Even before COVID-19, Telehealth and Telemedicine were becoming an integral part of many medical practices for physicians, nurse practitioners, and physician’s assistants. Telehealth and Telemedicine allow for more efficient and more convenient communication between patients and healthcare providers. Telemedicine makes communication possible even in the face of the current stay-at-home orders. Yet while Telemedicine promises renewed ease of interaction, it also poses significant problems and limitations for physicians.
In this article, I shall review Telehealth and Telemedicine from the standpoint of practitioners who are either using this technology now or contemplate using it soon. I shall review the potential benefits as well as the limitations of this technology that promises to change the face of medical practice.
TELEHEALTH, TELEMEDICINE AND THE COVID-19 PANDEMIC
For this article, I shall use the term Telemedicine to include both Telehealth and Telemedicine, although the former implies more health maintenance and the later diagnosis and treatment of diseases.
The need for social distancing to mitigate the COVID-19 Pandemic has pushed the technology of Telemedicine to the forefront of patient/physician communication.
In response to the need for social distancing, new policies have emerged, such as broader payment for Telemedicine, expanded scope-of-practice for nonphysician practitioners, and increased ability of physicians and nurses to practice across state lines. The Cleveland Clinic completed more than 60,000 Telemedicine visits this March compared to its prior average of about 3,400 visits per month.
What will become of Telemedicine once the COVID-19 crisis is over? Will regulations on medical practice that have been relaxed be reinstituted? Will patients then prefer to interact with medical practitioners remotely rather than in-person? Will medical practices, both large and small, need to reduce their staff or close entirely as a result of fewer in-person visits?
And what about the quality of medical care delivered by Telemedicine? Is it equivalent to, better than or equal to medical care delivered in-person? The answers to these questions will not be available for many months or even years. Some information, however, is known about the promise and limitations of Telemedicine.
THE PROMISE OF TELEMEDICINE
Telemedicine, both at present, during the COVID-19 Pandemic, and in the future, has the potential to make medical care available to patients who would otherwise go without care. It provides rapid and convenient communication between patients and healthcare providers. It avoids the cumbersome need to schedule an appointment for the future. It avoids travel to the practitioner’s office, only to wait in the office to see the practitioner for 10 or 15 minutes, and then return home. Telemedicine thus holds great promise for improved patient access to medical care providers.
Patients who need urgent care can be assessed at home by Telemedicine without the delays necessary for him or her to get to a crowded emergency room or hospital.
Triage can be conducted by Telemedicine to prioritize care at home for some patients or to direct others to a physician’s office or an emergency room. As we shall see, however, diagnosing and treating patients via Telemedicine carries the risk of medical mistakes made for lack of detailed information that might not be available remotely.
LIMITATIONS OF TELEMEDICINE
Although Telemedicine can improve the ease and efficiency of communication between the healthcare provider and patient, it has several limitations.
The lack of an in-person physical examination is a significant limitation of this technique. If a patient reports, abdominal pain is it indigestion or appendicitis? A physical exam to look for abdominal “rebound” tenderness might help to differentiate the two. Vital signs such as pulse rate and body temperature could also serve as could a lab test of the person’s white blood cell count.
Is a headache a migraine? Is it a tension headache? Is it a brain tumor? Is it a subarachnoid hemorrhage? Could it be meningitis? A physical exam, some lab studies, and a CT scan could all help to make the differential diagnosis between a “benign” headache and one that could signal a life-threatening condition.
There are many other examples of situations in which Telemedicine cannot provide the necessary information upon which to make intelligent recommendations to patients about their concerns. Chest pain, for example. A complaint of a “fever” when the patient has no thermometer to measure their temperature. Shortness of breath that could be early congestive heart failure of COVID-19.
Telemedicine has the potential to make the communication between healthcare providers and patients more efficient, less expensive, more accessible, and provide a better quality of care than the traditional approach. In some medical specialties like Psychiatry, Telemedicine communications could almost completely mimic in-person office sessions.
The role of Telemedicine in medical practice will be better defined once the COVID-19 Pandemic is over. Still, it seems clear that this new technology will change the future of medicine for patients as well as for physicians.
Ronald Young, M.D.