Physician Focus: Telemedicine Basics

By Adam Licurse, M.D. and Steven Locke, M.D.

Dr. Adam Licurse and Dr. Steven LockeFrom diagnosing disease to record keeping, technology is rapidly changing the practice of medicine.  One of the areas where technology is having a dramatic impact is telemedicine, affecting both physicians and patients alike.

Defined as the exchange of information by electronic means to improve a patient’s health, telemedicine (also called telehealth) can be traced back over decades, certainly since doctors began connecting with patients over the telephone.

With advances in technology, however, telemedicine has expanded quickly over the last two decades.  Today, the menu of choices available for physicians and patients to connect electronically is much larger and more complex, and hospitals, physician practices, and other medical facilities are now incorporating and expanding telemedicine services for their patients. 

Tools such as video platforms permit real-time, two-way communication between physician and patient.  Other methods, like text messaging, health “apps,” and patient portals through health information networks, also allow two-way communication.  Some apps, for example, can relay a patient’s blood pressure, heart rate, or other vital signs directly to a doctor from the home, office, or other remote location.

While technology is driving the growth of telemedicine, other factors are also at work.  Medicare now reimburses physicians for services like office visits and consultations, within certain restrictions. Private insurers are also beginning to pay for telemedicine, and more employers are offering their workers telemedicine consultations.  A survey by the consulting firm Towers Watson, for example, discovered that by the end of 2017, more than 70 percent of employers will be offering telemedicine services to their workers. 

One of the biggest advantages of telemedicine is that it makes health care more convenient for patients. Barriers to care, such as distance, lack of transportation, or physical inability to get to a doctor’s office, are reduced or eliminated, thereby increasing access. Telemedicine is proving to be especially helpful for patients in rural areas, for example, where medical facilities or physicians may be few in number.  

Patients who see several health care providers because of multiple or chronic conditions can also benefit from telemedicine because there are often accompanying behavioral symptoms that can easily be treated. Individuals with diabetes or congestive heart failure, for example, are known to have higher rates of depression and associated disorders such as anxiety or substance abuse.

Those conditions can compromise the outcomes of the care they receive and interfere with the patient’s participation in their own care. By capturing patient information that can be shared, telemedicine enhances provider-to-provider communication, giving them a more complete picture of a patient’s health.  

Provider-to-provider communications are also enhanced with telemedicine when physicians seek consultations on particular conditions from specialist colleagues, such as radiologists or pathologists. It may a puzzling diagnosis or a surgical procedure, but transmitting images, X-rays, or scans facilitates consultations and can lead to faster and improved diagnoses and better treatment plans for patients.  

The benefits available from telemedicine are real, and the service carries much promise, but it raises questions and concerns.  Physicians and patients are concerned that the quality of “virtual care” be equal to that of an in-person visit.  It may also increase disparities in care with certain populations that may not have access to the technology needed for telemedicine. And though it may rate high in convenience, some patients or physicians may prefer the traditional in-person visit, to firmly establish and maintain the trust needed for an effective and long-lasting physician-patient relationship.  

Another current shortcoming is state licensing laws governing physicians. A doctor seeing a patient in one state may not be able to treat that patient if he or she moves or travels to another state if the physician isn’t licensed to practice in that state. This situation can affect such patients as college students or senior citizens who move to warmer areas during winter months.

Patients who may have the convenience of telemedicine available to them should discuss the pros and cons of using such a service with their primary care provider, keeping in mind their particular health conditions and needs.  Telemedicine, which represents a new frontier in the delivery of care, may be appropriate for some services and conditions; it may not be for others.  Psychiatry, for example, is especially suited for telemedicine, as it doesn’t require the physical exams needed by other specialties.

For more information, visit the National Institutes of Health at www.physicianfocus.org/telemed. For a video discussion, visit www.physicianfocus.org/telemed.

Adam Licurse, M.D. is a primary care physician and associate medical director of Partners Population Health.  Steven Locke, M.D. is a psychiatrist and co-founder and chief medical officer of iHope Network. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.     


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