The issues with the US healthcare system are no secret: too many people miss out on adequate medical treatment because they face too many barriers -- lack of insurance, exorbitant costs for care, long wait times to get an appointment, lack of transportation -- to make it to the .
While political debates about health insurance rage on, many medical professionals are turning to more pragmatic solutions to help patients in today's world. One such proposed answer is , which allows physicians to through a digital connection, such as a video call. While some whole-heartedly embrace as a solution to get more people access to quality medical treatment, others are skeptical of moving away from brick and mortar doctor's offices.
Telemedicine is a complicated answer to a convoluted problem, and I wanted to understand more about who it might work for and whether or not it's a viable option for a broad group of people. So, I got the chance to talk with a few experts to get the rundown on digital healthcare and all its intricacies.
What is telemedicine and who is it for?
Essentially, telemedicine is the process of doctors treating patients remotely instead of face to face, using some sort of digital connection, whether that be a video call or a messaging system. Video conferencing is often used with psychiatric treatment, or when patients need to show their doctor a physical symptom. Other providers practice asynchronous telemedicine, which is when patients and doctors connect over online messaging such as email to discuss symptoms, and do not communicate in real-time.
In 2018, 7 million patients used some sort of a telemedicine service in the US, and that number is only expected to rise. Over half of US hospitals use some sort of telemedicine, and it's ubiquitous in every state, with more than 200 telemedicine networks in the US alone.
Kaiser Permanente uses telephone calls, video chats and email messages, and counts them all as doctor's office visits. Health insurance company Cigna provides a telehealth connection where patients can video chat or online message a medical professional 24-7. There's a whole host of telemedicine organizations not associated with the traditional model of health insurance, including Alpha Medical, Curology, Talkspace, First Opinion and others.
Telemedicine appeals to anyone who doesn't have the resources to see a doctor in person. Maybe they don't have insurance, but need to see a doctor. Some cannot go to a physical doctor's office because they are going to school or work long hours, and aren't free during normal business hours. Others lack adequate transportation or have chronic illnesses that make it hard to leave their residence.
Because of the low out-of-pocket-costs for some telemedicine providers, telemedicine can also be an enticing option for those who don't have insurance. A 2018 study from the US Census Bureau reported that 27.5 million Americans don't have health insurance, compared to 25.6 million people in 2017. The demographic with the highest rate of uninsurance was the 19-to-25 age group, followed by people aged 26 to 34. It's most likely not a coincidence that these age ranges coincide with when a lot of people enter college, go into the workforce and get bumped off their parents' health insurance policies at age 26.
But while telemedicine can help you diagnose common health issues and get medications, it's not a full replacement for seeing a doctor in person. It cannot help you in an emergency, or if you need to get lab tests or imaging. Using telemedicine as an alternative to getting health insurance leaves you vulnerable to massive medical bills should you need to go to the hospital or get surgery.
Is telemedicine the answer to our healthcare problems?
Dr. Mary Jacobson and Gloria Lau, the women in charge of Alpha Medical, believe that 70 to 80% of conditions that people seek treatment for can be administered remotely through an online appointment. Alpha Medical is a digital healthcare company that focuses on women's care, dermatology and mental health, as well as a broad area of urgent care covering anything from a sore throat to a bladder infection.
For the remaining 20%, Alpha is committed to "quarterbacking" patient care, meaning that they will serve as the point of contact for different public health clinics and work with the patient's schedule and needs to find the cheapest and most convenient care nearby.
Take acne for example. According to Alpha, mild to moderate acne has no reason to be treated by a licensed MD in a dermatologist's office. Rather, it can easily be treated with an asynchronous telemedicine practice, where the patient lists their symptoms and, a short time later, a doctor reviews the case, diagnoses the patient and provides adequate treatment. Curology, a dermatological telemedicine company, uses a similar model.
If the doctor determines that the patient has a more serious skin condition, Alpha can help them find a local clinic and help make an appointment for them.
The women at the helm of Alpha believe that overcrowding at doctors' offices as a large part of the healthcare system's inefficiencies. People aren't able to book appointments quickly to see a doctor of their choice, and when they do make it to the doctor's office, they end up waiting for far too long. Overcrowding can also lead to medical professionals burning out and rushing through appointments because there are too many people to see. Alpha's telemedicine services can keep people with non-serious conditions out of doctor's offices, reducing overcrowding.
