Your Patient Is Logging on Now: The Risks and Benefits of Telehealth in the Future of Healthcare
Long before the COVID-19 pandemic struck, telemedicine was part of the standard delivery of care in the U.S., but used very rarely. By the end of April, telemedicine visits had skyrocketed to nearly one million visits per week.1 (By telemedicine, we mean live remote visits with a clinician, as opposed to telehealth, a broader term encompassing telemedicine plus remote monitoring, asynchronous data collection, and a variety of other incorporations of technology into nonclinical patient and professional health-related areas.)
Many patients and physicians have discovered that they appreciate the conveniences of virtual healthcare, and its support of the physician-patient relationship.2 They’ve considered how telemedicine increases access to care (for some patients) while decreasing infection risk, not only in a pandemic but during routine flu season or for immunocompromised patients. Though telemedicine’s near future is clouded by uncertainties regarding reimbursement,3 state-to-state licensing hassles, and privacy issues, for the long haul, telemedicine is here to stay.
Sweeping benefits from telehealth are still emerging—and so are its risks. Reduced infection risk and increased access to care are possible with recognition that telemedicine is not a panacea: Telemedicine is a helpful adjunct to in-person care, when supported by best known practices.
A study released by the American Medical Association (AMA) in February 2020, just before the pandemic hit the U.S. hard, reveals that telemedicine visits with physicians had already doubled from 2016 to 2019.4 Still, the pandemic has led to an unprecedented spike in usage. Telemedicine is here to stay, but exactly how it will be incorporated into evolving community standards of care is the question driving discussion and argument within many specialties.
- Increases access to care for most patients, including many patients in rural locations, patients who struggle to cover the peripheral costs of an in-person visit (transportation, childcare, time away from work, etc.), and patients with chronic conditions.
- Enhances the ability to manage chronic conditions by making more frequent contact easier. This management is already supported by at-home devices that record blood pressure, blood sugar, and other essential data points.
- Reduces infection risks, not just for COVID-19, but for post-op patients, patients who are immunosuppressed, etc.
- The remote exam’s inherent limitations mean physicians must know when to ask patients to come in to avoid missed diagnoses.
- Increases cyber liability, especially when providers are seeing patients from a variety of devices in a variety of locations.
- Privacy issues come in high-tech forms: Is the video visit interface HIPAA compliant? And in low tech forms: Conversations may be interrupted by household members at either end.
- Decreases access to care for some patients: Half of U.S. seniors do not have internet access.5 On the other hand, some hospitals serving low-income populations have found that when remote visits are available via mobile device, and don’t require a computer, a surprising number of patients can access telemedicine visits.6 That said, many communities do not have sufficient internet bandwidth; some patients are prevented by a language barrier or lack of technological savvy from accessing a telemedicine portal.
- Reimbursement is uncertain: Pre-pandemic, “Low reimbursement for telehealth was viewed as a critical disincentive,” say the authors of an opinion piece in JAMA, because “Without payment, it would be difficult for clinicians to afford to provide the service, despite data from previous studies suggesting clinicians were broadly supportive about its use.”7
(See link for article)
Without the proper security controls in place, a provider’s private conversation or exchange of information with a patient could be found via a Google search. A hacker could shut down a network after pocketing a provider’s cell phone. Patient information could be stolen through a network device with minimal security controls. Any device connected to the network can provide an entry point—physical access to the practice is not required.