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Telehealth: How virtual can medicine get?

COVID has forced us to use telehealth a lot. How much of it will doctors and patients put up with?

Chances are good that by now you've experienced the peculiar undertaking of visiting a physician not in their office but via video chat. Life sciences research firm InCrowd reports that as of late 2020, 84 percent of its 1.8 million member clinicians were using telehealth tools due to the COVID-19 pandemic and that a third of all appointments were taking place via remote means.

"Many primary care docs like me saw that 60 to 70 percent of visits could be done virtually without a physical exam," says Washington, D.C.-based physician Dr. Shantanu Nundy. "In some specialties, like dermatology and rheumatology, it can be as high as 80 to 90 percent."

"The major healthcare providers have all seen a huge uptick in people wanting to use the telehealth service," says Lance Helmke, healthcare distinguished technologist at Hewlett Packard Enterprise. "One of our main customers has seen 150 percent growth in this sector in the last year."

Please read: Telemedicine reduces healthcare workloads and increases access

Which leads to a key question: Just how much healthcare can happen remotely?

Telehealth began maturing in earnest in 2019 as regulations across the country eased the rules around remote care and as insurers began to approve payments for virtual visits. Things can get complicated if doctor and patient are located in different states, but that's a rare occurrence, and by and large, telehealth services are booming.

The catch is, for most patients, telehealth has often meant "a Zoom call with your doctor." And doctors point out that in many cases that's enough. "It's a well-known truism in medicine that 85 to 90 percent of the information required to arrive at a diagnosis is gathered from a patient's history," says Dr. Barry Issenberg, director of the Gordon Center for Simulation and Innovation in Medical Education at the University of Miami. That said, there's also a general acknowledgment that a physical examination and in-person diagnostics are still important and can be essential in some cases.

The doctor will Zoom you now

The potential to bridge the gap between virtual and physical is rapidly developing, thanks to a range of digital medical devices that are putting the physical examination back into the telehealth visit—or at least a semblance of it.

In its simplest form, digital medical equipment allows patients to report their temperature, pulse oximetry, and even blood pressure to their clinicians, presuming they are using home equipment properly. The real fun comes when physicians implement devices that work directly with a smartphone or other camera to relay images and vital signs directly from patient to physician, reducing the chance of errors while increasing the usefulness of the data.

For example, digital stethoscopes like the Thinklabs One and 3M's Littmann Core are allowing remote physicians to get a classic listen to heart and lung operations without having to be in the same room. If your kid has a sore throat, you'll soon be able to mount the TelScope system on the back of a phone and gently insert it into your child's mouth, illuminating the chasm to give a remote doctor or dentist a clearer look. There's also the Tytocare system, a do-it-all box that can examine a wide variety of physiological systems based on the patient's symptoms.

These technologies are young, but they seem to be working well. Dr. Mick Connors, CEO of telehealth provider Anytime Pediatrics, is a fan, saying, "Telehealth otoscopes [the device your doctor uses to look in your ear], like those by Remmie, are low cost and can be purchased online. Stethoscopes, like Eko, also can be used to listen to the heart and lungs. And the future promises a more seamless connection of key data elements."

Helmke notes that these types of connected devices will soon become important not just for acute care but for ongoing wellness needs. "Patients will opt in to being monitored using these devices," he says, "for which they'll receive discounts on their insurance. There's a big rush to develop AI models to capture this data and address health issues before they become a big problem."

Apps like Luscii Vitals are part of this trend. It prompts the patient to periodically check their vitals, and using AI to watch for any anomalies, the app handles everything behind the scenes—meaning the patient doesn't have to enter data into a form and send it to the doctor.

Please read: How healthcare technology uses data to transform the system

Not every telehealth device has to be completely connected or use AI to have great utility. "During the pandemic, my sister's newborn baby was struggling with low birth weight," says Nundy. "This required frequent visits to the doctor largely to accurately weigh the baby and see if additional interventions were needed. She was balancing the logistics of a newborn baby and a toddler at home, as well as the pandemic and risks of getting exposed to COVID-19. So she got herself a weighing scale for a baby, and instead of weighing the baby once or twice a week at a clinic, she was able to weigh the baby daily at home and then use telemedicine to share the results with the doctor."

"Telehealth is undoubtedly the future," says Sarah Johnson, an RN who works for FamilyAssets, a web-based elder care resource, "especially for people living in rural and underserved areas. In the United States, 80 percent of rural counties are considered 'healthcare deserts,' with many counties having no general surgeons or advanced diagnostic equipment. Telehealth could potentially revolutionize non-emergency and routine care for millions of people, especially those living prohibitively far from primary care."

When telehealth isn't enough

Of course, speed bumps on the road to universal telehealth care remain.

The biggest caveat is the inherently buggy nature of technology itself. "These devices are dependent on technology always working, and becoming too dependent on them runs the risk that practitioners will lose traditional skills that will be necessary when the technology fails," says Issenberg. "We cannot wait to consult the Geek Squad to fix a device before taking care of the patient."

Issenberg also notes that the quality of some digital telehealth device findings can often be lower than you would get using, say, a real stethoscope in a clinical environment.

There are also inevitable limits to what you can do remotely. Says Connors, "Patients who need acute management or a more extensive physical examination or intervention will need in-person care for IV hydration, complete abdominal examination, radiological testing, surgical treatment, or emergent medical management." To date, no one has developed an IV that can be delivered over Zoom.

Perhaps the biggest criticism of telehealth comes from Jami Carder, an RN working in home care who notes that, for many patients, telehealth is just too complex. "The system is flawed when it comes to senior citizens," she says, "and I now spend a significant amount of my workday helping them navigate the new world of telehealth. Many of my patients miss appointments and fall through the cracks. I have had countless patients have a telehealth visit scheduled, and they have no idea what that even means. Many are afraid of technology and uncomfortable asking for help, so they just don't participate in the visit at all. This has become a huge safety issue."

Please listen: Healthcare clinicians, patients embrace technology (podcast)

Carder says that even cursory telehealth visits for her patients can run for more than an hour and that she often must use her own phone to help them because they don't have the necessary technology. "I would love to see a new standard of care which includes ensuring patients are comfortable using technology—say, a practice visit or two—before they have a virtual appointment made," she says.

The road to wellness

Regardless of the hiccups, telehealth looks like it's here to stay—even after COVID-19 has passed or at least faded. "I think you're going to see a big pivot," Helmke says. "If I can avoid a single ambulance ride, that saves a provider $55,000 on average. I think you'll start to see wearables increasingly being used to catch things before you have to go to the hospital."

"Telehealth and virtual care can become the initial source for care," says Connors. Not only will physicians be able to use telehealth to treat patients from home, but "they'll be able to prevent many problems from occurring and can ensure patients get the right care, at the right place, at the right time, with the right clinician," he says. "The value of this type of tool is only limited by those to whom the patient is connected."

Lessons for leaders

  • The arguments for telehealth are numerous and powerful: cost savings, convenience, and outreach to underserved areas, among others.
  • The limitations of telehealth are clear and yet hard to define. Sometimes the doctor must physically examine the patient.
  • Younger people are more comfortable with technology so they will be more comfortable with telehealth.

This article/content was written by the individual writer identified and does not necessarily reflect the view of Hewlett Packard Enterprise Company.