Telehealth and its impact on patient relationships

Blog post by Colin Hung

If you scan the healthcare technology headlines these days, it is easy to tell where all the glitz and glamour is – mobile health, wearables and EHRs dominate the daily headlines. In fact, I would hazard a guess that 2014 will become known as the year that fitness trackers and other forms of wearables truly hit their stride (pun intended).

However, there is a trend that’s been growing over the past several years that I believe will have a greater impact on the future of healthcare – telehealth.

Telehealth, the act of “seeing” a physician, nurse or other healthcare professional via video chat or on the phone, has been around for over 10 years. However, it is only in the last 2 years that it has begun to attract significant investment and attention.

According to a report published by BCC Research, the telehealth market was $16.3 billion in 2013, will end 2014 at $19.2 billion and should grow to $43.4 billion by 2019 – an annual compound growth of 17.7%. What’s fueling this phenomenal growth? A confluence of factors including:

  • Technology advancements: smartphones, high-speed connections, high-quality video
  • Technology literacy by physicians & nurses
  • Willingness of payers to compensate for telehealth consults
  • Government recognition that telehealth can lead to significant cost reductions
  • Public recognition that telehealth is convenient

In a recent Medscape post, Joseph Scherger, Vice President for primary care and academic affairs at Eisenhower Medical Center in California and a pioneer in providing telehealth to patients points out:

The Internet has created new ways to deliver chronic and preventive care and treat minor acute problems, and those modes will be used. You’ve got this new platform of communication and care that is going to be delivered, whether it’s by a continuity provider or by somebody else.

While some practitioners like Scherger have wholly embraced telehealth, others have chosen a more cautious approach. Reid Blackwelder MD, president of the American Academy of Family Physicians stated in an interview with Medscape Medical News that

Our first guidelines for electronic visits is that they’re available only to established patients who previously received care from a physician practice.

Regardless of the approach, one thing is clear, telehealth is gaining traction and as it does, everyone involved in healthcare will have to wrestle with all sorts of challenging questions. Should there be restrictions on the type of prescriptions that can be made via telehealth? What happens when the patient is from a state/country that the doctor isn’t licensed for? What new forms of fraud will emerge? What reimbursement models make the most sense? Answering these questions will change the way healthcare is provided. But one of the most interesting questions is how telehealth will impact relationships with patients.

Patients are certainly in favour of telehealth, but there has been some resistance to it from physicians. Pauline W. Chen MD wrote about this in her New York Times article “Are Doctors Ready for Virtual Visits?”. Chen cites a study from the University of Texas Medical School

Although the researchers had initially set out to study telemedicine’s effect on mortality, complications and the length of stay of patients in five different hospitals, they inadvertently discovered the extent to which clinicians were reluctant to incorporate this technological change… Despite the seemingly obvious advantages and patient willingness, however, the majority of doctors in the study chose to have as little remote involvement for their patients as possible.

While this isn’t the first time or last time a new healthcare technology has encountered resistance, what is interesting is the REASON why many were reluctant to using telehealth. According to the study one of the key reasons was concern over how telemedicine would affect the relationship with patients. In her article Chen goes on to say:

…acceptance will first require redefining the patient-doctor relationship in light of this new use of technology. Telemedicine and the idea of unseen clinicians in a remote “control room” doling out care is scary… it will only work if all of us, doctors and patients, accept care from a clinician working in conjunction with a team of providers, each of whom is deeply engaged and committed to the patient, and some of whom, on occasion, may not be anywhere near that patient’s bedside, city or state.

Those words “redefining the patient-doctor relationship in light of this new use of technology” is what inspired this week’s chat. If telehealth takes off like the experts predict, then physicians, nurses and other caregivers will need to embrace new ways of forming relationships with patients that are not dependent on in-person visits. They will have to become adept at building and sustaining online/remote relationships using technology intermediaries like email, secure messaging and video-chats (similar to Skype and FaceTime).

The good news? There is already a way for physicians and nurses to “practice” this type of relationship without having to wait for telehealth. Those of us who are active on social media are already familiar with how to establish and sustain relationships with people we have never met in-person. I’m going to go out on a limb and suggest that those physicians and nurses who are social media savvy are the ones who will have the smoothest transition to telehealth because they have already mastered the necessary skills of virtual relationships through their Twitter, Facebook and LinkedIn usage.

What shape will this new form of relationship take? Will patients be accepting of this new way of connecting with their primary care doc? Are there certain things that should not be done via telehealth (like certain prescriptions? Mental health issues?)?

