Necessity is the mother of invention, we often hear. While it is true that telemedicine has been around for decades, the pandemic has seemingly reinvented the breadth of this developing tool. Historically, telemedicine practices have only been implemented in remote areas, where the logistics of routine doctor’s visits are too complex or the sheer number of qualified healthcare providers is insufficient. As the U.S. was hit with a wave of COVID-19 cases in March of 2020, many hospitals were quickly overwhelmed. With little being known about the virus, and physicians at a high risk for carrying and spreading the disease, there was one obvious solution for patients seeking non-emergent care: telemedicine. Now, as more Americans have been exposed to doctor’s visits over the telephone or Zoom calls, many are finding this to be the more convenient option.
While it has not yet become mainstream, COVID-19 is not the first emergency situation for which Americans have turned to telemedicine. In the past, private telemedicine companies have stepped in to provide care to victims of natural disasters. Even NATO had a telemedicine system designed for military related situations in 2000. Despite those few exceptions, prior to the pandemic, there was a fair bit of seemingly well-intentioned, bureaucratic, red-tape preventing more widespread adoption of telemedicine. A major sticking point in the American healthcare system is that of patient privacy. Prior to the pandemic, HIPPA regulations left hospitals unprotected in the event of any security breach during a telemedicine visit being conducted on most mainstream video chat platforms. Legal concerns also existed on the part of many healthcare providers regarding their liability in technological malfunctions that could take place during a visit, especially if such a malfunction were to impact a patient’s condition. Furthermore, many Americans rely on Medicaid or private insurance to help with healthcare related costs. Because these institutions did not cover telemedicine visits to the same extent they did an office visit, patients were most often traveling to their doctor’s office. The pandemic has placed many of the challenges health experts have been grappling with when it comes to telemedicine, into perspective.
While health experts and the WHO have been studying telemedicine for decades, it was not a topic that drew the attention of many others, at least not until COVID-19 appeared. Just a few months after the virus arrived in the U.S., the stocks of private telehealth companies, like Teladoc Inc., began to climb. Finally, as the larger threat of COVID-19 loomed, patients previously deterred by the regulations of the healthcare industry began to demand telemedicine. With that demand, and the overwhelming public health crisis occupying our hospital beds, hospitals, governmental agencies, and insurers were suddenly ready to embrace the idea of a virtual doctor’s visit.
It is not hard to believe that gaining access to healthcare in a timely manner is all the more complex for Americans living in rural areas. According to the Center for Disease Control and Prevention (CDC), Americans in rural areas are more likely to develop and die from the five leading causes of death in this country than their urban counterparts. For this reason, the CDC created numerous programs dependent upon telehealth, ranging from diabetes management to tobacco cessation. In addition to providing the remote communities with healthcare, telemedicine can help bridge more than just physical distance. A virtual doctor’s visit can help overcome language barriers that often arise between a physician and patient, connecting a patient to a provider with whom they are more easily able to communicate.
For many years, the U.S. has been confronted with a physician shortage, particularly in rural areas. Currently, many programs exist that incentivize physicians to work, for a period of time, in more remote, underserved areas, ensuring those communities are not without healthcare services. The need for such programs arises because doctors working in more densely populated areas see more patients, gaining experience and typically a higher salary. If telemedicine were to become routine, doctors based in remote areas would not necessarily be confined to treating fewer patients.
The U.S. Census Bureau estimates that 21% of the U.S. population will be over the age of 65 by the year 2030. On top of that, the funds that Medicare and Social Security have per retiree are steadily declining. We could soon be seeing a generation of individuals who cannot afford their access to healthcare after retirement. However, telemedicine may offer a way to cut the cost of caring for America’s elderly population: one program found a 19% saving when at-home medical care is compared to inpatient treatment. Using virtual doctors visits to perform routine monitoring of chronic conditions can increase the volume of patients a physician can treat, and may allow the elderly to live on their own for longer. Changes on the infrastructure side also need to be implemented for all Americans to reap the benefits of telemedicine. According to the FCC, in 2016 over 34 million Americans lacked access to broadband internet connection. 39% of this group were those living in rural communities — those whose access to healthcare would be most improved by telemedicine. Technological literacy would also need to be expanded, should telemedicine services take off across the globe, as many studies signal to this being a limiting factor in its implementation. In the end, however, with a larger global implementation of telemedicine, a more far-reaching framework for medical innovation will be possible.
While telemedicine is far from ready to replace in-office doctor’s visits, COVID-19 has opened our eyes to its many applications in day to day life after the pandemic. Telemedicine is by no means perfect, but its potential to expand high quality healthcare access into less populated areas cannot be ignored. As of September 2020, the relaxations in HIPAA regulations that allow for widespread telemedicine are set to expire post-pandemic. Medicaid and private insurers have made no plans to continue matching their coverage of telemedicine visits to that of in-person visits. It is clear that throughout the emergency created by the coronavirus, telemedicine proved to be a valiant savior, and now we must push for its continued use in fighting against the inequitable access to healthcare that long pre-dated COVID-19.
Edited by Rohan Ravirala