The New Healthcare
Telemedicine is changing lives for the better in many places across the U.S.
“Digitization is the process of using technology advancements linked with physical and digital assets to redefine and reimagine current business practices to create a significant competitive advantage” [1]
Numbered are the days of battling rush-hour traffic and searching endlessly for a parking spot in an overfilled garage just to be on-time to wait in a room where sick people cough all over you. In short, the experience of seeing a doctor is changing thanks to digitalization. The inflow of patients to see doctors has been inefficient since the beginning of time, but increasingly, healthcare professionals are utilizing telemedicine to streamline the process. “By definition, telemedicine is any form of clinical health care provided at a distance by way of telecommunications.” [2]
Telemedicine is a progressive form of healthcare that has proven particularly impactful for low income rural communities where healthcare is scarce or unavailable. One organization that is at the forefront of this technology is the University of Mississippi Medical Center, which is located in a region with some of the highest rates of obesity, diabetes, and heart disease in the nation. Currently, the population per physician ratio in Mississippi counties with less than 15,000 people is more than 3,000 to one. [4] To more efficiently access and move patients through its healthcare system, the University of Mississippi Medical Center serves as an information and diagnosis center for satellite patient facilities that are easily set up in remote locations. These satellite facilities require minimal square footage and no on-site doctors, while providing patients access to healthcare via video and medical image transmitting equipment. “Rather than drive 100 miles to a large hospital, a heart patient could be examined by a specialist in a health clinic in his own town.” [3] Medical specialties including, but not limited to asthma care, pediatric cardiology, gynecology, and mental health are accessible at satellite facilities conveniently located in places like shopping malls and retail strip centers. [5]
Although the upside of this new technology is immense and far reaching, telemedicine does not come without its challenges. Some physicians have difficulty getting comfortable with either the concept or technology, and as a result are reluctant to become telemedicine practitioners, even after seeing the impact and value it can provide. Another challenge is some insurers will not reimburse for telemedicine services, citing concern that telemedicine “will increase their costs as patients have easier access to a wider range of providers.” [6]
The progress that has been made by the University of Mississippi Medical Center is really just the tip of the iceberg of what is possible in terms of efficiency and reach. Today, millions of Americans still do not have access to healthcare, much less specialty healthcare. As telemedicine adoption becomes more widespread, unit cost will decrease and effectiveness will increase. In several of the premier medical facilities in the U.S. and around the world, telemedicine is going past the diagnosis and monitoring of patients, and is now providing remote treatment. At Cedars-Sinai in Los Angeles, fully remote operations are being performed by surgeons via robots. Although in their infancy, these types of procedures will someday be optimized such that patients in almost any location can receive affordable treatment from the most qualified doctor regardless of proximity.
There are several things that institutions like the University of Mississippi Medical Center must strive to accomplish as they move forward. One such thing is partnering with local and federal governments to subsidize the costs for innovative care. Additionally, such institutions must also work with insurers to make sure that patients have affordable access to healthcare that was not previously accessible. Both of these points will be essential to creating the healthiest population possible as the world benefits from digitalization and technology. (Word count 787)
- The supply chain of the future – new study finds digitization a top priority to drive next generation supply chain performance. (2016, May 16). Business WireRetrieved from http://search.proquest.com.ezp-prod1.hul.harvard.edu/docview/1789028010?accountid=11311
- Meena, H. (2016). The digitization of U.S. health care.The Mississippi Business Journal., 38(18), 20-20,23. Retrieved from http://search.proquest.com.ezp-prod1.hul.harvard.edu/docview/1789076868?accountid=11311
- Russell, K. (1997). Healing at a distance: Emerging technology can save patients time.The Mississippi Business Journal (Pre-Aug 20, 2012), 19(13), 8. Retrieved from http://search.proquest.com.ezp-prod1.hul.harvard.edu/docview/206576528?accountid=11311
- Prestridge, S. (1992). Attracting doctors to rural mississippi.The Mississippi Business Journal (Pre-Aug 20, 2012), 14(29), 13. Retrieved from http://search.proquest.com.ezp-prod1.hul.harvard.edu/docview/206564422?accountid=11311
- Lowery, C. L., Bronstein, J. M., Benton, T. L., & Fletcher, D. A. (2014). Distributing medical expertise: The evolution and impact of telemedicine in arkansas.Health Affairs, 33(2), 235-43. Retrieved from http://search.proquest.com.ezp-prod1.hul.harvard.edu/docview/1498231615?accountid=11311
- Butcher, L. (2015). TELEHEALTH AND TELEMEDICINE TODAY.Physician Leadership Journal, 2(3), 8-13. Retrieved from http://search.proquest.com.ezp-prod1.hul.harvard.edu/docview/1699520263?accountid=11311
- Hertz, B. T. (2013). Telemedicine: Patient demand, cost containment drive growth.Medical Economics, 90(3), 37-42. Retrieved from http://search.proquest.com.ezp-prod1.hul.harvard.edu/docview/1288726518?accountid=11311
Thanks for sharing this, Matt. Per your write-up, I think telemedicine will begin to play a bigger role in providing healthcare to rural or underserved communities. I recall reading this article (https://www.theatlantic.com/health/archive/2014/08/why-wont-doctors-move-to-rural-america/379291/) about how the dearth of applicants to medical school from rural communities ultimately led to fewer doctors serving those communities down the line, and made for worse health outcomes in such communities. Telemedicine creates an avenue for doctors who would otherwise not settle in underserved communities to provide healthcare to such areas, and could also lower costs of healthcare to patients since they do not have to travel to larger cities to receive specialized care.
