Telehealth has the potential to greatly expand the reach of medicine, not only in remote areas around the globe, but also for various socio-economic groups, according to an article in The New England Journal of Medicine.
Technology has the potential to disrupt established patterns of care and address ongoing concerns about the distribution of providers, according to the authors, E. Ray Dorsey, M.D., of the University of Rochester Medical Center, and Eric Topol, M.D., with the Scripps Research Institute.
They point to three trends shaping telehealth: a shift in focus from increasing access to convenience and lower costs; expansion beyond addressing acute conditions such as stroke to wider uses including chronic care management; and the movement away from hospitals and clinics to patient homes and mobile devices.
Various telehealth organizations now offer e-visits at less than $50, while a 20-minute appointment with a doctor, including travel time, can take two hours--and cost significantly more, Dorsey and Topol note.
One major limitation on telehealth is reimbursement, though 29 states have telehealth parity laws. The real laggard is Medicare, they say. Other issues include lower-quality patient–physician relationships, fragmentation of care, multi-state licensure and liability. The biggest issue, however, is the digital divide, in which the elderly, lower income and less educated are less likely to have the technical means to access telehealth.
The doctors foresee a future in which wide adoption of smartphones will enable a range of diagnostic and monitoring capabilities, combined with patient-generated real-world data, including from sensors, to aid doctors remotely.
The doctor “visit” will change, rather than replicating traditional encounters to play on the strengths of telehealth. Visits likely will be shorter and more frequent, using multiple means of communication with diverse providers.