Before I switched my insurance to a high deductible plan, I wanted to get prescriptions refilled on the old plan. I called my doctor for the refills, but some required a doctor visit. The staff started to make an appointment for me to come into the office.
This was in April, with the pandemic still chugging full speed ahead. I asked the staff if it was possible to set up a telehealth visit for me. She kind of stumbled at first. She was surprised I asked, which surprised me as I figured this would be a common request by now!
Then she gave me instructions on what to do. I had to download Google Meet, join the appointment 10 minutes in advance, and wait for the doctor to join. Having been into an app store or two, I easily found the right app, logged in early, and was so happy to see my doctor on the screen. With no sound. We fumbled around a bit and got it to work and everything else went well.
I thought to myself that, yes, there was a stumble or two, but all in all a good alternative! Why are more people not requesting this? There are so many benefits, so what are the barriers?
The obvious benefit of telemedicine is that, especially in a pandemic, healthcare can continue to be delivered with no contact. Outside of pandemic, no contact visits could still be of value. Who wants to go to a doctor’s office during respiratory season? But then there are also people who have a much harder time leaving their homes, such as the poor and elderly populations. Then there is the rural population where it may be a very long drive to get to a doctor’s office.
Telemedicine is also useful within the walls of the hospital. Technology can help with distancing providers from infectious rooms as well as allowing collaboration amongst many providers as needed. It can also allow healthcare workers who must quarantine after testing positive to still work with their colleagues.
EHR company athenahealth reports that their network saw “a 3,400% overall increase in daily telehealth visits from mid-February to late April." Epic is having the same experience and launched their new telehealth portal Twilio. It seems to be true everywhere. “Nearly half of physicians are now using telehealth technology, up from just 18% in 2018, according to a nationwide survey of 842 physicians conducted by physician search firm Merritt Hawkins.”
All this extra business can help providers continue getting reimbursed for patients they might not have otherwise seen. In fact, at the state and federal levels, the statutes are being updated to include allowing submission of telehealth visits to insurance payors and Medicare. Even TRICARE regulations are updated for those serving the military. This will indeed help struggling physicians’ offices (including behavioral health therapists and others) stay afloat during the pandemic.
The first thought I had about the barriers to adopting telemedicine was the number of people out there who are technically challenged. I have personally trained people on how to use Zoom because they are not technically savvy. The range of people who will shy away from this technological benefit is great, from poor people who do not have internet or computer skills to the elderly to average people who are just not comfortable fumbling around learning a new program.
Money is always a consideration in emerging technological trends. The patient would have to have the equipment to use both audio and video in most states. Some states may allow for a simple voice call to be classified as “telehealth” while others do not. Those that do not would require a smart phone with enough data plan to handle a video conference of unknown length. Or they would have to have a personal computer with internet access. There are plenty of people who do not have the appropriate technology to handle telemedicine.
Security is definitely a concern. There are very few platforms for video conferencing that are cleared for HIPAA. “The Department of Health and Human Services is using its enforcement discretion to allow providers to use video-calling platforms, such as Zoom and Facebook Messenger, that are not compliant with HIPAA privacy rules.” State and federal emergency declarations have cleared the way for use of less secure platforms, opening potential for privacy issues. Adoption of telemedicine platforms has been rapid, but “when you mix this rapid, enhanced adoption [of telehealth] with this enhanced threat … that's where the trouble lies".
Here to Stay?
It is hard to believe that any of this new infrastructure and healthcare ecosystem would go away after the pandemic. Over the next several months to even longer than a year while we wait out this pandemic at home, new habits will be formed and discoveries will be made. This will also apply to how healthcare is delivered. The new conveniences of telemedicine will have been felt by a good portion of healthcare consumers given the current numbers of increased usage already in just two months.
Is telemedicine here to stay? What form will it take? Will there be a push to rein it in with regulations after the pandemic ends, or maybe just some fixes to the security and privacy issues that may arise? All of that is to be seen. But it sure feels like it is here in a big way and will become part of our new normal.