Telehealth visits in the US have dropped dramatically since April 2020, but the end of the pandemic shouldn’t mean the end of telehealth. It can play a valuable role in health care delivery. The key to harnessing its potential is to bring many elements of the clinic to the patient. A host of new technologies and services make it possible.
Are the best days of telehealth already behind us? We don’t think we are, although the concern is understandable given that the end of the public health emergency has set many pandemic-related telemedicine regulations. But we believe the next level of virtual care can only be achieved if we bring more elements of the clinic to the patient.
At the onset of the Covid-19 pandemic, amid unprecedented rates of telehealth usage, some considered whether it was the beginning of a new normal with telehealth as a critical component of how patients receive care. To date, the result has been more of a modest shift than a paradigm shift. The number of telehealth visits per month in the United States has declined significantly since its peak in April 2020 and today accounts for approximately 5% of all outpatient visits. Patients and doctors have largely returned to in-person visits, in many cases because they question the quality of care at a telehealth visit and especially the failure to conduct a physical exam and key tests (eg, electrocardiograms).
The remedy is to bring the key aspects of the doctor’s office to the patient. An emerging industry aims to fill this gap. Patients can already use connected devices to check blood pressure, blood sugars and other physiological measurements at home and share them remotely with their doctor. There has also been movement to get this data through consumer wearables like the Apple Watch. Lab testing providers such as LabCorp and Quest offer an extensive network of patient care centers for out-of-office sample collection, as well as a growing range of mail-in test kits. Portable diagnostic service providers can come directly to a patient’s home to perform X-rays and ultrasounds or draw blood for lab testing.
These changes are just the tip of the iceberg. This future must not be limited to simply recreating a standard medical examination, but can go much further through the use of new devices such as digital stethoscopes or ultrasounds. Looking at a child’s ear in the doctor’s office is difficult. Often the doctor only gets a fleeting glimpse of the eardrum. TytoCares Home Smart Clinic and other similar devices could in theory cause Better tests compared to what is available in the office, helping the parent obtain a complete video of the child’s eardrum that can be sent to the doctor and revised as needed.
New technologies can even collect data that was never before available in a doctor’s office. While it sounds futuristic, increasingly many of the sicker patients have devices implanted in their bodies for managing their conditions. Millions of heart failure patients in the United States have a pacemaker, defibrillator, or other implanted device. These devices continuously record a variety of data whose scale eclipses anything collected in the clinic. Researchers are working to identify new ways to leverage this wealth of data to improve chronic disease management.
These emerging technologies also have the potential to dramatically alter the way patients interact with their providers. While previously patients could have a visit with their doctor every few months, these new offerings allow for more frequent, and sometimes 24/7 monitoring. The result is a richer sense of health and of the patient’s progression. In the traditional model of care, it is up to the patient to initiate treatment. In this new model, doctors can see immediately when things go wrong and contact their patient proactively, engaging patients when the need is greatest. Furthermore, by separating data collection from the visit itself, the physician-patient interactions that occur can be maximally productive, focusing on treatment and guidance, which synchronous interactions are uniquely suited to provide.
While there is tremendous potential for this future of telehealth, there are critical barriers that need to be overcome. Many of these technologies are prohibitively expensive for the average patient and provider, particularly if intended for only occasional use. Ease of use is also likely to be a big deal given that the typical healthcare consumer is older and, on average, less tech savvy. Health equity is also a key consideration.
The future of telehealth should be democratized and made accessible to rural people, racial/ethnic minorities and other historically disadvantaged communities. Opening this future to the patients who need it most will require new processes and institutions that enable affordable access to these devices, but also provide the necessary degree of human touch to overcome technological barriers.
Hybrid models that incorporate both virtual and in-person contact can help alleviate many of these barriers. For example, physical telehealth hosting sites can be set up in local clinics, pharmacies or grocery stores, or workplaces; these hosting sites could provide space for telehealth visits, the latest telehealth technology, and telepresentation staff who are easy on the technology and can offer in-person patient support.
While we emphasize the importance of bringing the clinic to the patient, we recognize that many other factors will influence the future trajectory of telehealth. With the expected waning of the Covid-related temporary telehealth policies, there are open questions about what the future of telehealth reimbursement and regulation looks like. Furthermore, when it comes to new telehealth technologies, the role that self-insured health plans and employers will play in supporting and covering these products is still ambiguous. However, this uncertainty hasn’t deterred the wealth of companies looking to innovate in this space.
Telehealth has not yet reached its full potential because many doctors and patients feel that visits lack the necessary exam and testing capabilities to provide the highest quality of care. However, new technologies and care approaches are pushing the frontier, not just of virtual visits but of healthcare as a whole. For healthcare providers, insurers and employers, it is important to be aware of these trends and determine how to facilitate this new future of telehealth for their patients, beneficiaries and employees.
Technology, however, will rarely be a solution on its own. A significant degree of human touch will always be needed. Businesses and vendors need to identify ways to deliver this along with technology cost-effectively. This can be achieved by identifying partners who provide true end-to-end solutions that span technology and in-person support, or by establishing in-house systems such as employer-based telehealth hosting sites.
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