Join us Tuesday December 2nd at 8:30pm Eastern (for your local time click here) for the weekly #hcldr tweetchat where we will be discussing the following questions:

  • T1 How will telehealth impact patient-physician relationships? (+ve or –ve)
  • T2 What new skills will need to be learned to effectively create relationships via telehealth?
  • T3 What do you believe SHOULD NOT be done via telehealth? (ex: narcotic prescriptions)
  • T4 As a patient, what do you expect from telehealth? How/Why would you use it or not use it?

Resources

“Need a Quick Diagnosis? A Prescription for What Ails You? The Doctor Will Video Chat With You Now”, Randy Rieland, Smithsonian Magazine, October 6 2014, http://www.smithsonianmag.com/innovation/need-quick-diagnosis-prescription-what-ails-you-doctor-will-video-chat-you-now-180952928/, accessed November 29 2014

“Global telemedicine technology market to hit $43B by 2019”, Dan Bowman, Fierce Health IT, October 17 2014, http://www.fiercehealthit.com/story/global-telemedicine-technology-market-hit-43-billion-2019/2014-10-17, accessed November 29 2014

“Is the average patient ready for teleheath?”, MacLean Guthrie, iTriage, October 27 2014, https://blog.itriagehealth.com/average-patient-ready-telehealth-infographic/, accessed November 29 2014

“Telemedicine: What effect on the Physician-Patient Relationship?”, John DeGaspari, Healthcare Informatics, Jun 8 2012, http://www.healthcare-informatics.com/article/telemedicine-what-effect-physician-patient-relationship, accessed November 29 2014

“Docs mull impact of telemedicine on patient interactions”, Katie Dvorak, Fierce Health IT, July 25 2014, http://www.fiercehealthit.com/story/docs-mull-impact-telemedicine-patient-interactions/2014-07-25, accessed November 29 2014

“Telecare improves chronic pain management”, July 16 2014, Fierce Health IT, July 16 2014, http://www.fiercehealthit.com/story/telecare-improves-chronic-pain-management/2014-07-16, accessed November 29 2014

“Does Telelhealth Diminish Physician-Patient Relationships?”, Ken Terry, Medscape, July 25 2014, http://www.medscape.com/viewarticle/828874, accessed November 29 2014

“Are Doctors Ready for Virtual Visits?”, Pauline Chen MD, New York Times, January 7 2010, http://www.nytimes.com/2010/01/07/health/07chen.html?_r=0, accessed November 29 2014

“Unlocking the Potential of Physician-to-Patient Telehealth Services”, Castro et al, Information Technology & Innovation Foundation, May 2014, http://www2.itif.org/2014-unlocking-potential-physician-patient-telehealth.pdf, accessed November 29 2014

“Telemedicine: Is Prescription Writing Allowed?”, American Medical Association, 2014, http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/telemedicine.page, accessed November 29 2014

“Survey Results: Are Projections for Telehealth Fact or Fiction?”, Kevin Riddleberger, August 7 2014, HL Standards, http://www.hl7standards.com/blog/2014/08/07/telehealth-future/, accessed November 29 2014

Image Credit

Telemedicine Consult – Intel Free Press

https://www.flickr.com/photos/intelfreepress/6948764580/in/photolist-bA3eBS-fuTzAT-fuTARc-7UDYR1-9wSAah-fv8UJE-fuTAB6-fuTA6x-7zT5aJ-cS66ZJ-oMZ27Z-oMZLEP-p5tWK4-p5m6cs-9CXJTn-7zPj6e-66eL1z-cS67eY-5M3E71-5PMQn9-6EWZyz-7jhzy5-baAnCD-9wSA6W-9wPAZH-9wSA3q-bTb7Z2-nwHi2F-7jdFwp-cmhTW7-5ovyzD-89m8co-baAnDK-8mWhej-8uJkqP-9yQ7h6-9mKGSu-9mKGTu-baAnGp-nuE9Vj-nytM6v-nfdpnL-89hXG8-92qpXd-7jhzsj-8uMpE9-cmXUTC-MYeGx-5ozR6E-89hR6z

4 comments

  1. Reblogged this on HealthcareVistas – by Joseph Babaian and commented:

    Intriguing discussion on telehealth along with impact on patient relationships. Talk about value to patients, providers, and the relationships therein. Read the blog and then join the Tweet chat Tue 12/2, 830p E. #hcldr

  2. Reblogged this on healthcare software solutions lava kafle kathmandu nepal lava prasad kafle lava kafle on google+ <a href="https://plus.google.com/102726194262702292606&quot; rel="publisher">Google+</a> and commented:
    #telehealth #hcldr #genomics #Population #Health #care #Management #bigdata #portal #Analytics #Reporting @deerwalkinc

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