A subscription to Alpha Medical costs $99 per year, and each digital visit is an extra $10 on top of that. However, if they can't treat the symptom online, they don't charge you, and if you order a recurring prescription the membership fee is waived. Alpha is especially cost-effective because, if you do have an insurance policy, you can use it to pay for any prescriptions or extra healthcare needed (but not the membership fee or $10 cost per visit).
How can telemedicine remove barriers to care?
To better understand the benefits of telemedicine, I spoke to Dr. Vandna Mittal, MPH, the director of Digital Health Services at Stanford Children's Health and Chris O'Dell, administrative director of Digital Health Strategy and Alliances for Stanford Health Care.
Stanford offers several types of telemedicine, but the one I chatted with Mittal about is called clinic-to-clinic, where a nurse practitioner or other physician examines a child in person while another specialty doctor teleconferences in. Stanford uses this model to provide psychiatric care for children in smaller cities (such as Monterey, California) that don't have easy access to child psychiatrists. In this case, Stanford's telemedicine removes geographic barriers to specialty care, as well as cutting weeks off of wait times.
O'Dell mentioned that oftentimes surgery patients have their preoperative anesthesia and postoperative wound check appointments done through telemedicine, drastically reducing the travel needed for a single operation. He also says that telemedicine is useful for treating open-and-shut cases, like pink eye.
Alpha Medical already performs a similar service; if they cannot treat the symptom online, they work with patients to find a workable and realistic brick-and-mortar location to receive proper care.
What are the issues with telemedicine?
While telemedicine sounds promising, it's not flawless. I spoke with Dr. David Duke, MD, a physician advisor at Dignity Health, to understand the problems with implementing telemedicine as a widespread solution to our healthcare woes.
Duke believes that digital health services can expand and alleviate the healthcare gap, but he argues that they will never be a replacement for brick and mortar providers, whether that's seeing a doctor, nurse practitioner, or physician assistant. The biggest barrier he sees is that most patients aren't able to adequately describe their symptoms, and it's a challenge for doctors to correctly diagnose patients without seeing them in person. He argues that this can have dire consequences for the patient's health.
Duke gave an example of treating a sprained ankle. Let's say you have all the signs of a classic ankle sprain -- you were jumping on a trampoline, landed funny and now your ankle is swollen and painful. There's an infinitesimal chance it's anything other than a sprain that just needs to be rested and iced, but it's possible you're in pain because you had a cancerous tumor, and the awkward landing dislodged it. If, in a telemedicine call to Duke, he were to tell you that it's almost certainly an ankle sprain when it is in fact more serious, there's a good chance that you would take his advice and not pursue further treatment.
O'Dell was skeptical of the validity of Duke's objection. He explained that he doesn't want to let outliers (like the ankle sprain example) determine their policy or inhibit their progress in terms of implementing telemedicine. Stanford is extremely careful to examine any and all possible liabilities, but they don't let edge cases dominate their thinking process.
Is there still a way telemedicine can help?
The short answer is yes, absolutely. Duke believes that telemedicine is extremely useful in navigating patient experiences, and that it can cut down on inefficiencies in the healthcare system. Stanford uses clinic-to-clinic digital healthcare to give rural patients access to specialty care, as well as cutting down patient wait time. And Alpha Medical provides care for people who cannot make it to a doctor's office. A more efficient medical system helps reduce medical professional burnout and even physician suicide rates, as the final doctor I interviewed told me.
Lastly, I spoke to Dr. Peter Yellowlees, a past president of the American Telemedicine association. He told me that while telemedicine, especially third-party digital health apps, isn't a comprehensive answer to the healthcare gap in itself, it's pushing us towards a hybrid care -- a blend of digital and in-person -- and this will be the care of the future.
A lot of the problems in our current healthcare system stem from insurance policies that are too expensive, public health clinics that are too crowded, and innumerable barriers to accessing adequate healthcare. While telemedicine cannot solve all of these problems, it could cut down on waste in the health care system and break down these cost and convenience barriers over time.
Correction, 3:20 PM December 6: Dr. Mary Jacobson is a Chief Medical Director.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.