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Readers Write: Telemedicine Is Just Medicine

October 5, 2016 Readers Write 6 Comments

Readers Write: Telemedicine Is Just Medicine
By Teri Thomas


Telemedicine. MHealth. Remote healthcare. What’s the best term for a given use case? A large portion of my job is focused on it, yet my answer is, “I don’t much care what term you use.” 

Well, I guess I care a little if I see confusion getting in the way of progress. Don’t get me wrong — I’m glad that nobody has been saying “mMedicine” yet (would that be like, “mmm…medicine” or “em-medicine?”) I don’t love “virtual health” as it makes me wonder if I watch lots of exercise shows and raw food infomercials, could I get virtually healthy? 

Defining telemedicine as a subset of telehealth related to direct care at a distance vs. provision of healthcare-related services at a distance, while correct—who cares? Consider if when indoor plumbing was new, people discussed “s-water” (out of a stream), vs. “i-water” (from in the home). I guess i-water would be better than p-water from pipes (it’s OK to giggle a little — be a middle-schooler for a minute). We care about perhaps three factors:

  • Is it modified/sparkling/flavored?
  • Do we have to pay for it (bottled water vs. tap water)?
  • Is it clean enough to drink?

Medicine is medicine. Healthcare is healthcare. It’s care: good, bad, and a ton in the middle. Yet I hear murmurs like, “Telemedicine isn’t good quality healthcare.” That’s like saying tap water isn’t good enough to drink because you’ve spent time in Flint.

Good quality care isn’t determined by the location of the provider or patient. Care can be done very well without requiring the patient and the clinician to be in the same room. It can also be done very poorly. Probably the majority of it — just like when the doctor and patient are together in a room — is not perfect, not bad, and mostly OK. 

Not every type of visit is appropriate over video, but many types are. In dermatology, providers have been using photos for decades. Camera cost and image resolution have dramatically improved so that even inexpensive systems can provide more image detail than a physician with the sharpest of vision. Stethoscopes, lights, cameras, video connections, telephones—all are tools to help us practice medicine better.  Sometimes the tools work great and are helpful and sometimes not.

If the Internet connection is slow or the battery dies, quality is impacted. But think for a minute about the impact on quality of care for the physician who had an extra-complex first appointment and is running an hour or more behind. The patients are stacking up and getting upset about their wait times. The clinic day is lengthening. The pressure to catch up mounts. Finally, consider the patient taking off work, driving to a clinic, parking, sitting in a waiting room with Sally Pink Eye, feeling at bored at best and anxious and angry at worst about their wait times.

How high of quality will that encounter be compared to the patient connecting with the provider from home or work? The patient didn’t have to drive, and even if waiting, likely they were in a more comfortable environment with other things to do.

Keep in mind that if the patient were physically there in the dermatology office and the lights went out or the dermatologist’s glasses were suddenly broken, it would be very hard to provide a quality exam. For a remote derm visit, if you can ensure reliable “tool” quality (history from the patient and/or GP, high enough resolution video/images, clear audio), why should there be a care quality concern? Yet these kinds of “visits” — heavily image-focused encounters — are still traditionally accomplished by asking a patient come to the provider. 

Thank you to Kaiser and other telemedicine leaders for providing us with the validating data: remote visits can be done with high quality, lower costs, and positive quality care and patient satisfaction outcomes. On behalf of patients who are increasing expecting more convenient care, healthcare providers who are hesitant — please invest in video visit technology and seek opportunities to provide more convenient care for your patients. Payers, please recognize that this is in everyone’s best interest and start financially rewarding those providers.

Teri Thomas is director of innovation for an academic medical center.

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Currently there are "6 comments" on this Article:

  1. Lights, Camera, Uterine Contraction!

    Video visit reticence is justified and I think falls well within the “be careful what you wish for” bucket of technology-enabled solutions.

  2. I think if you’re talking about video visits, Kaiser does not do that much. They talk more in terms of overall virtual health care (secure messaging + phone based appointments +video), which there is published data on. I don’t know if there’s actual published data on patient satisfaction, I think they more make the assumption of satisfaction based on the huge increase in virtual visits. Telephone visits have definitely been a success, so much so that it’s been hard to get doctors to adopt video visits because telephone visits already work well. Of course it’s much easier for Kaiser to be a leader in this area given its incentive structure. Virtual visits are much more productive.

  3. While my article was about more than video visits, I do believe in substantiating any claims, so for anyone interested in my sources (besides talking to Kaiser), here are a few links:
    http://www.modernhealthcare.com/article/20150221/MAGAZINE/302219977 shows that Kaiser actually does thousands of video visits even just in their smaller regions
    http://www.bizjournals.com/baltimore/blog/cyberbizblog/2016/03/kaiser-permanente-looks-to-video-visits-to-improve.html if you look at the very end, cites this region doing 10,000 video visits per year.
    http://medcitynews.com/2016/04/virtual-care-kaiser-permanente/ shows that they expect virtual visits (includes e-visits) to exceed in person visits

    Here’s a link to a site with various stats about telemed use. I am skeptical about a few, but sharing nontheless: http://www.wexhealthinc.com/healthcare-trends-institute/telemedicine-statistics-show-big-growth-potential/

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