My worries about telemedicine echo some of those you’ve outlined around physicians’ resistance to its adoption and relatively high upfront costs to the hospitals that adopt the technology. In addition, though, I worry that some of the empathy and bonds that doctors form with their patients may be lost when the interaction takes place over a screen and not in-person, and that this may impact the care which doctors put into their diagnoses. In addition, if patients are not able to properly explain their symptoms over video to doctors because they lack the vocabulary, and doctors can’t compensate for this lack of communication by physically interacting with the patients to get a better sense of what’s wrong, I worry about misdiagnosis occurring at a greater frequency in telemedicine interactions than in regular office visits. However, in the absence of viable alternatives, telemedicine is a worthy option for rural communities that would otherwise lack affordable healthcare options.
Matt, it will be very interesting to see where telemedicine goes in the coming years. I think telemedicine is attempting to solve two unique supply chain problems when it comes to healthcare. First, as you mentioned, this will keep many patients out of hospitals by meeting their needs remotely rather than having them step foot in a hospital and unnecessarily add to the backlogs. Second, telemedicine increases throughput per doctor, which serves to alleviate the critical shortage of doctors. In the U.S., it is estimated that the physician shortage will reach 90,000 in 2020 and 130,000 by 2025. I also agree with your assessment that the University of Mississippi Medical Center must partner with government and insurance agencies, lest they risk fragmenting the physician supply and have the reverse effect.
In addition to expressed concerns about having the face-to-face doctor experience, I am concerned that certain specialties such as mental health, gynecology, and anything to do with higher risk conditions will not be an accepted application. I think that these areas are too risky and even inefficient to not be handled in person. Rather, telemedicine, at least in the near term, should be reserved for diagnostics, consultations, and low risk procedures that do not require doctors to be present.
Matt, thanks for writing about such an exciting topic. Telemedicine, given advances in telecommunications technology, really does sound like a promising technology.
While I agree that telemedicine could play a meaningful role in a future healthcare delivery system, it seems that there are major challenges to adoption beyond what you’ve mentioned in your article. Beyond insurers and individual physicians, I can imagine physicians’ associations resisting this (to combat outsourcing of their jobs), reluctance of patients (including the poor/ elderly, who are least likely to be in a position to adopt the nascent technology but who most need the intervention), and regulators concerned about privacy, safety, and quality of care.
I’m curious what your take is on how telemedicine providers can overcome these constituencies while combating legitimate threats such as fraud and security concerns.
Thanks for you commentary, Matt.
I believe the opportunity for telemedicine is most promising in developing countries where lack of insurance, talent constraints and even travel costs required to access care alone are prohibitive. For example, in India, 75% of the population live in rural areas, while 75% of doctors operate only in major cities [1]. The efficacy of telemedicine has already been proven in India and fundamentally transformed the way that people in remote areas are receiving healthcare treatment.
However, this benefit comes with its challenges. Most notably, the initial investment to already resource-constrained hospitals make the implementation of telemedicine difficult. This presents a particularly paradoxical problem where the areas of the world that need this the most are the most challenging to places to implement. How do you think society, government and business should each play a role in quickening the pace of telemedicine adoption?
[1] Bagchi S (2006) Telemedicine in Rural India. PLoS Med 3(3): e82. https://doi.org/10.1371/journal.pmed.0030082.
Great article, Matt. Thanks for sharing. People talk a lot about the potential impact of telemedicine outside of the US (which, don’t get me wrong, is both massive and incredibly important), but seem to talk less of its impact within the continental US, which you’ve done eloquently here.
