Even if no other good for health care emerges from the coronavirus crisis, one development – the incorporation of telemedicine into routine medical care – promises to be transformative. Using technology that already exists and devices that most people have in their homes, medical practice over the internet can result in faster diagnoses and treatments, increase the efficiency of care and reduce patient stress.
Without having to travel to a doctor’s office or clinic, patients can have many ailments “seen” on a computer, tablet or smartphone by a health care practitioner and have treatment prescribed as needed. For patients like me, who won’t return to medical offices that keep me waiting long past my scheduled appointment time, being able to “see” the doctor in my home most often at the prearranged time will be more than enough to encourage a telemedicine visit when feasible.
A televisit is like having a videoconference with one’s doctor, with technology improving health care in ways no one has yet thought of, Dr Angela Fusaro, founder of Physician 360, a telemedicine company, says.
Dr Emil Baccash, a geriatrician in Brooklyn, who set up remote access for his patients when Covid-19 struck the city, says: “Telemedicine will definitely be part of the future of medicine.” Baccash is my personal physician, and during a recent telemedicine visit, while I sat at my home computer, he diagnosed a likely rotator cuff injury by having me move my painful right arm into different positions. Although an MRI is most likely needed to confirm my exact problem, until the coronavirus threat eases and I can safely have the scan done, physical therapy exercises, also available via telemedicine, may alleviate it.
For nearly two months now, as the coronavirus ravages many communities large and small throughout the country, most patients have been unable or unwilling to access in-person care from health professionals. Even if someone is able to get to a doctor’s office or clinic safely, who wants to sit in a waiting room where you or another patient might transmit the infection? But with an internet connection through a computer, tablet or even a smartphone, patients can safely show various body parts to an examiner who is then able to recommend treatment or order a test or prescription that can be delivered to the patient’s home by the nearest pharmacy.
“Telemedicine is not a substitute for seeing and physically examining a patient,” says Baccash, who still makes house calls when needed. “But there are some patients, especially elderly patients, who can’t get out of the house. I can talk to them and look at their problem on my computer, take a snapshot, say, of a leg infection and enter it directly into their medical record. If a blood test is needed, I can have a lab technician come to their house.” Even X-rays can be done at home with a portable machine that can manipulate the images digitally, he says.
“We’re taught in medical school that taking a medical history gives you 90 per cent of the information you need, with the remaining 10 per cent coming from the physical exam,” Baccash says. “If you talk to patients long enough, they’ll tell you what’s wrong with them, which is why telemedicine can be so helpful – we get most of the information we need from talking with and listening to patients. And patients are more relaxed and feel less rushed in their own homes.”
He adds that with a telehealth visit, the doctor may be able to assess a patient’s living conditions and determine how they help or hinder the patient’s health problem. For example, for those who get up during the night, perhaps multiple times, is there an obstacle course between the bedroom and bathroom that is an accident waiting to happen? How safe is the bathroom for patients with physical problems?
Telemedicine can also provide easy medical access to patients who live in rural communities many miles from good health care. For many common health problems or follow-up care, an in-office doctor visit may not be needed. Patients could be seen during a televisit by a registered nurse or physician assistant.
Even in areas where people lack good broadband connections, local telemedicine internet cafes could be established that enable patients to connect to appropriate specialists perhaps a thousand miles away.
“Before Covid,” Fusaro says, “telemedicine seemed like a luxury, but people are now thinking that a technology-based health care experience will become the new normal.” Even with a fee-for-service company like hers, getting telemedicine care might appeal to someone with medical insurance who prefers to avoid the time and expense involved in getting to a doctor’s office or urgent care clinic and paying a deductible, she suggests.
For the many millions of patients with chronic health conditions, an invaluable asset of telemedicine could accrue from the use of body-worn sensors through which potentially serious changes in a patient’s health status can be monitored remotely. And as a group of experts in chronic neurological disorders recently noted in JAMA Neurology, “remote monitoring options, by offering reliable insights into issues that matter most to patients, will empower clinicians in delivering tailor-made counselling to patients via videoconferencing”.
In studies of patients infected with the liver-damaging hepatitis C virus, for example, the responses to treatment delivered via video teleconferencing have been as good as or better than among patients receiving in-person treatment, researchers studying chronic liver disease have reported.
For now at least, the Covid-19 crisis has made the delivery of care through telemedicine reimbursable for any condition through Medicare and through most supplemental insurers. It has also loosened former requirements that the patient and provider must be in the same state, permitting an expert, say, in New York to be reimbursed for consulting with a patient in Vermont via telemedicine. For the benefit of us all, doctors as well as patients, let’s hope these new rules long outlast the pandemic.
Baccash says he strongly suspects that “when the virus goes away, some patients who have used telemedicine will prefer televisits to coming to the doctor’s office”. However, no matter how thorough such visits might be, he emphasises: “There’s no substitute for seeing a patient and examining them physically. Otherwise, you can miss a lot.” Examples he gives include a lump in the breast, a heart murmur or a mass in the abdomen.
“Sooner or later, we have to examine patients in person,” he says. “Most of us want to see patients at least once a year, more often – every four months or so – if they have a chronic disease.”