The telemedicine revolution: What telehealth might look like after COVID-19

For 10 years, Darren Sommer, DO, MBA, MPH, has been among the small number of physicians using telemedicine as a major part of their practice.

The hospitalist and internist does about 4,000 visits a year with patients from his home and office. Many of those visits are virtual, allowing Dr. Sommer to offer long-distance medicine.

“The care we are providing is to rural and underserved communities, and they really need it,” says Dr. Sommer, assistant professor of medicine and technology with the New York Institute of Technology College of Osteopathic Medicine.

In the wake of the COVID-19 pandemic, doctors across America suddenly are joining Dr. Sommer and turning to telemedicine. That reality has revolutionized how telehealth is perceived in the health care community and beyond.

Telemedicine is now seen as a legitimate, mainstream modality for health care delivery, which has led to many more physicians picking it up, Dr. Sommer says.

Michael Brown, DO, says this widespread turn to telemedicine is likely to last far beyond the pandemic.

“You will see a revolt from patients if we start requiring them come back to the clinic for conditions that could easily be treated by telemedicine,” says Dr. Brown, who practices family medicine with Meritas Health in Smithville, Missouri.

Advantages of telemedicine

Dr. Brown—who is the former director of telemedicine at Mosaic Life Care in Kearney, Missouri—says his patients report that they love the convenience of a telemedicine visit. They also appreciate not having to sit in a waiting room with others who may be ill.

Cole Zanetti, DO, MPH, says doctors have discovered that telemedicine is just as effective as face-to-face care in many instances.

“We are finding that those practicing primary care are capable of doing upwards to 90% of care through a telemedicine modality,” says Dr. Zanetti, co-director of the digital health track at Rocky Vista University College of Osteopathic Medicine’s (RVUCOM) Colorado and Utah campuses.

Telemedicine allows patients to see their doctor without having to take time off from work, Dr. Zanetti says.

“It is also more convenient to do a visit from your home, and reduces concerns of traveling during inclement weather,” Dr. Zanetti says.

Regan A. Stiegmann, DO, MPH, says that because patients typically are in their homes during a telemedicine visit, they also may be more at ease with their physicians.

“Patients oftentimes feel more comfortable in their own homes when discussing their vulnerabilities, and they become more comfortable being honest about medical issues,” says Dr. Stiegmann, who is co-director of the digital health track at RVUCOM.

Telemedicine and future challenges

Although telemedicine has gained ground over the past few months, Dr. Sommer notes that much of the telemedicine being practiced during the pandemic remains technologically unsophisticated.

“When you look at the telemedicine today that a lot of people are using, it’s really just a conversation between two people,” he says.

However, he believes the telemedicine of the future will be more robust. Rather than mere conversations, in the future, telemedicine will more closely approximate the care that takes place in a face-to-face encounter.

For the past three years, Dr. Sommer has used this more comprehensive approach when providing long-distance care to patients in rural hospitals.

When he checks in with a patient, a nurse is at the bedside to help facilitate the exam, placing the stethoscope on the patient’s chest and sending heart and lung sounds to Dr. Sommer.

“I have the capability to listen and to visualize and to interact with patients in a manner similar to what I would do if I were physically present,” he says.

This type of interaction offers a deeper level of care to the patient than many of the simple video interactions that occur between doctors and patients today, Dr. Sommer says.

Dr. Sommer believes that as physicians gain more experience with telemedicine and the technology continues to grow more sophisticated—via the use of digital stethoscopes and similar tools—both the medical community and health insurance companies will more fully embrace telemedicine as a legitimate way to treat patients.

Telemedicine’s role in the future

Going forward, Dr. Brown envisions two potential telemedicine models that may catch fire. In the first model, physicians might divide their day into regular visits and telemedicine visits.

“A physician might say, “Between 12 and 2, I’m going to do my telemedicine calls every day,’” Dr. Brown says.

In the second model—which Dr. Brown says he prefers—in-office visits and telemedicine visits would be seamlessly integrated throughout the day.

“I might go into room No. 1 and see a patient face to face, and I might go into room No. 2, (where) there is a laptop set up for me to see the patient by telemedicine,” he says.

Telemedicine appointments could become standard for many types of visits, including:

• Mental health issues. “If you are a primary care physician, that’s a huge chunk of your practice,” Dr. Brown says.
• Medication management. Via telemedicine, the doctor can quickly catch up on the patient’s progress. “And if they’re doing OK, we just give them a refill,” Dr. Brown says.
• Investigating simple conditions. Right now, a patient wondering if she should see her physician has “to go to the doctor to get that question answered,” Dr. Brown says. A simple telemedicine visit is a better choice for the first appointment, he adds.

“In my mind, the word ‘telemedicine’ needs to disappear from our vocabulary and we need to just call it what it is, and that’s ‘medicine,’” Dr. Brown says.

Dr. Zanetti envisions a world where “care intensity triage” determines how medical visits are scheduled.

The system would be structured like that of the triage that takes place in a hospital, with a “medicine bed being equal to a phone visit, a telemetry bed being equal to a video visit, and an ICU bed being equal to a face-to-face visit in terms of care intensity,” he says.

Dr. Stiegmann says it takes time for some patients to adjust to using telemedicine. “However, after a few sessions, patients regain their comfort with interacting with their physician,” she says.

An additional challenge arises when a patient sees a new doctor for the first time via telemedicine. In this case, the physician can help to personalize the relationship through their web presence, by sharing the following with patients:

• Their professional website
• Links to webinars
• Online presentations
• Short videos that address commonly discussed health topics

Whatever the future holds, Dr. Brown believes telemedicine will be an essential part of patient care.

“The days of us requiring all patients to take a half-day of their lives to come to our clinic to wait in a packed waiting room with sick, coughing people are over,” he says.

Related reading:

How to do telemedicine in the time of COVID-19

Navigating HIPAA and telemedicine during COVID-19