The Benefits of Telemedicine During COVID-19 and Its Future Applications

From common emergencies like late-night stomach aches to unprecedented situations such as potential COVID-19 exposure, there are moments when visiting a doctor in person isn't feasible. Imagine the convenience of having a doctor visit you virtually. Telemedicine makes this possible, allowing consultations to occur through your smartphone or computer, offering a unique experience compared to traditional in-person visits.

According to the American Academy of Family Physicians (AAFP), telemedicine involves using technology to deliver healthcare remotely. Its origins trace back to the 1960s, primarily serving rural communities seeking access to specialized care. However, its popularity surged with the advent of the computer revolution and the widespread adoption of broadband in the late 1990s, enabling seamless sharing of medical records and facilitating video consultations.

The 2020 COVID-19 pandemic has been a pivotal moment for telemedicine, highlighting its importance in the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act. The legislation emphasizes that expanding virtual healthcare access is a key strategy in combating COVID-19. This development is particularly beneficial for rural residents, veterans, seniors, and other high-risk individuals who often face challenges in accessing or traveling to in-person medical care.

"During the COVID-19 crisis, promoting social distancing is essential," explains Dr. Steven Waldren, vice president and chief medical informatics officer at the AAFP. He highlights the importance of this measure, as many asymptomatic individuals can unknowingly spread the virus. "For elderly patients managing chronic conditions, follow-ups that were traditionally in-person are now being conducted via telemedicine to minimize their exposure to public spaces."

Types of Telemedicine

Telemedicine is categorized into three primary types, each suited to different healthcare needs. These include:

Synchronous telemedicine (also known as "real-time" telemedicine): Waldren compares this to a Zoom or FaceTime call, where the doctor and patient interact simultaneously through video or audio. This method is perfect for individuals in good health who require immediate care for a resolvable concern.

Asynchronous telemedicine ("store and forward"): This method allows the physician and patient to engage in the consultation at separate times. "Patients input their information, which is then compiled and forwarded to the physician," Waldren states. "The physician reviews the data, typically within a few hours, makes a care decision, and sends a response." For example, medical records or imaging results can be sent to the doctor by the patient or an imaging center. This approach is highly convenient as it adapts to everyone's schedule. "Physicians can maintain their workflow, and patients can submit information at their convenience," he adds.

Telemonitoring (or "remote patient monitoring"): This approach involves tracking a patient's health metrics remotely. For example, a diabetic patient can monitor their blood sugar levels and share the data with their healthcare provider.

Seeing a Telemedicine Doctor

Elizabeth (last name withheld) from Atlanta has utilized the services of Doctor On Demand three times, including once during the company's 24/7 availability. "I had the flu and was extremely ill at 3 a.m., unable to leave my bed," she remembers. "The doctor prescribed medication, and my husband picked it up when the pharmacy opened." The other two visits involved antibiotics for urinary tract infections (UTIs), a painful condition requiring prompt treatment to alleviate symptoms and prevent complications.

If you're curious how a UTI can be diagnosed without lab tests, Doctor on Demand's website clarifies: "A lab sample isn't always necessary for diagnosis. Physicians can often identify a UTI based on symptoms and medical history. ... In some cases, they may recommend an over-the-counter home UTI test. Additional evaluations can be conducted via video to check if the infection has spread to the kidneys, with the doctor providing instructions remotely."

Elizabeth has been highly satisfied with the efficiency and affordability of her telemedicine experiences. Each visit cost her $40, though prices may vary based on employer agreements or insurance coverage. For those without insurance, a medical consultation at Doctor on Demand is priced at $75. (GoodRX has introduced a telehealth marketplace featuring various providers with competitive pricing.)

Elizabeth notes that her initial appointment lasted 22 minutes due to account setup and payment processing, while subsequent visits were shorter, ranging from seven to 12 minutes. This saved her significant time compared to traditional in-person visits. She also appreciated the quick scheduling, mentioning that her 3 a.m. consultation was immediate, and another appointment was available within two hours of her request.

Limitations of Telemedicine

One major limitation of telemedicine is the absence of physical interaction. "Conducting a physical exam remotely remains a challenge," Waldren explains. While advanced tools like the Apple Watch, which can detect atrial fibrillation, provide useful data, most patients lack access to such technology unless they have specific medical conditions.

Despite the lack of in-person contact, telemedicine offers workarounds. Many symptoms are self-reported by patients, even during traditional office visits. "As family physicians, we often rely on the patient's account," Waldren states. He emphasizes that virtual doctors gather comprehensive information to ensure accuracy, such as verifying proper temperature recordings, to make informed decisions.

Billing has historically posed challenges for telemedicine patients. "Some health plans don't cover payments for virtual consultations," Waldren notes. Patients are advised to confirm coverage with their insurance provider beforehand. Thankfully, the CARES Act addresses this by allowing high-deductible health plans with health savings accounts to include telehealth services before meeting the deductible.

Technical issues also present hurdles. Waldren points out that establishing a stable video connection can be difficult for some, whether due to unreliable internet or unfamiliarity with the technology. The CARES Act accommodates this by permitting audio-only consultations, removing the requirement for real-time video in telehealth services.

Not all medical conditions can be addressed through telemedicine. The feasibility depends on the ailment and the provider. "It's ultimately a decision between the physician and the patient," Waldren explains. "Many hospitals and clinics provide guidelines on which conditions they can treat remotely."

While telemedicine is a valuable addition to healthcare, establishing an in-person relationship with a primary care physician remains essential.