Telehealth

It is necessary to maintain high quality of care and be able to shift to meet the patient’s evolving needs. We have witnessed the evolution of medical care through revolutionary technologies and changing methods for effective patient care.

Allowing patients to receive care from their chosen physician remotely could revolutionize healthcare.

When thinking about healthcare, most of us conjure up images of office visits or trips to the ER. Whether it’s for a routine check-up, lab tests, an outpatient procedure, or major surgery, the norm is for patients and caregivers to leave their homes (often sitting in traffic or rushing from work) to meet their doctor at a healthcare facility of some kind. But things are changing.

Traditional practices not only in medicine but in other industries as well, have been replaced by technology like the internet, smartphones, social media platforms, Uber, cryptocurrencies, electric vehicles, E-commerce, etc. Revolutionary technologies that forever change the way something is done.

I like to use the payphone example. In the United States, the number of public payphones reached its peak in 1995, with approximately 2.6 million payphones installed across the country.

Millions of people used them daily. Imagine in the 80s if someone told you that they would be replaced by mobile phones—you wouldn’t believe them, right?

By 2018, only about 100,000 payphones remained in operation and the last public pay phone was disconnected in 2022. It’s amazing how technology can displace things.

Traditional media is another example of an industry that has been replaced with new mediums. The accessibility of digital information has forever shifted the way people consume media.

As with many other examples, this is what’s happening with telemedicine. People, in this case, patients, change their standards and preferences according to the new available technologies.

It’s widely known that technology has been the single most important driver of human progress throughout history. Medicine is not the exception to the phenomena.

Technology has allowed physicians to expand their horizons of patient care and telehealth seems to be the next step in that path forward.

If we are sincere about this—with a good understanding of the science of medicine and good clinical skills in most of the specialties, with a few exceptions, most diagnoses can be made utilizing telemedicine.

Practically speaking, this solves some key issues for both patients and also physicians. The first of the many is convenience.

Patients don’t need to leave their usual spaces to be attended by a physician, even when traveling. A patient can receive care anywhere with an internet connection. On the care side, this is a huge solution for doctors. It is no secret that health systems are saturated, doctors’ offices are filled to the brim with patients, and maintaining quality of care is becoming increasingly difficult.

Simply avoiding long in-office wait times, increases the quality of care, dramatically. Without mentioning the current shortage of doctors. According to the Association of American Medical Colleges (AAMC), there is expected to be a shortage of about 86,000 physicians by 2036.

Something increasingly prevalent in medicine is the need for chronic, recurring disease management and monitoring. Due to the obvious increase particularly in chronic diseases over the last couple of years, telehealth can be a solution.

At scale, doctors are not only able to treat more patients this way, but in some cases, more efficiently. Virtual check-ups as opposed to recurring in-person visits.

While this service isn’t intended to replace physical care in its entirety, I believe it can be used to facilitate the management of patient care.

Telemedicine has grown exponentially, driven by both necessity and technological advancements. For instance, as early as 2007, I was conducting telehealth practices across international borders, earning the nickname “Dr. Internet.“ At the time, these consultations were conducted over the phone with limited tools.

Today, advancements such as video conferencing and remote diagnostic devices have streamlined this process, making telemedicine accessible and more effective for both patients and providers.

One of the most attractive benefits of technological innovations is its cost-cutting attribute. This is very much the case with telemedicine. These technologies can have the potential to cut the cost of care, in turn reflecting lower costs for the patient.

Some big players in global healthcare are recognizing these benefits. Particularly insurers and health systems in the United States. Increasingly these patient care systems are being integrated into regular medical practice.

The market for these technologies is growing rapidly. As outlined in the graph above, the market size is projected to more than double in size by 2030, according to Precedence Research.

I felt the need to consult with a true expert on this issue. In my search for specialists in the practice of telemedicine, I found Dr. H. Chase Bradford. Dr. Bradford is a Psychiatrist who consults patients from multiple states in the United States through telemedicine.

He broke down how these technologies work, how they could be utilized to facilitate care, and what their limitations are.

Dr. Bradford breaks this down into various points that clearly describe this technology, its current state, and where it’s going. He describes telemedicine as “a new frontier in healthcare”, as a care alternative that “better meets their (patients’) needs.”

One of the aspects I found most interesting in the analysis was his emphasis on ease of access. He mentioned the following: “Doctor office waiting rooms are only a notch below the DMV in terms of frustrating places you might find yourself.

It was clear early on that many of my patients were pleased to be able to speak with me over the phone or through Zoom. Patients were able to access their providers in the comfort of their own homes, without the headaches of travel and waiting rooms. In the same way, many remote workers were reluctant to return to the office, so too, patients became accustomed to the ease of access with telemedicine and now prefer this method of healthcare over traditional brick-and-mortar facilities, whenever possible.”

This demonstrates that patients are seeking convenient alternatives due to shifting preferences and easier access. This access can span across states and in some cases even international borders. The benefit of interconnectivity allows people to have broader access to higher quality care, especially if it isn’t available locally.

I provide the example of image readings. A growing practice is teleradiology. Radiologists are interpreting images while not being physically present in the location where the image was taken.

But—what’s driving this exponential growth?

Dr. Bradford stated something profoundly true. During the COVID Operation, we weren’t given an option. As Dr. Bradford states, we were “forced to try” these methods, both patients and providers. “Unless it was absolutely necessary, many patients were encouraged to meet with their outpatient clinicians remotely in the first year of the pandemic.” However, he states: “While most providers, including myself, may have initially felt uneasy with this unfamiliar approach, the results were quite surprising.”

I think we sometimes forget how dramatic the changes were during this period. The exponential growth in this industry is undoubtedly a remnant of the pandemic-era social shift. Dr. Bradford mentions: “Most of the time, we would make treatment recommendations without ever laying eyes on the patient or placing a stethoscope on their lung fields.”

Doctors were forced to innovate and change according to the circumstances.

Dr. Bradford also mentions some of the limitations that this modality can present. At the moment this practice is limited mostly to clinical specialty and primary care that doesn’t require physical examination or diagnostic testing.

He mentions the following: “The most obvious downside of virtual healthcare is the inability to conduct a thorough physical exam or quickly run diagnostic studies.”

Although even this barrier is being broken. With increasing access to home diagnostic testing and streamlined systems that allow physicians to access the information almost immediately, even these services can be provided remotely.

These technologies have the potential to make healthcare far more efficient than it currently is. Dr. Bradford mentioned the fascinating fact that “Less than 10% of emergency room visits result in any significant hospitalization or treatment.” Providing this option will make systems more efficient than they currently are. Relieving the burden from doctors, but also improving care quality and outcomes for patients.

The future of telehealth is very promising. Dr. Bradford calls this the “Parallel Healthcare System”. Patient care is evolving rapidly, and as Dr. Bradford mentions “The virtual space became a refuge for doctors (like myself) and other clinicians who were disillusioned by the traditional medical system.” Dr. Bradford believes, as I do, that these technologies and shifting methods have the potential to revolutionize care in a very positive way. He goes as far as to say that he believes that telemedicine will eventually, “account for the majority of patient-physician encounters nationally.”

I’ve touched on this subject in the past on my Substacks. The fact that there is discontent within the traditional medical systems globally. Patients must resort to being treated by a physician’s assistant or a nurse practitioner in today’s system.

And if you’re lucky, you’ll get to see a physician for a short visit. The shift to telehealth is one of the ways that the distrust and disillusion as Dr. Bradford calls it, is manifesting itself.