Telemedicine has promised to transform healthcare since the dawn of telecommunications.
Recent decades saw it move from the realm of science fiction to functional reality. But it remained on healthcare’s sidelines, progressing steadily, but still far from its promised potential.
Then came COVID-19, and with it, telemedicine’s perfect storm: a national health crisis demanding unprecedented levels of care and social distancing, a healthcare system stretched to the breaking point and near-universal adoption of remote working methods and technologies.
And just like that, it seems, telemedicine has arrived.
But has it? Where do we really stand on the road to universally available and effective telemedicine? And what impact will it have on a health plan’s mission to deliver access to care?
This four-part series examines the state of telemedicine in America, the journey that brought us here, and the road that lies ahead. Over the course of this series, we will examine the following ideas:
- Before there was COVID, there was Telemedicine
- The COVID Effect: Will It Last?
- Telemedicine Today: What’s Happening?
- Telemedicine Tomorrow: What’s Coming? Ultimately, we seek to answer the question, are we there yet—and if not, when?
Before there was COVID, there was Telemedicine
Unless you are an industry insider who’s been keeping close tabs on telemedicine, you’re likely to find it surprising that there were more than 60 specialty telemedicine programs available at the start of 2020.
Most people are surprised at the breadth of programs. But the truth is, telemedicine was in good shape coming into 2020, well before COVID-19 pushed it into the spotlight. A concerted effort had been made in 2018 and 2019 to sign up client and vendor accounts. Due to that effort, telemedicine achieved at least some level of penetration into almost every medical specialty and subspecialty. Some of these specialty programs are not large—some are university-based, many are commercial—but the fact that there is now penetration in all these specialties is impressive. But as we will see, specialty penetration is only one small part of the telemedicine story.
Four Obstacles to Telemedicine Adoption
There have long been four obstacles that have slowed telemedicine's widespread adoption, even after many technological hurdles had largely been solved. These obstacles were still very much in evidence coming into 2020, but the industry made steady progress in solving and/ or solutioning with workarounds.
Obstacle #1: Providers Were Resistant To Adoption
The vast majority of doctors had no desire to practice telemedicine—and for a good reason: All their training is based on providing a hands-on exam to establish a diagnosis and, for many, they did not believe they could deliver medicine without it.
Understandable though their position is, this aversion to telemedicine is a significant barrier to adoption. But as the industry implemented telemedicine programs in health systems and group practices in recent years, my colleagues and I have found approaches that help address physician concerns and increase adoption.
In most healthcare system implementations I have been involved with, we have seeded adoption by choosing “champions,” or early adopters. These tend to be younger “techie” physicians—a bit on the nerdy side—who love technology and are more than happy to lead the telemedicine charge for their companies.
But even with this approach, we would generally implement telemedicine for only 5% to 10%, and occasionally 20%, of an organization’s providers. The remaining 80%-plus were very reluctant. (Amwell 2020 Physician-Consumer Survey)
An essential step in any telemedicine implementation—for early adopters and naysayers alike—is to educate providers on how to perform an effective patient-facilitated exam. We educate them on how to teach patients to palpate, how to look at different angles, perform range of motion testing, observe gait, and of course, general mental status and visual cues of the patient’s level of illness.
The goal is to show physicians how to perform an effective virtual exam and convince them that “good” medicine that is appropriate to the severity of the illness can indeed be delivered remotely.
Want to read more?
To explore the remaining obstacles outlined in Part One of this four-part series, visit https://questanalytics.com/telemedicine and register for the download, as well as receive updates as Parts 2-4 are released.
Dr. Bill Lewis, a leading telemedicine expert, Quest Analytics Board Member and former chair of the National Telemedicine Accreditation Program