You spoke about the impact of tele-health on the specialty care domain, creating supply in remote parts of the US where it is more difficult to attract specialists. But I want to point out that there is also shortages in primary care, due to young medical professionals increasingly selecting specialized fields where earning potential is greater [1]. Unlike the problem in specialty, this problem is not geography-specific within the US. Telemedicine provides the opportunity not only for primary care MDs to offer care for unserved geographies, it also allows them to generally operate more efficiently, decreasing cycle times and increasing utilization. Beyond that, primary care is unique in that it allows physician’s assistants and nurse practitioners, which are disproportionately located in major metro areas, to provide lower cost primary care to remote areas. In this way, digitization dis-intermediates the traditional provider chain, such that patients can pay for only the services they need (which often do not require an MD), and therefore can reduce the cost of care further.
Source:
[1] Huffington Post, 2017 “Primary Care Is In Crisis. Here’s One Way To Fix It”
Thanks for this – I hadn’t considered telemedicine in the context of the United States before. In the developing world, telemedicine is a super hot topic and has attracted an enormous amount of funding and attention from big donors [1]. On one hand, telemedicine allows healthcare to be delivered into communities which are far too remote and far too poor to support high-quality physicians which are based locally. On the other hand, having telemedicine as a band-aid solution may make it less likely that governments will invest less in healthcare for the poor since international donors have already put in a “good enough” option. Moreover, for many critical health problems, the issue is access to affordable treatment. Between 2011 and 2014, the Gates Foundation funded a project in India to implement a telemedicine program for diagnosing and treating early childhood diarrhea [2]. The big problem: diarrhea is easy to diagnose and even easier to treat with a simple oral rehydration therapy. No amount of investment in telemedicine is going to ensure that treatment is delivered to those that need it most.
That said, this makes me wonder what other problems in healthcare could be solved by a more distributed model of delivery. I love the idea of giving access to top-quality diagnostics and advice for challenging ailments to hard-to-reach populations. But I also wonder whether there is opportunity to use what Mississippi is doing in a more generalized way to change healthcare delivery from a model centered around clinics and hospitals to a model based on the home – say, through Skype-based check-ins on your computer or at a local pharmacy. Beyond the benefits of improved access, maybe it could help reduce costly, unnecessary hospital traffic and facilitate an efficient, more call centerized approached to first-line consultative care. For most, the human connection is central to care, but I wonder how preference for such care is going to change over the coming decade. Insurers could have a big role to play since they may appreciate the cost savings opportunity – most, but not all, states have telehealth coverage in Medicaid [3], but many people still cite lack of coverage as a concern [4].
What isn’t super clear to me is how physicians will react. While the physician community more broadly seems supportive, but providing care to a computer screen is never going to feel as fulfilling as providing face-to-face care, so I wonder whether even junior physicians will be willing to dedicate themselves to teleconference-based work. If you can’t get high quality physicians on board, I worry about the ability to telemedicine to deliver the promised impact.
Sources:
[1] Overview of current practices and challenges of telehealth in the developing world: https://www.dovepress.com/telehealth-in-the-developing-world-current-status-and-future-prospects-peer-reviewed-fulltext-article-SHTT
[2] Failure of Gates-funded telehealth franchising model to improve childhood diarrhea in rural India: https://sanford.duke.edu/articles/acclaimed-program-fails-improve-health-care-children-rural-india
[3] State coverage of telehealth services: http://www.ncsl.org/research/health/state-coverage-for-telehealth-services.aspx
[4] Great WSJ article on early state and early impacts of telemedicine in the US: https://www.wsj.com/articles/how-telemedicine-is-transforming-health-care-1466993402
This is an interesting topic Matt! There are many positive things related to telemedicine, specially in low-income areas. In places where the supply (doctors) cannot meet the demand requirements (patients) the ability to let doctors in developed countries examine patients in underdeveloped countries will help reduce the existing gap.
My biggest concern is how to make this viable/profitable. Assuming people in underdeveloped countries cannot afford the price that doctors from developed countries demand, which mechanisms can be established to make this happen? Another concern I have regarding telemedicine with underdeveloped countries is the delivery of medicines. One thing is to connect doctors and patients, and another more complicated issue is how to take the medicine to the patient.
Thanks for writing this blog post Matt! I agree that telemedicine is the way of the future and a viable way to make healthcare more accessible to many people who don’t currently have access. However, one other big challenge that comes to mind is that not all EMRs have the capability to integrate with telemedicine technologies. At athenahealth, where I worked prior to HBS, we partnered with several telemedicine companies to create opportunities for our providers to adopt the technology. However, EMRs, especially the smaller, custom EMRs, struggle to integrate telemedicine services into their existing technology.
In addition, in a survey of 500 tech-savvy consumers, 39% indicated that they hadn’t heard of telemedicine and 42% said they preferred in-person doctor visits. [1] That being said, some of these concerns will likely be addressed with time but worth considering as this technology makes its way into the industry. Assuming with time, these issues are addressed, I’m still left with one concern as it relates to telemedicine – are patients trading in quality for convenience?
[1] https://www.wsj.com/articles/how-telemedicine-is-transforming-health-care-1466993402