With patients and providers alike becoming more tech-savvy, it is no surprise that technology is increasingly being implemented to facilitate the patient-physician relationship. Telemedicine, which is defined as the remote diagnosis and treatment of patients by means of telecommunications technology, has seen an exponential rise in recent years. Based on a study done by JAMA, there has been a surge in e-visits. E-visits spiked from 200 in 2015 to 200,000 in 2017. E-visits had a compounded growth rate of 52% from 2005-2014 and 261% from 2015-2017. Higher education has already begun adjusting their curriculum to keep up with the changing medical care landscape. During the 2016-2017 school year, 84 medical schools across the country offered elective or mandatory courses in telemedicine. Although visits to ambulatory practices declined nearly 60 percent in mid-March and have remained low through mid-April post COVID-19 quarantine measures, telehealth visits increased and accounted for 30% of all medical visits. These numbers show that telemedicine is the wave of the future.
With telemedicine becoming increasingly available to patients, it is important to examine some of its different uses. Physicians are currently using e-visits to diagnose and treat patients, follow up with patients after recent office visits, and track the condition of patients with chronic illnesses. Unfortunately, e-visits have their limits, as they are only effective for diagnosing low-acuity conditions such as acute respiratory infections, urinary tract infections, rashes, and musculoskeletal strains. The AMA estimated that telemedicine use is highest among radiologists (39.5%), psychiatrists (27.8%), and cardiologists (24.1%). Telemedicine also has high use among primary care physicians. It has even been incorporated into hospitals to expand their access to remote specialists in fields such as neurology, cardiology, neonatology, pediatrics, and mental health.
This new avenue of healthcare comes with a plethora of benefits for its users. Besides increasing the efficiency of physicians, e-visits also allow them to extend their reach beyond their local community. This is most applicable to rural areas that are severely under-served. Urban areas generally tend to have more of allure among graduating medical school students; they offer higher prestige and greater potential for higher incomes than positions in more rural areas. As a result, people living in rural communities must travel long distances to receive care which adds additional costs. E-visits would allow these people access to physicians, particularly specialists, living in urban areas which would result in better health outcomes and lower healthcare costs. E-visits typically lower healthcare costs overall regardless of where one lives. One study compared the cost of a UTI visit between a typical office visit and an e-visit and found that the e-visit came at a much cheaper cost of $74 compared to the $93 office visit.
Although telemedicine has a lot to offer, it is not a flawless system. While higher access to healthcare in rural areas sounds great, lack of affordable broadband impedes the practicality of online visits. Another issue with physicians going online is the risk to patients’ personal information. While physicians are obligated through HIPAA to protect the medical information of their patients, data storage, and transfer of information over long distances causes this information to be susceptible to interception. Physicians are also struggling with legal issues regarding licensing due to the different policies that change from state to state. Physicians must be licensed within the state they practice medicine, which presents a problem when they are treating patients remotely from out of state. Many states have tried to amend their laws to allow for such things, but these laws are vague. A national licensing system has been proposed to alleviate this issue, but until then this barrier remains.
Despite these flaws, it appears that the medical field is slowly shifting its direction toward telemedicine. Of course, telemedicine cannot replace regular office visits entirely. In a study done by Mayo Clinic, only 12% of patients who had high-acuity cases diagnosed or specialist assessments via e-visits found that their diagnosis remains unchanged upon a follow up face-to-face office visit. Compared to low-acuity cases in which only about 2-4% of patients received revised diagnoses, it can be concluded that e-visits are best implemented in less severe cases.
There are many driving forces pushing medicine toward this online form of care, including low healthcare costs, greater efficiency of services, and extending access to underserved communities; however, the changing preferences of the patients is also an important factor to consider. The younger generation of today, those who grew up immersed in a world of technology, are seemingly always on the go. Anything to make their life more convenient is appealing, which could explain why telemedicine is particularly popular among the younger generation. In a poll taken by the Kaiser Family Foundation, approximately half of the young adult populations (between the ages of 18-29) reported having no primary care provider. Telemedicine could potentially reduce this statistic, as they would be more likely to schedule e-visits over picking up the phone to call and make an appointment.
The push toward telemedicine may come sooner than expected, however, given the current state of the world. Due to the COVID-19 outbreak, we are being urged to stay home and avoid nonessential contact with other people. Healthcare visits fall into the essential category, but physicians are forced to schedule fewer patients to prevent them from coming into close contact with each other. While the situation varies across different fields of medicine, many physicians are being encouraged to adopt telemedicine into their practice so that they can see patients from home. As more physicians offer e-visits to their patients and expose them to the concept of e-visits, we could potentially see a growing preference for the implementation of telemedicine into our healthcare system.
Barnett, M.L., Ray, K.N., Souza, J., et al. (2018). Trends in Telemedicine Use in a Large Commercially Insured Population, 2005-2017. JAMA, 320(20):2147-2149.
American Medical Association. AMA offers first estimate of telemedicine use by physicians.(2018).https://www.ama-assn.org/press-center/press-releases/ama-offers-first-national-estimate-telemedicine-use-physicians
Achenbach, S. J. (2020). Telemedicine: Benefits, Challenges, and Its Great Potential. Health Law & Policy Brief, 24(1): 1-24.
Mehrotra, A., Paone, S., Martich, D. G., et al. (2013). A Comparison of Care at eVisits and Physician Office Visits for Sinusitis and Urinary Tract Infections. JAMA Intern Med., 173(1): 72-74.
Habermann, E.B. (2019). Advancing the Science of E-Visits in Primary Care. Mayo Clinic Proceedings, 94(6): 939-941.