When I think of telehealth, I think of the conventional telephone. In that light, physicians have been doing telehealth for many decades and, during this time, have gradually figured out which clinical problems are amenable to a telephone consultation and which are not. The same thing is going to happen with the new generations of “telephones,” if you will, which have video capability and built-in sensors.
Consulting a physician via a device will never wholly replace the in-person examination, however, after a time, the acceptable use-cases for telehealth consultations will solidify into a conventional standard of practice, just as the profession saw with the telephone.
But there is one important difference between telephone technology and today’s mobile technology: Before smartphones arrived, telephone technology was relatively static – it exchanged voices in an intelligible manner, no more, no less. Today, however, smartphones have become *platforms* permitting the exchange of voice, video, sensor data, and who-knows-what in the future. As a result, physician-patient telecommunication capabilities will continue to evolve, and the profession will constantly have to adapt to a moving target.
As with any new medical technology, reimbursement will be an issue. Generally, telephone consultations have not been reimbursed. With telehealth, we’re already seeing a change – a CPT code for telehealth services now exists. Although it is applicable only under narrow circumstances, we should expect evolution here, too, especially to the extent telehealth proves to deliver better outcomes at lower cost.
We have to be careful with telehealth reimbursement, however, because it could absolutely reformulate clinical care. No one doubts that a long-term personal relationship with a primary care physician is a good thing. It would be very easy for poorly constructed telehealth reimbursement policies to destroy the last vestiges of such relationships in today’s medical system. My personal opinion is that we should not reimburse physicians for telehealth consultations unless there has previously been an in-person consultation. This is sensible because, just like the days when conventional telephones ruled the communications landscape, physicians will need to assess whether a particular patient can use telehealth technology successfully and give reliable information. Among the sick and infirm, using modern interactive telehealth technology will be much more problematic than using simple telephone technology.
There is another aspect to technology adaptation. For the younger generation of physicians just starting their careers, an important lesson is: do not accept today’s status quo as the ultimate good. Medicine is a very old profession that has always made great demands on technology, evolving workflows and information-handling procedures over thousands of years. Workflows based on papyrus technology became incredibly well optimized, but were largely destroyed by the imposition of electronic technology that did not enable a similar degree of optimization. The profession is adapting to new technologies, but we’re far from optimized now.
So, if you are coming into the medical profession, do not be satisfied with the systems that are put in front of you. If you think of a way such systems can be improved, say something to the people who can make changes, or, better yet, help the profession by working yourself to make the changes happen.