Digital transformation in health care
These days everybody’s tele-this and tele-that. How does that affect our health care? A bigger question might be, how does it affect our health?
The truth is, in health care, doctors have been providing remote care, on a limited scale, for a long time—whether its phone calls to discuss patient issues or messages through a portal.
But sorting out all the terms around telehealth can be confusing. Let’s look at some in more detail.
Telehealth and telemedicine
Both of these are broad terms used to describe the use of electronic and telephone communications for clinical care of patients. But there’s a slight difference.
Telemedicine, defined by the World Health Organization, means "healing from a distance." It’s the term that describes the interaction between doctors and patients—or doctors and doctors, when they’re talking about patients. This could entail virtual visits or e-visits. It could include remote monitoring of patients. Radiologists who examine X-ray and MRI imagery and communicate their findings electronically practice telemedicine.
Telehealth is an even broader term. In the Venn diagram of health care, telemedicine would be encircled by telehealth. Telehealth reaches beyond patient-doctor interaction to describes all of the health care activities that can be handled electronically, including administrative tasks. This includes non-clinical things like patient scheduling, the storage and accessing of electronic health records, physician education, public health and education.
Some people define telemedicine as the act of using telehealth technology in the practice of medicine.
E-visit and virtual visit
Again, we have two terms that seem a lot alike, although providers and payers may make a distinction. While both occur virtually, an e-visit is generally done via a patient portal or some sort of communication in which the patient answers a questionnaire focused on a specific symptom. It is, according to Medicare, a non-face-to-face patient initiation which requires some clinical decision making to help the patient.
An e-visit can happen asynchronously—in other words, you can go online, fill out a questionnaire and submit it. The doctor isn’t necessarily right there waiting to look at your answers. He or she might pick it up later that day, or the next day. The doctor and patient may communicate by email, phone or text later.
Virtual visits, on the other hand, are synchronous. Both the patient and the doctor appear on a video platform at the same time and communicate in a virtual space. The doctor will ask questions about the patient’s condition and general health and address any issues that do not demand an in-person physical exam (although more about that later). Virtual visits happen mostly over the internet, often on dedicated platforms built with security features to protect patient privacy in accordance with HIPAA regulations.
Both e-visits and virtual visits can be helpful in managing relatively uncomplicated illnesses, where risks of negative outcomes are low and the need to do complex or invasive testing is minimal.
Teletherapy
Like telehealth and telemedicine, teletherapy has been evolving for a long time. It’s simply the remote delivery of mental health care therapies using electronic means of communication. For decades people have talked to their mental health therapist over the phone. More recently therapy has included one-on-one video interaction, therapeutic messages via email, group chat apps for group therapy and other techniques.
Like telehealth and telemedicine, teletherapy had been slowly evolving over time—and then all of them were kicked into high gear by the constraints of the Covid-19 pandemic. And most health care providers see the shift to digital communications and capabilities as permanent and game-changing.
Dr. Tara Bishop, former Surest chief clinical officer, researched the health care industry’s adoption of virtual delivery systems back in 2012. "It was on people’s radar, but the provider systems were not by and large embracing it," Bishop says. Providers were worried about how to reimburse for electronic visits. The technology wasn’t quite good enough to deliver care seamlessly. Some doctors said it would add another layer of work on top of seeing patients face-to-face.
Then the pandemic pushed this slowly moving trend into a dramatic shift to more virtual care within weeks. - Tara Bishop, MD, MPH, FACP
And many physicians who rapidly pivoted from in-person to virtual care think that virtual care is here to stay.
Prior to the pandemic, heath care providers were interested in vendors like Doctor on Demand or 2nd.MD, both of which offer remote consultations. Providers were offering patients the option to come in-person or do remote care for routine visits, but it was a slow adoption. "And then, with Covid," says Bishop, "within days there was a dramatic transformation."
Bishop says trends in digital technology point to even more telemedicine being practiced. Smartphones can be equipped with otoscopes sensitive enough to send images of a child’s ear infection. Smartphone cameras can capture enough resolution to make some basic decisions about a patient’s sore throat. People with diabetes can do a finger stick and upload the results into their phone, to be shared through an app with their doctor. Skin rashes can be examined remotely through photos.
"Enabling the technology to do much of the physical exam at home is starting to shape up and become a reality," Bishop says.
Artificial intelligence (AI) is also a driver in telemedicine. In some studies, AI programs have proven as effective as the human eye in accurately reading radiology images. Mental health providers are trying to use AI and remote sensors to detect patient movement in order to signal when someone might be at risk from a severe depressive episode.
Now that it’s been suddenly accelerated, telemedicine could have considerable impacts on the health care industry in the US. The outcomes are hard to predict. If, say, 50% of visits continue to happen virtually, how much infrastructure do health care providers need to maintain? How much real estate do they need for exam rooms? How much administrative and support staff will they need for scheduling? How will they bill? Will providers lose revenue? Will patients save money?
Still, Bishop sees significant positive outcomes from the advancement of telemedicine and telehealth. "I’m excited about the ability to improve access in areas where you need it," Bishop says. "Mental health, which is an area in which we had terrible access before. Or older people who can’t leave their homes. I think of that mother who doesn’t have to take a half-day off work to drive her sick kid to the doctor’s office. This can be transformative for those people."