Since the 1970s, telemedicine—the exchange of medical information between a patient and care provider over the web or telephone—has helped bring care to underserved patients who are immobile or who live in rural areas or places without a solid healthcare infrastructure.
Because of recent technological advances such as better access to broadband connections and affordable high-resolution cameras, a new kind of telemedicine is on the verge of a boom. Many laptop and smartphone cameras already provide a better visual image than the naked eye. And continuous access to accurate health data directly from a patient through over-the-counter wearables such as Misfit devices as well as through remote biometric monitoring systems is viable. In short, high-quality, remote care is not just feasible, but desirable for patients and providers in developed economies as well as in emerging ones without a solid healthcare system.
However, “formidable challenges impede the expansion of telemedicine,” says Roberta Carter, integration partner at KPMG in the UK. “A lack of technology standards hampers both doctors and patients who want to use multiple health apps on specific mobile devices. And even when the technology is in place, knowing how to use the information received—and how to seamlessly integrate the practice into doctors’ and patients’ lives—will likely be difficult. But the potential benefits are well worth the effort,” Ms Carter adds. “Providers that can overcome these challenges have the potential to empower doctors in measurable ways.”
For telemedicine to gain mainstream acceptance in the medical community, several things must happen, says Richard Bakalar, MD, KPMG International’s Global Healthcare Center of Excellence and managing director with KPMG in the US. The availability and reliability of the technology are all key enablers, he says. But the industry will also have to establish reimbursement/payment incentives; overcome regulatory barriers (such as state versus national licensure); and establish permissible telemedicine services by state medical boards. The medical community may struggle with these hurdles, he says. So it may well be the consumer who actually demands the change, says Dr Bakalar. “Consumers will likely drive adoption as they have in digital retail and financial networks.”
Telemedicine is already radically changing how healthcare is delivered, and it will continue its course over the next decade. The global market for telemedicine is expected to be worth more than US$34bn by the end of 2020, according to an August 2015 report from Mordor Intelligence.
The fastest-growing areas for telemedicine include neurology and the treatment of chronic conditions such as diabetes. Telemedicine is also popular in dermatology, cardiology, pediatrics and psychiatry. And in countries such as Africa, China and India, it’s already starting to have a major disruptive impact, since physical clinics are few and far between. The technology does have its limitations, however. Some areas of medicine, such as orthopedics, are less suited for telemedicine, since orthopedic surgeons must touch a patient in order to diagnose and treat.
Still, where great geographic distances exist between people and healthcare, telemedicine has essentially created new health systems without the bricks and mortar. Even in developed nations with advanced healthcare systems, the pervasiveness of laptop computers and mobile phones is encouraging patients to move care outside of the four walls of a hospital setting, where there’s a danger of picking up infection, says Ms Carter.
Telemedicine has the potential to reduce significantly the time and money required to get care, especially for people who would have to travel a long way. “We’ve saved 15.4m miles of travel to see a doctor,” says David C. Gordon, director of telemedicine at the University of Virginia, a telemedicine leader in the US. The university has virtual clinics in prisons, schools, community health centers, rural hospitals and mental health facilities. And it treats everyone from migrant workers with high-risk pregnancies to rural patients with diabetes or depression who need their meds adjusted. Mr Gordon asserts that telemedicine improves no-show rates and time to provide care, reduces the length of stay of preterm babies in NICU, and helps to offer better end-of-life care in nursing homes.
Despite the impressive technological advances, the convergence of existing technologies—so they are usable on all mobile devices—is still a significant barrier to achieving scale. The situation is similar to how ATMs used to accept only their own cards but are now interchangeable, says Dr Bakalar. He suggests that consumers will force the convergence of healthcare tech, too. Furthermore, patient data will also need to be sharable among providers so that it can be normalized and distributed across telemedicine. According to Dr Bakalar, “The ability to collect data is in the present; the ability to use data is in the future.”
To develop a standard technology so that telemedicine apps may be used across all mobile devices, consumers need to be educated on their value, says Dr Bakalar. Consumers must overcome privacy concerns and providers need to trust the value of this non-traditional data source for making clinical decisions. “It is better than what is currently available, but not perfect,” notes Dr Bakalar. “Providers need peer-reviewed research evidence of its safety and effectiveness—and that will take time,” he says. The benchmark should not be perfection, but improvement on the status quo, he says. It should be incremental like other healthcare disruptive technology and clinical practices.
Standardization will occur over time and trusted private or even public cloud health repositories will help drive data aggregation, says Dr Bakalar. The convergence and data sharing among patients, providers, payers and life sciences healthcare segments will likely drive this adoption as well. Retail clinics can also drive down the cost and increase the value of data sharing and virtual care. The radiology global adoption of industry PACS and RIS standards under DICOM 3.0 are early examples of the power of healthcare standards.
From the side of healthcare providers, to date, the main telemedicine adoption bottleneck has been an inability to fit remote consultations into physicians’ workflow. Ashraf Shehata, KPMG International’s Global Healthcare Center of Excellence and principal with KPMG in the US, points out that if physicians can still see patients in the same way they do normally, then adopting telemedicine is doable. Driving this new model of care and building it into their workflow should then make doctors’ lives easier.
The other stumbling block is fee structure. Current reimbursement is quite limited for telemedicine, but it is improving, especially for care provided to consumers online or through mobile devices. The cost for virtual care is about US$40 to US$50 per patient encounter, compared with over US$100 for a typical in-person visit to a clinic, according to Dr Bakalar.
For patients, telemedicine should grow as demand for in-person visits continues to rapidly outstrip supply. The healthcare system, particularly in Britain, says Ms Carter, is feeling the inequity in supply versus demand. The need for more medical services is bringing healthcare systems to their knees. In fact, Ms Carter says, “those economies are looking to tele-anything to answer that dilemma.”
She adds that telemedicine can help solve the moral dilemma inherent in healthcare. The US Department of Veterans Affairs, for example, has been on the cutting edge of telemedicine and remote monitoring precisely because serving a population in need was the right thing to do, and tech helped accomplish this goal. “If we want to drive change, the moral imperative may be the way to do it,” says Ms Carter.