Telemedicine Usefulness and Risks Considered

Worldwide, the practice of telemedicine has been growing very fast over the last decade. As with other service delivery models, a number of market factors have converged to influence this rapid growth – aging demographics and a related increase in chronic illnesses, technological developments and the pressure to deliver more cost effective services, to name a few.

In April, I attended the American Telemedicine Association, 2017 2.0 Telehealth Conference in Orlando. The exposition hall was quite large and the event well-attended, which is one measure of how far the industry has come. In discussion with other professionals I met, I learned that compared to previous meetings, the attendance, including exhibitors has been growing rapidly.

Further to this anecdotal exchange, resource material from the American Telemedicine Association mentions that while US and global markets have seen rapid growth, the market size statistics for telemedicine shows variability depending on the source.

From my vantage point as a medical doctor practicing in this emerging field, I do believe that telemedicine can improve patient care, but there are also risks. In this time of rapid change and growth, telemedicine should not completely replace the face-to-face practice of medicine, but we must recognize it as a value driven approach, appropriate to augmenting or filling the gaps and deficiencies of our current health care system.

By way of example, balancing prudence with practicality, I remember a mother that called me because her two-year-old daughter had been having shortness of breath and she was by automatic inclination requesting a steroid. I strongly suggested to the mother that she first take her daughter to the nearest children’s hospital. On the other hand, I also do believe that once assessed properly, conditions such as acute pharyngitis can be treated safely over the phone.

A solution for reaching those remote

The application of technology can allow a medical team to access patients in remote areas, diminish congestion of ER and Urgent Care centres, with conditions such as flu, urinary tract infections and sinus infections for example. Also due to the lack of availability of certain specialties in remote hospitals, practitioners will be able to access patients with telemedicine services.

Of course, one of the challenges of doing telemedicine remotely is that the patients must have technology at their location such as a computer and internet connection if they prefer to do video conferencing or transmit data.

In some cases, patients do not get a refill on their medications due to provider negligence or abuse, or other reasons such as inefficiency of pharmacies or insurance claim problems. Telemedicine should be able to facilitate or better still, fix these type of problems. I have had frequent instances where I ordered a medication for a patient by calling the pharmacy but the pharmacy kept saying that they didn’t receive any order.

Many times the insurance provider decided not to cover certain medical services or treatments. I have been continuously receiving increased notices from insurance companies that they will refuse to pay for certain medications

Cost effective, but not put patients at risk

As mentioned earlier, one key advantage of telemedicine is cost savings. Actually, some insurance companies will only cover patients for telemedicine services. In my experience, from practicing telemedicine in the USA, from a cost effective point of view, it is not always necessary to examine patients in order to diagnose or treat some conditions, such as acute otitis media or acute pharyngitis.

On top of this, with the use of technology, we should be able very soon to get signs of symptoms from a patient, which are the findings we get by doing the physical exam, in a way that could be more accurate and economical than with the traditional physical exam. This data could be quickly transmitted to a provider through a secured network, without the need for the doctor to be in person with the patient.

Yet there is high potential for abuse by using this service. Until we are certain that it is thoroughly safe to practice telemedicine, we should use a conservative approach, and only use this service for conditions where we do not put patients at risk. I think the biggest risk in using telemedicine is to assume that this new and rapidly emerging service works efficiently where we still do not have enough evidence for the conditions as presented by the patient.

Adolfo Cotter, MD

7/14/2017

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