The near-exponential growth of telemedicine in recent years has prompted some industry observers to question whether the quality of health care can keep pace with the sharp increase in the use of this technology to link medical professionals with those most in need of their care.
Akhilesh Pathipati, a Stanford University graduate student pursuing both a medical degree and an MBA, recently gave voice to those concerns in an op-ed article written for the Sacramento Bee. Among other things, he cited an article that appeared in the July 2016 issue of “JAMA Dermatology” acknowledging that direct-to-consumer teledermatology significantly increases patient access to dermatologic care. However, it noted that doubts remain about diagnostic and treatment quality.
Appropriate Care Is Not a Given
Pathipati cited other studies that purported to show that telemedicine providers recommended appropriate care in only 34 to 66 percent of their consultations with patients. He also noted that “direct-to-consumer services also score worse than physician offices on several performance measures, and some are staffed by physicians not licensed to practice in the United States.”
However, he acknowledged that telemedicine offers enormous potential for bridging the growing gap between the demand for health care services and the medical community’s ability to meet that demand. However, he said that the credibility of telemedicine as a model for the delivery of health care is being undermined by concerns about the quality of care that it provides. Such concerns are fueled by a rise in incorrect diagnoses, unlicensed providers, and inappropriate treatments.
Could Tighter Regulation Help?
As one remedy for growing concerns about the flagging quality of health care delivered via telemedicine, Pathipati recommended tighter regulation of this sector. Whether the oversight of telemedicine comes from a government agency, professional society, or elsewhere, it should incorporate a robust accreditation process. Such an accreditation process, he said, would allow telemedicine providers “to showcase the quality of their services while providing patients with information on options for care.”
Pathipati also voiced concern about the lack of coordination of care between telemedicine providers and the primary physicians of the patients they treat. He recommended that telemedicine providers join the growing health care industry initiative to increase interoperability between direct-to-consumer health care providers and their regular doctors.
Cites Stanford’s Telemedicine Initiative
As an example of what can be done, Pathipati recounted his role in launching a direct-to-consumer telemedicine operation at Stanford, one of the first such services to be operated at an academic medical center. Under this operation, patients received remote medical consultation with Stanford doctors, and the specifics of these interchanges, as well as subsequent care, were automatically documented in their medical records.
Providing further insight into the market forces that are driving telemedicine’s growth was a recent article posted at Optum360Coding.com in late February 2017. The article cited the results of Harris Poll surveys commissioned by American Well, one of the country’s largest telemedicine providers.
Consumer Interest Is High
The Harris polls revealed that nearly two-thirds of consumers would like to be able to consult with their primary care provider via telemedicine, at least for certain services that lend themselves well to this technology. Specifically, respondents said they would consider using telehealth communications to consult on such matters as chronic conditions, birth control consultations, inpatient or post-surgery care, and filling prescriptions.
Accounting in part for this upsurge in consumer interest in using telemedicine services is not only improvement in telemedicine technology but also the increasing willingness of insurers to reimburse for such services. Yet another factor in the growing consumer demand for telehealth services is the lower cost of such services, compared to traditional face-to-face medical care. The article cited a 2014 price analysis that found a typical face-to-face appointment for an acute medical condition cost an average of $136, compared with $40 to $50 for a telemedicine consult.
More Employers Offer Services
Also fueling the growth of telemedicine services is the growing number of employers that are offering coverage of telehealth consultations for their employees. Typically, such consultations are used to seek care for non-emergent medical issues, such as rashes, mild viruses, and earaches.
The article at Optum360Coding.com also addressed concerns that the growing demand for telemedicine services is outstripping the ability of providers to maintain the highest standards of care for remote patients. Such concerns prompted the American Medical Association in mid-2016 to issue ethical guidelines for physicians who are providing telemedicine services. According to the article, the AMA guidelines seek to ensure “that physicians put the patient’s welfare first, provide competent care, give patients sufficient information for them to make decisions about their care, safeguard patient privacy and confidentiality, and keep the continuity of care in mind.”
2 Market Research Reports
Also reflecting the growing adoption of telemedicine by traditional health care providers are a couple of market research reports from HIMSS Analytics, an international health care advisory service that promotes the use of information technology to improve the quality of health care. Findings from the market research reports were published in an article posted at mHealthIntelligence.com in late April 2017.
The two reports, one covering inpatient care and the other focusing on outpatient services, concluded that the overall adoption of telemedicine technology had risen from about 54 percent in 2014 to an estimated 71 percent in 2017. Fueling the rapid growth in the use of telemedicine technology in the inpatient setting, according to HIMSS Analytics, were hub-and-spoke platforms. They would use telemedicine technology to link health care providers and patients within a single large medical center, such as those operated in conjunction with medical schools. Among inpatient services using telemedicine, hub-and-spoke use accounted for 59.6 percent of provider use.
Other Telemedicine Growth
Other areas of telemedicine growth on the inpatient side of health care — and the percentage of provider use — included the following platforms: patient portal or patient-focused applications, 34.6 percent; concierge services, including e-visits, 29.2 percent; and remote patient monitoring, 12.4 percent.
On the outpatient side of the telemedicine equation, the single largest area of growth was also on the hub-and-spoke platform, utilized by 44.9 percent of providers. Other growth areas in outpatient care included patient portal or patient-focused applications, 34.6 percent; concierge services, 19.2 percent; remote patient monitoring, 14.1 percent; and consumer-grade remote monitoring from off-shelf devices or wearables, 7.7 percent.
Telemedicine Not for Everybody
Although telemedicine provides an ideal way to extend care to patients who might otherwise go unserved, some medical disciplines are not as adaptable to telemedicine technology as others. Not surprisingly, the HIMSS Analytics study found that providers who rely heavily on counseling/communicative disciplines had a higher use of telemedicine than general practices. Psychiatry accounted for 21 percent of telemedicine use, followed by pediatric services at about 20 percent. The rate of telemedicine use in general medical practice was 13 percent, according to the HIMSS survey.
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