Telemedicine has been developing as a form of patient communication for years, and it has now become a driving force shaping the doctor-patient relationship and improving overall care.
Telemedicine: An Early History
While many think of telemedicine as a modern invention, doctors have been using technology to communicate with patients for more than a century. Perhaps the earliest mention of telehealth practices is in an article published in The Lancet in 1879 that advocated for doctor-patient communication over the telephone in order to help patients avoid coming into the doctor’s office[1].
Using Telemedicine for Interprofessional Communication
Telehealth involves not only communications between doctors and patients, but also among healthcare professionals. As new technology has been developed, doctors, health experts, and thought leaders have found new ways to adapt tools for healthcare needs.
In the 1920s through 1940s, health facilities in Norway, Italy, and France used radio technology to provide medical advice to healthcare workers on ships[2]. In 1948, the field of teleradiology was born as radiologic images were transmitted over phone lines between West Chester and Philadelphia, PA. In the following decade, radiologists in Montreal built upon this system in order to send images through coaxial cables[3].
In the 1960s, healthcare workers at the University of Nebraska built a telemedicine program connecting health professionals with Norfolk State Hospital using two-way televisions[3]. Meanwhile, Massachusetts General Hospital in Boston built a telemedicine system communicating via television with the health clinic at the Boston Logan Airport. Across the country, health aides working in remote Alaskan communities were trained to consult with specialists working at medical centers in larger cities[1].
One notable telemedicine program was built by NASA in the 1970s. In order to develop and test a system that could be used to monitor astronauts in space, several private and government groups came together to build a program that would help the Tohono O’odham Indian Nation people living in remote parts of southern Arizona. The program, named STARPAHC, provided increased access to healthcare by connecting local health workers with specialists[4].
Learn How Patient Communication Transforms Healthcare
Learn how telehealth and virtual care solutions offer highly integrated yet easy-to-use care collaboration and patient communication options. Download the eBook now.
In more recent decades, improvements in technology have further shaped the healthcare landscape. The telephone is routinely used as patients call their doctor’s office to ask medical questions, and there are now many advice lines staffed by nurses that provide people with basic medical support.
The use of medical devices has also expanded the scope of telemedicine. One of the first such instances was pioneered in the 1980s when the US Department of Veterans Affairs developed phone-based monitoring programs to oversee the use of pacemakers[3]. In recent years, home devices such as blood glucose monitors and blood pressure monitors have enabled patients to take an active role in managing their health.
Several decades ago, the VA also played an important role in establishing remote care management programs, where patients with chronic conditions could receive education, be monitored, and get feedback from their care team from their own homes[1]. Home monitoring programs are now widespread and frequently lead to better outcomes for patients with chronic conditions by decreasing hospitalization rates and reducing healthcare costs[1].
In recent years, some of the fields that have embraced telehealth practices include[1]:
Radiology: Teleradiology platforms are still used extensively today in order to outsource the reading of digital radiological images.
Pharmacy: Physicians routinely order scripts online, and pharmacists may review and even dispense prescriptions remotely.
Dermatology: Development of secure data sharing platforms has allowed primary care providers to send images to dermatologists for better diagnosis.
Psychiatry: Studies have found that patients have similar diagnoses and treatment plans whether they are treated in-person or through a virtual visit.
In summary, throughout the modern history of medicine, remote delivery of medical care has been a frequent occurrence, while the actual modes of communication have been ever-changing.
2020: A Turning Point for Telemedicine
The original purpose of many telemedicine programs was to better treat patients located in remote areas, or to connect healthcare workers in order to provide better quality care. In more recent years, the focus of telemedicine has shifted to provide additional convenience for patients.
During the COVID-19 pandemic, telemedicine became a necessity, with usage skyrocketing almost overnight. Many states limited doctors from providing elective procedures or non-critical, in-office care. Some practices temporarily closed or immediately shifted to virtual services. In one health organization in New York, virtual visits increased by 683% between early March and mid-April, 2020[5]. Previously, patients and providers alike were reluctant to try new telehealth services, but COVID-19 became a catalyst for change.
Patient Adaptation to Telemedicine
In the wake of COVID-19, many patients learned how to use telehealth services, finding them to be an effective, convenient tool. Certain groups may be particularly likely to continue to use telemedicine services moving forward. This includes people who:
Live in remote areas, or areas with a shortage of healthcare workers
Can’t travel easily
Are part of younger, connected generations
Have busy schedules or frequently travel
Have childcare or eldercare responsibilities
Are diagnosed with conditions needing regular consultation
Patients with chronic conditions are especially likely to benefit from telemedicine. More than 100 million people are living with chronic disorders, and they make up 75% of healthcare spending[1]. People in this category may have weakened immune systems, and telemedicine enables them to have regular checkups without risking exposure to infectious diseases, even after the pandemic ends.
Healthcare System Adaptation to Telehealth
One of the biggest barriers to adoption of telemedicine services has been concern about reimbursement[1]. As regulations loosened in the wake of COVID-19, two rule changes in particular aided reimbursement. The first, from the Centers for Medicare and Medicaid Services, expanded Medicare reimbursement from specific designated rural areas to all Medicare users. The rule change also made virtual visit reimbursement rates equivalent to in-person visit rates[6]. Many states subsequently enacted telehealth parity laws that provided similar coverage. The second rule change waived HIPAA penalties for providers that used certain communication technologies (this is a temporary change).
