The Digital Doctor: The Next Big Leap in Healthcare
JULY 26, 2019
Technology has become increasingly important to the healthcare industry. Video chat allows patients to see a doctor in the comfort of their home; apps and wearable technology have revolutionized how health can be monitored.
However, as technology’s role becomes clearer, so does the uncertainty around its regulations, efficacy, and access.
Tabassum Salam, MD, American College of Physicians (ACP) vice president for medical education, believes despite these clear challenges, telemedicine is here to stay.
She told MD Magazine® the college is currently working on educating physician members on how to more effectively incorporate the technology into their practice. Such an effort couldn’t be timelier. According to a recent survey conducted by the ACP, most members have implanted at least 1 of 5 technologies—video visits, e-consults, remote patient monitoring, remote care management, or wearables—in their practice.
E-consults, or physician-to-physician electronic consultations, are the most widely used, with one-third of respondents saying they have the technology. Of those, 63% use it weekly; just 9% said they have never used it.
The obvious benefits of telehealth drive its popularity among today’s physicians. Salam explained its innovation has the ability to close the healthcare gap and provide assistance to those who need it most: individuals with limitations that prevent them from getting to the doctor’s office.
“It’s a physical or emotional strain to leave the home and go to a doctor’s visit and the likelihood of those patients adhering to those appointments is low,” Salam said. Video visits may help the most at risk patients keep their appointments.
Though just 1 in every 5 surveyed ACP physicians with video visit technology reported using it weekly, half said they use remote care management on a weekly basis. That said, another 42% of respondents said that even if reimbursement was satisfactory and regulations were barrier-free, they would have trouble integrating virtual care into practice workflow.
Increased technology poses real challenges and questions. Patient privacy, broadband coverage, and overtreatment are all real possibilities when it comes to telehealth.
As telemedicine networks grow, licensing becomes an increasingly large issue. Medical licensing is done on a state by state basis, so even though a patient has the ability to speak to a specialist in another state, that doesn’t mean they are able to talk to them. For example, a patient in Colorado can’t use telemedicine to receive advice from a doctor in Nevada if the doctor isn’t licensed there.
Barriers to care
Manish Shah, MD, MPH of the John & Tashia Morgridge Vice Chair of Emergency Medicine Research at the University of Wisconsin-Madison School of Medicine and Public Health, told MD Mag state-by-state licensing systems cause issues for telemedicine's spread.
The end-result is simply more hoops for any telemedicine healthcare provider to jump through, he explained.
Additionally, having the technology doesn’t necessarily equal use, the ACP found. A lack of access, errors, and patient privacy were also major concerned raised by ACP members, with 36% saying that patients don’t have access to the technology needed. Over a quarter of respondents (29%) said they have concerns about medical errors when using the technology and 23% said they have patient privacy and security concerns.
The least common technology among the surveyed physicians was wearables. Just 9% of ACP physicians reported using it, and another 9% expressed interest in implementing it in the next year.
Another barrier to telemedicine’s success is that broadband coverage is uneven across the country, and people who may really benefit from increased technology don’t necessarily have access to it.
Neal Kaufman, MD, the chief medical officer and cofounder of Canary Health, a digital health company based in California, said that cell phones can be leveraged in areas where broadband is lacking. “You can do things through text messaging, through apps on the phone. So, yes there is a digital divide, but I think if we look to the next 10 years that divide will be much, much less,” Kaufman said.
For Shah, the answer can lie in what he calls 'high-intensity telemedicine.' This is when a health technician would come to your home and bring the internet with them. They would then take measurements and observations which would be sent back to the doctor. This would save the doctor travel time and the patient money.
The doctor's digital role
“The telemedicine assistant would not be the definitive health care provider...they’re just helping the patient along,” Shah said. He noted that having the health technician would also ensure that patients aren’t over treated. They would provide the doctor with more accurate information in order to make informed decisions.
But despite these limitation and setbacks, telemedicine is growing and is already changing the US healthcare system. And with it, the doctor-patient relationship can also be reshaped. That change is one which should be monitored closely.
“I think society has changed, so potentially how the patient and physician relate may vary, and needs to be carefully thought of,” Shah said.
For Kaufman, the future of technology in medicine is much broader than video visits and e-consults. He believes, a concept he dubbed ‘digital therapeutics’ could be the next step.
A new medicine
"A digital therapeutic is the same, but it’s not a pill,” he explained. “It’s therapy that’s ideally, theory-based, research-based, and proven to have a benefit comparable to medicine. I think that’s where the industry's going.”
As such, digital therapeutics could be used in conjunction to, or even in place of, a traditional medicine. Digital therapeutics is something that can be scaled, and a single program has the potential to reach large patient populations.
“But now imagine that you have program where someone can come on, automated and personalized to your personal experience, even to the digital level,” Kaufman said. “You’re able to take this digital therapeutic and offer it to a large portion of the population, you’re able to go to scales in ways you’re never able to imagine.”
Technology has already changed the healthcare industry, without its full potential yet actualized. Despite barriers and limitations, how care providers use technology is changing, and it has the potential to continue advancing healthcare capabilities.
Though it may be hard to see equal growth between medicine and technology right now, they will soon be synonymous.
“Healthcare hasn’t changed, but we made it to the moon,” Shah said. “I think the change in healthcare is happening now.”