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When something innovative comes along, people instinctively compare it to something that already exists.
Automobiles in the early 1900s, for instance, were thought of as nothing more than motorized versions of the horse-drawn carriage (all revved up on “horsepower”). Before there were highways, gas stations and roadside motels, people could only envision what was, not what could be. A century later, our jobs, food sources, cultural institutions and communities all revolve around our motorized vehicles.
It almost always takes a generation for innovative technologies to gain proper recognition for all they can do.
In this century, telemedicine is one such innovation, underappreciated and underused.
Most physicians and patients view telemedicine (also: telehealth or virtual care) as a convenient alternative to an in-person medical visit. Granted, convenience is a notable benefit—one that appealed to millions of first-time users in the early days the coronavirus pandemic, when no one wanted to sit in a waiting room alongside people potentially infected with Covid-19.
But telemedicine has the potential to be so much more than a virtual exam room.
This technology has the power to break down the barriers of time and distance that stand in the way of optimal care. Telemedicine can dramatically reduce healthcare costs and deliver top-notch medical expertise to people everywhere. Phrased differently, telemedicine is not a second-rate substitute for the traditional office visit. It is a way to dramatically improve medical care.
In my last article, I wrote that telemedicine will transform healthcare in our post-pandemic world. Several readers—including those in healthcare and finance—wanted to better understand how that will happen. This column examines three ways to tap into this tech’s full potential.
Note: The examples herein aren’t hypothetical. During my time as CEO of the Permanente Medical Group (the half of Kaiser Permanente responsible for providing patient care), these solutions were employed daily by the group’s 10,000 physicians.
1. Telemedicine can make specialty care more efficient
Let’s say you have a problematic rash. You schedule a visit with your primary care physician, who isn’t sure of the diagnosis. The doctor refers you to a dermatologist and you call to make an appointment that same day. Then you wait to be seen, which could take up to three or four (very long and itchy) weeks.
When the day arrives, you take a half day off work, drive across town and sit in the reception area for an hour before finally getting a definitive diagnosis and the prescription you need. A few weeks later, you receive a bill for $200, which you must pay out of pocket since it’s below your deductible.
Two weeks and $200 is a lot of time and money to spend on a rash. Telemedicine offers a more efficient solution. Imagine this: Instead of sending you to see a dermatologist in person, your primary care doctor connects you with one instantly. Via video, the specialist observes your rash, listens as you describe the problem and—in conjunction with the primary care physician—explains your diagnosis and prescribes the appropriate treatment. You leave that day with a prescription in hand. Before the week is over, your problem disappears. This isn’t just possible. It’s happening.
Even prior to the pandemic, physicians at Kaiser Permanente routinely used telemedicine to successfully resolve this type of dermatological concern. In fact, it worked 70% of the time in under five minutes and at a fraction of the cost. But telehealth benefits aren’t just limited to rashes. Factoring in all specialty referrals of every type, telemedicine at KP solves almost 40% of all patient problems.
Nationwide, doctors make more than 210 million specialist referrals each year. If every physician practice in the country could deflect 40% of all those in-person specialty visits, replacing them with telehealth, the cost savings would be measured in the hundreds of billions of dollars.
Often, primary care physicians only need a small piece of advice to appropriately care for a patient. However, the prevailing model of U.S. healthcare delivery requires that patients either get a full specialty consultation or nothing. Telemedicine makes it possible for doctors of every medical and surgical specialty to consult virtually with dozens of primary care physicians on any given day. It’s not just a more convenient solution. It’s a superior solution that happens to be more efficient, too.
2. Telemedicine can eliminate geographic distance
When patients discover they have a complex or unusual medical issue, the most common question is: Who’s the best physician for my problem? Usually, the correct answer is a physician practicing far, far away. Patients are, therefore, left to choose from doctors practicing in their community.
Telemedicine broadens the horizons of medical expertise. In Northern California, a region of Kaiser Permanente that stretches 100 miles in every direction, there are dozens of specialists who are recognized as world leaders in their respective areas—from rare congenital birth defects to complex cancers.
One such physician focuses exclusively on kidney cancer. Given his location, some patients have to drive three hours to visit with him. Since it’s not convenient or even possible for everyone with this malignancy to travel halfway across the state for a consultation, our medical group began offering patients three options: visit with a different urologist in the community, consult with the kidney cancer expert in his office or connect with him via telemedicine.
More than half of eligible patients chose the virtual meeting and, in follow-up surveys, nearly all believed they picked the best option.
Of course, they lauded the convenience. But that’s not all. They also marveled at how much could be accomplished over a screen. The specialist used telehealth technologies to review patient X-rays, look at pathology slides and review the technical details of the planned operative procedure.
Across the United States, patients with rare and complex problems tend to bounce from one doctor to another, paying high prices for second, third and fourth opinions—sometimes never getting a correct diagnosis or optimal treatment. This is often the consequence of our nation’s stubborn physician culture, which prevents doctors from admitting the limitations of their knowledge and abilities. But this dilemma is solvable.
Telemedicine provides a safe, high-quality, personalized and expert solution to the problem of geographic distance.
3. Telemedicine can keep patients out of the ER
Here’s something technology can’t do: It can’t prevent you from getting sick or injured when your doctor’s office is closed. Medical problems happen 24/7 and yet no physician can be expected to care for patients around the clock.
As a result, people who need care on weekends or after 5 p.m. on weekdays are almost always told to go to the emergency department, where care is very expensive (up to 12 times more than visiting a physician’s office) and very slow (averaging more than two hours per visit in many states). These visits are also largely unnecessary. It’s estimated that two-thirds of all trips to the emergency department are avoidable.
In the mid-Atlantic states, Kaiser Permanente offers “after-hours” video visits to any patient who needs one. Although KP members can go to the local ED if they prefer (insurance covers the bill either way), the majority opt for a video consultation with an emergency physician stationed in the region’s call center. Those who choose the virtual visit have their issue resolved more than 70% of the time—typically in a matter of minutes, not hours, without ever having to leave their homes.
Telemedicine vs. tradition
Putting the pieces together, one thing is clear: Telemedicine is capable of far more than delivering traditional office care virtually. Done right, it’s superior medical care, that’s also more convenient. Telehealth solutions are less expensive and can be made available anywhere at any time. They’re quicker to access and, as a result, often yield higher quality outcomes.
Prior to the coronavirus pandemic, I predicted virtual visits would replace 30% of all medical services provided in a doctor’s office. I’m now convinced that telemedicine is a superior solution for 40% or more of all medical problems.
But this transformative technology won’t reach its full potential as long as doctors and patients think of it merely as a more convenient alternative to an exam room, or a way to avoid personal contact with someone who may be sick. Americans are fed up with the old medical model. Their healthcare experiences are cumbersome, redundant, time-consuming and expensive. The only reason people tolerate what exists today is because they don’t realize a better alternative is already available.
Back when Model T’s were still rolling off the assembly line, vehicular transportation served one function: getting from one side of town to the other. Therefore, most Americans deemed Ford’s innovation as only marginally better than the horse and buggy. Hardly anyone could have imagined a future in which people would travel across the country in great comfort and at minimal cost.
Once people realized the true potential of the automobile, they gladly abandoned the clunky transport solutions of the past. The same will be true for telemedicine.