Many healthcare organizations are switching to systems that not only offer virtual visits, but also are integrated platforms that connect many aspects of patient care, such as electronic health records (EHR) and care team communications. These platforms ensure that all patient information can be found in one place, leading to greater efficiency, faster treatment, and better outcomes. Some telehealth software solutions can send out alerts or notifications when there is a change in the EHR, when a lab result comes in, or when a patient is transferred. Interconnected, mobile telehealth platforms can lead to higher-quality communication, improved relationships among healthcare workers, and more efficient workflows[7].
One barrier to implementation of these systems is cost. However, many studies have found that improving communication can lead to cost savings through greater efficiency and productivity. For example, a study at one community hospital found that healthcare workers often spent hours per day using paging systems, leading to $17,000 in lost productivity costs per month[8]. Throughout the healthcare industry, switching to smartphones has already boosted productivity by $11.2 billion[9]. Additionally, outsourcing services such as pathology or radiology using telehealth platforms may allow organizations to save both time and money[1].
The Future of Virtual Healthcare
Even when states loosen COVID-19 restrictions and doctor’s offices reopen for in-person visits, telehealth services will continue to be used by patients. FAIR Health’s Monthly Telehealth Regional Tracker shows that between August 2019 and August 2020, the number of telehealth claim lines increased by over 3,500%[10]. Telehealth is likely here to stay, quite simply, because patients have found they like it.
The Rise of Healthcare Consumerism
In recent years, many patients have taken a consumerist approach to manage their healthcare. The Internet has provided more access to health information, leading patients to be better informed, feel more empowered to make health decisions, and to price shop for services. As a result, the doctor-patient relationship has been shifting towards greater patient empowerment and patient choice.
Healthcare organizations can take advantage of this trend by accepting that patients prefer to take part in the decision-making process. By enabling patients to take a more active role in their health, doctors may find that patients are more satisfied with their care and may have better outcomes[11]. Using telehealth tools can help in this process. For example, patients can more easily provide their doctors with relevant health information, and providers can better communicate reminders related to treatment plans through messaging services. Both parties can readily get feedback from the other when more efficient lines of communication are opened.
Another aspect of healthcare consumerism is that many patients choose care providers based on cost. This is particularly relevant in 2020, as many people have had reductions in employment, income, or health insurance during the pandemic. Telemedicine services can help healthcare organizations stay competitive by offering patients more accessible quality care, convenience, and cost savings.
The Future of Telehealth Regulations
As of December 2020, telehealth regulations are undergoing a period of change, leaving many healthcare organizations unsure of how to plan for future virtual care services. However, the trend is shifting towards increased coverage for telemedicine:
The US Congress is considering multiple bills that would expand access to telehealth services
The Centers for Medicare and Medicaid Services is collecting public comments on a document that would add new telehealth services to the Physician Fee Schedule[12]
The President signed an executive order that aims to expand telehealth services for Medicare beneficiaries and to increase healthcare access in remote areas[13]
Some states have already extended their temporary rules related to expanded telehealth coverage, or have even begun to make these changes permanent
Regulators are recognizing that virtual services are necessary for modern healthcare. Investing in telemedicine software that is compliant with HIPAA privacy and security laws can ensure a solution is future-proof.
Summary
Technology improvements have led to better affordability, accessibility, and convenience for patients. The COVID-19 pandemic prompted many patients and providers to quickly adopt telemedicine services. Patient and provider satisfaction and a changing regulatory landscape indicate that these changes are here to stay. Healthcare organizations can use telehealth platforms to engage patients seeking more empowerment in their healthcare, improve efficiency, and meet the needs of a busy, connected society.
References:
Board on Health Care Services; Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington (DC): National Academies Press (US); 2012 Nov 20. 3, The Evolution of Telehealth: Where Have We Been and Where Are We Going? Available from: https://www.ncbi.nlm.nih.gov/books/NBK207141/
Ryu S. History of Telemedicine: Evolution, Context, and Transformation. Healthc Inform Res. 2010;16(1):65-66. doi:10.4258/hir.2010.16.1.65
Institute of Medicine (US) Committee on Evaluating Clinical Applications of Telemedicine; Field MJ, editor. Telemedicine: A Guide to Assessing Telecommunications in Health Care. Washington (DC): National Academies Press (US); 1996. 2, Evolution and Current Applications of Telemedicine. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45445/
Freiburger G, Holcomb M, Piper D. The STARPAHC collection: part of an archive of the history of telemedicine. J Telemed Telecare. 2007;13:221-223.
Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc. 2020;27(7):1132-1135. doi:10.1093/jamia/ocaa072
Kessels RPC. Patients’ memory for medical information. J Royal Soc Med. 2003;96(5):219-22. doi:10.1258/jrsm.96.5.219
Mehrzad R, Barza M. Are physician pagers an outmoded technology?. Technol Health Care. 2015;23(3):233-241. doi:10.3233/THC-140865
Thomairy NA, Mummaneni M, Alsalamah S, Moussa N, Coustasse A. Use of Smartphones in Hospitals. Health Care Manag (Frederick). 2015 Oct-Dec;34(4):297-307. doi: 10.1097/HCM.0000000000000080
Zeckhauser R, Sommers B. Consumerism in health care: challenges and opportunities. Virtual Mentor. 2013 Nov 1;15(11):988-92. doi: 10.1001/virtualmentor.2013.15.11.oped1-1311
The White House. Executive Order on Improving Rural Health and Telehealth Access. 2020 August 3. Available from: https://www.whitehouse.gov/presidential-actions/executive-order-improving-rural-health-telehealth-access/
Will O’Connor, M.D. is the Chief Medical Information Officer at TigerConnect. As a physician executive with more than 20 years of healthcare experience, Will is a passionate advocate for rapid advancement across the healthcare industry.
