatment and guidance, which synchronous interactions are uniquely suited to provide.
While there is tremendous potential for this future of telemedicine, there are critical barriers that must be overcome. Many of these technologies are cost prohibitive for the average patient and provider, particularly if intended only for occasional use. Ease of use is also likely to be a major issue given health care’s typical consumer is older and, on average, less technologically savvy. Health equity is also a vital consideration.
The future of telemedicine should be democratized and made accessible to rural populations, racial/ethnic minorities, and other historically underserved communities. Opening this future for the patients who need it most will require new processes and institutions that enable affordable access to these devices but also provide the necessary degree of “human touch” to overcome technology barriers.
Hybrid models that incorporate both virtual and in-person contact can help alleviate many of these barriers. For example, brick-and-mortar telemedicine hosting sites can be set up in local clinics, drug or grocery stores, or work sites; these hosting sites could provide space for telemedicine visits, the latest telemedicine technologies, and “tele-presenter” staff who are facile with the technology and can offer in-person patient support.
While we emphasize the importance of “bringing the clinic to the patient,” we acknowledge that many other factors will affect telemedicine’s future trajectory. With the expected sunsetting of Covid-related temporary telemedicine policies, there are open questions as to what the future of telemedicine reimbursement and regulation will look like. Additionally, when it comes to new telemedicine technologies, the role that health plans and self-insured employers will play in supporting and covering these products is still ambiguous. However, this uncertainty has not deterred the wealth of companies seeking to innovate in this space.
Telemedicine has not yet reached its full potential because many physicians and patients believe the visits lack the necessary exam and testing capabilities to provide the highest quality of care. However, new technologies and care approaches are pushing the frontier, not just of virtual visits but also of health care as a whole. For health care providers, insurers, and employers, it is important to be aware of these trends and determine how you will facilitate this new future of telemedicine for your patients, beneficiaries, and employees.
Technology, however, will rarely be a solution by itself. A meaningful degree of “human touch” will always be necessary. Companies and providers must identify ways to provide this together with technology in a cost-effective manner. This can be achieved by identifying partners that provide true end-to-end solutions spanning technology and in-person support or by establishing internal systems such as employer-based telemedicine hosting sites.