Telemedicine: Today’s frontier of health care

The practice of medicine is constantly evolving to accommodate the changing needs of patients. In 2020, the pandemic created an enormous shift toward telemedicine as the premier modality to treat patients. Prior to the pandemic of 2020, telemedicine was a novel commodity that most insurers would not pay for, or the reimbursement was so low that the majority of physicians did not consider integrating it into their medical practice.

However, since the pandemic severely restricted patient access to physicians across all specialties, in many instances the only opportunity for doctors to treat them was through telemedicine. Practically overnight, Zoom chats were set up and insurances paid doctors for their video services. We jumped light-years ahead of government legislation.

Advocating for telemedicine

Doctors like Michael Brown, DO, who had been promoting telehealth for over 10 years, assumed a leading role in the instructional training of physicians regarding telemedicine services. For example, in March 2020, Dr. Brown gave a live webinar for the AOA advising physicians on the current telemedicine climate. It was one of the most-watched live webinars the AOA has ever featured on its website. During the telemedicine webinar, Dr. Brown taught physicians how to conduct office visits through Zoom and address effective clinical medical techniques to deliver high-quality health care online.

According to Dr. Brown, although pandemic restrictions have for the most part been lifted, telemedicine is here to stay as an integrated part of primary care services for patients, and they certainly like the convenience it affords. Patients no longer have to take a half-day day off work to see him, and through telemedicine, they can seek medical care at their cubicle. College students who study out of state can schedule virtual visits with him instead of seeking out a minute clinic for medication refills.

As an example of his post-pandemic workday, Dr. Brown’s staff will schedule telemedicine appointments for one-third of the medical visits. Annual general physicals are in-person, whereas medicine refills or psychiatric visits are primarily telemedicine.

Dr. Brown states, “As an osteopathic physician, I practice medicine holistically. I maintain a relationship with multigenerational families, and telemedicine enhances that connection. It is just another option for integrating medical care into my patients’ lives.”

Virtual in-patient services

The pandemic has not only impacted outpatient medicine; in-patient hospital services are also increasingly being delivered via telehealth. Darren Sommer, DO, is the founder of Innovator Health, a telemedicine company that offers health solutions in a variety of medical settings including hospitals, outpatient clinics and emergency rooms.

Dr. Sommer first came up with the idea of telemedicine after he was deployed from Fort Bragg as part of the Army’s 82^nd division to Afghanistan. There he saw patients who were much sicker than those he saw during his residency in the U.S., and he had a limited supply of drugs at his disposal. Frequently he would reach out to his colleagues around the world for consultation on what treatments were available for the wounded soldiers.

When he returned to the United States, he initially worked in one of the poorest counties in the U.S., where patients would need to be transferred out because the depth of knowledge of the specialists was not there. He decided to create a telemedicine solution for underserved rural communities where there would be access to specialists through virtual services. Currently, the medical solutions offered through Innovator Health include life-size 3D imaging, which requires little interaction with the staff, minimal physician training and little bandwidth.

Telehealth across the globe

Dr. Sommer believes that he has made the most impact in countries like Guam, where telemedicine has transformed the entire health care system. It is there that Innovator Health is used to provide hospitalist services including H&Ps, daily rounding, soap notes and discharges in the one hospital on the island. The ICU is also staffed virtually by doctors.

The workflow is identical, so doctors can easily adapt to delivering virtual care through bedside nurses supplying the palpatory and auscultatory perspective with the use of digital stethoscopes. Instead of one intensivist and a handful of hospitalists overwhelmed with patient loads, the virtual service frees up the limited supply of island doctors to attend to the most critically sick of the hospitalized patients.

Since this is a novel modality of providing medical services, feedback from patients is critical in determining quality of care. Thus far, patient surveys containing feedback have been mostly positive. The liability has not increased for the telemedicine services vs traditional hospital practice. With the looming shortage of physicians only increasing over the years, Dr. Sommer believes telemedicine will be the premier medical modality to deliver health care in the future.

He states, “Hospitals will not be the largest provider of medical services, instead telemedicine companies will outpace hospitals in delivering health care through telemedicine. It just offers doctors an opportunity to practice medicine more efficiently with less cost.”

Whatever medical field the doctors of the 21^st century practice in, telemedicine is here to stay. It remains to be seen what telemedicine’s future impact will be. Thus far, telemedicine’s role in health care has been largely positive, benefiting both patients and doctors.