Telehealth is the future but it is obscured by a dismal present

In so far as our current public health emergency is concerned, telehealth has obvious, indisputable benefits.  The redirection of patient flow has enabled the conservation of personal protective gear, decreased nosocomial transmission of the coronavirus, and, therefore, saved lives, especially those who are immunocompromised, who are far more likely to contract COVID-19 as well as experience worse outcomes. As most of us fully appreciate, telehealth is not, however, a mere stopgap measure or temporary expedient to be duly abandoned, but a great boon to health care; it should be embraced as such.

This is not to say it isn’t without practical limitations. Its limitations must be acknowledged. Connectivity and broadband infrastructure may remain problematic for already underserved rural areas. The FCC, however, has poured 200 million USD into the Rural Health Care Program, a significant sum disbursed at exactly the right moment. Tech-literacy for the elderly may present distinct challenges, but these too are remediable. In most instances, a short tutorial will suffice. Failing that, a friend or relative can help facilitate consultations.

Doctors who do not yet practice telemedicine will have a learning curve of their own. A web-side manner must be learned and developed, and a context-specific etiquette enforced. As is standard, eye contact is desirable, as is a professional, congenial tone. Identification must be prominent, and it remains the physician’s responsibility to discuss confidentiality and secure informed consent. It’s best to have a contingency plan in the event of a glitch.

Urgent clinical concerns that require a thorough examination must resort to fully provisioned brick-and-mortar inpatient care settings. This is also true of cases that require highly specialized and exhaustive batteries of tests. But many peripherals available to consumers (blood pressure cuff, thermometer, pulse oximeters, scales, etc.) can easily supplement most telehealth sessions. Moving forward, unobtrusive wearable technologies will assume their place and allow for longitudinal monitoring. Even in acute cases on intensive care wards, a virtual pulmonologist can remotely observe the ventilator settings of an intubated patient and confer with the patient’s bedside team. Remote may only mean a higher floor or adjoining wing.

As it pertains to the innumerable advantages of telehealth, its most important application has already been mentioned, curbing the possibility of a coronavirus surge that could incapacitate a city, state, or region. Tragically we’re seeing just these sorts of inundations where intensivists, respiratory therapists, and other clinicians cannot cope with the volume of demand, and risk falling ill to the virus themselves, further compounding the crisis. Wu Han was a close thing, and New York was touch and go for several consecutive days. Once the pandemic ultimately subsides, the ancillary benefits of telemedicine will come to the fore, some of which were already conspicuous prior to COVID-19.

Patients foregoing health care because of the commute it entailed need no longer do so. Travel is removed from the equation; wait times are shorter if they arise at all. Those parents who also work fulltime, i.e., most parents, can schedule a telehealth visit at their convenience. By extension, their employers don’t lose out on productivity. Safe, effective, patient-centric, and timely care delivery is conducted in the home, a place where most are generally at ease. Now, when so many are sheltering in place, a telehealth visit can allay fears and alleviate isolation.

Will the unfavorable regulatory environment permit telehealth to flourish? Perforce we’re beginning to see a relaxation of restrictions that have hitherto obstructed progress.  Recently, federal officials approved interstate licensing, thereby prompting greater telehealth conversion, utilization, and expansion. Medicare’s 1135 Waiver is also encouraging, and, in as much as it serves the same ends, the Drug Enforcement Administration’s leave to prescribe via telemedicine without a prior in-person meeting is a  similarly promising development. In light of circumstances, anything that might reduce cost, improve delivery, and wrest control from bloated, dysfunctional health care systems is viable.

What about telehealth’s security vulnerabilities? Most such liability falls to the actual session, but zoom, FaceTime, and others have taken action to eliminate the possibility of a breach. The consented sharing of medical records is another potential security issue. One solution is utilizing distributed ledger technologies, commonly known as blockchain, to ensure patients’ privacy. Blockchain allows for the easy, safe transmission of sensitive, personal information between patient and care provider. What’s more, records placed at the disposal of a physician for the duration of a consultation can be revoked or called back. They remain in the exclusive possession of the patient herself. There’s no reason for access to be extended indefinitely once the parties concerned have decided the consultation has finished. Should the patient want to revisit a topic with the same physician, access is simply granted a second time.

In giving the patient what’s hers by right, her medical history, we’re doing much to save time and reduce costs. There’s no need to reduplicate a series of tests for the benefit of a new doctor, nor must records be ransomed from a previous provider. Of course, there are innumerable cases where people neglect their health because they can’t afford to negotiate the transition from one policy or clinic to another. This is intolerable.

As others have remarked on this site, telehealth is the future, and though obscured by a dismal present, the future of health care is favorable for all concerned. Telehealth will present patients, irrespective of location, a wealth of choice in determining who can best serve their needs. Reviewing a physician’s credentials, rates, and availability will be a matter of a quick search. The administrative burdens that hamper care will be either waived, as we’re seeing, or tempered by governments seeking reasonable means to mitigate catastrophe. Easily scalable technology will allow us to dispense with antiquated, centralized, and inadequate systems, the very existence of which is often antithetical to their professed purpose.

David Hanekom is an internal medicine physician.

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