For years, telemedicine has been viewed as a panacea for the problems of American health care. Remotely connecting doctors and patients can increase access to care and reduce costs, all while maintaining quality. Unsurprisingly, telemedicine has exploded in popularity with more than 15 million virtual visits in 2015 and a growing number each year.
Direct-to-consumer services have been at the forefront of this growth with a market expected to exceed $1 billion by 2020. Using direct-to-consumer telemedicine, patients can initiate contact with a health care provider without a referral from their primary care provider. Dozens of companies offer fast and cheap consultations via a website or mobile app, obviating the need to make appointments, take time off from work and deal with the many other inconveniences of a traditional doctor’s appointment.
Although telemedicine has been well validated for many services (e.g. minor complaints, dermatologic issues, etc.), several recent studies have raised questions regarding the quality of direct-to-consumer providers. Research published in JAMA Dermatology found that telemedicine websites missed several major diagnoses, while another study found that they recommended appropriate care in just 34-66 percent of cases. Direct-to-consumer services also score worse than physician offices on several performance measures and some are staffed by physicians not licensed to practice in the United States.
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Telemedicine has enormous potential but clearly continues to face challenges. In order to overcome these challenges, the industry needs a reliable process of accreditation, interoperable medical records and care coordination, and the involvement of integrated health systems.
Quality remains the biggest concern with telemedicine. Incorrect diagnoses, inappropriate treatments and unlicensed providers threaten patient safety and undermine the credibility of telemedicine as a delivery model.
It is therefore critical to develop processes for accreditation and oversight of direct-to-consumer services (the American Telemedicine Association has begun one such program). Whether regulation comes from a professional organization, a government agency, or someone else, success will require buy-in from service providers and consumers. A robust accreditation process would allow companies to showcase the quality of their services while providing patients with information on options for care.
A second concern with telemedicine is the lack of care coordination. Many patients do not inform their primary care providers when they consult standalone, online services. As a result, their primary doctor does not have a complete record of their medical issues and medication regimen, both of which have important implications for future decisions.
Telemedicine providers should incorporate functionality to alert a patient’s primary doctor when he or she seeks care. There is also an ongoing push for interoperability of medical records, which would make it easier to track and share health data. From a telemedicine perspective, this would allow disparate providers to more effectively communicate and coordinate treatment.
Finally, traditional health systems should take on a larger role in offering telemedicine to their patients. I recently helped launch a direct-to-consumer service at Stanford University, one of the first of its kind at an academic medical center. By providing it through Stanford Hospital, we were able to mitigate concerns about quality and coordination – patients received remote care from Stanford physicians and the electronic encounters were automatically documented in their medical record.
Some integrated health systems like Kaiser Permanente have already implemented telemedicine offerings to provide more convenient care to their patients. As payment systems for telemedicine take shape, more providers should follow suit.
Telemedicine continues to show tremendous promise in transforming the way we provide health care. The right approach to telemedicine can help fulfill that promise.
Akhilesh Pathipati, a Sacramento native, is a MD/MBA student at Stanford University and a Harvard graduate. He can be contacted at firstname.lastname@example.org and on Twitter @apathipati.