By Johnathon Harris and Matthew Cryer

Medical Innovations:

The Rise of Telemedicine

By Johnathon Harris and Matthew Cryer

The growth of telemedicine has greatly expanded during the COVID-19 pandemic, in part due to its unmatched ability to continue care with patients while ensuring patients could socially distance; dramatically reducing risk of transferring the COVID19 virus.1 From 2019 to 2020, telemedicine visits for patients using Medicare increased by a factor of 63, from 840,000 to 52,700,000.2 Though the number of telemedicine visits has declined since the start of the pandemic, as of February 2021, there was a stable 38-fold increase in telemedicine usage in the U.S., which represents 13-17% of all medical visits.3 In a national survey conducted by the Harris Poll published April 2020, 35% of respondents would consider replacing their primary care provider with on-demand telemedicine visits.4 As a result of both advancement in information technology and the unique demands imposed on providers in a post-pandemic world, telemedicine as a medium for delivering quality health care is here to stay.

Telemedicine is considered a subset of telehealth and is defined as, “the exchange of medical information from two separate sites via electronic means to improve patient health.”1 It began over 70 years ago when hospitals started to share information via telephone.5 This audioonly form of telemedicine was improved upon by the 1960s when the University of Nebraska used a two-way interactive television, allowing its medical students to accomplish neurological examinations of standardized patients.6 With the invention of the internet and increased availability of transmitting devices, telemedicine has continued to evolve into an important tool for both clinicians and patients. It is currently used to provide high-quality health care to patients, regardless of their location or ability to travel.

Today, telemedicine is being incorporated in medical school programs, graduate medical education and in physicians’ practices. At the University of the Incarnate Word School of Osteopathic Medicine (UIWSOM), telemedicine was successfully used to allow osteopathic students the ability to interact with standardized patients during times of quarantine. UIWSOM students were taught how to accomplish a medical interview and physical examinations to include musculoskeletal and skin exams through a program that allowed for video/audio exchange, all from the safety of their homes. In 2020, the Accreditation Council for Graduate Medical Education (ACGME) approved the use of telemedicine for residents in certain programs through the academic year of 2021.1 Resources have even been made to help assist physicians with telemedicine, to include a guide on how to accomplish a virtual physical examination, how to accomplish a musculoskeletal exam and even more guides for more specific examinations, such as a virtual dysphagia examination.1 Along with benefits of reduced exposure to infections and an increased reach of health care to anywhere in the world, physicians are able to learn more about their patient and their current living conditions in ways that were not possible before telemedicine, such as the ability to get a visual tour of the patient’s home.1

Moving into the near future, telemedicine will likely have increased usage as a tool to help patients determine if and when they need to physically come into the hospital. It has already made its way into some emergency departments as a first triage before their visit to the emergency department.7 This has helped patients get screened from the safety of their home, protecting both physicians and the patient during the pandemic. Expanding this in the near future, the authors of this article believe that telemedicine could serve as a way to cut down wait time at hospitals and emergency rooms, while also allowing for the receiving hospital to better prepare for their incoming patients. Instead of a patient walking into an emergency department unannounced and then having to wait for hours based on their triage

position, the patient could call into the emergency department’s telemedicine line, be triaged at home, and then be told what time to come in. This would also allow the emergency department time to prepare for the patient and have all the needed equipment ready. Although the patient would wait about the same amount of time, it would be in the comfort of their own home, decreasing the amount of exposure to other illnesses, since less people would be in the emergency waiting room.

Three major ways the authors envision telemedicine advancing are multi-provider conferences with patients, telemedicine across borders to address supply and demand disequilibrium, and continued developments in the field of remote patient monitoring.

While it may seem obvious to most of us in the post-pandemic world that doctor-patient telemedicine conferences could include multiple providers, such as a patient’s primary care provider (PCP) and their specialist, the reality is that doctor-patient visits outside of formal hospital rounds rarely, if ever, include multiple providers. When dealing with providers that are not physically in the same space, it is understandable why this has traditionally been the case, but with the major advancements in teleconferencing technology we have seen in the last decade, the only major obstacles standing in the way of patients being able to converse with multiple providers at once are billing and scheduling. While billing and scheduling are not insignificant issues, in-hospital medicine has already accounted for both of them, and inasmuch as the providers are in the same health care system, this is not likely to be a major issue going forward.

Supply and demand disequilibrium can be characterized as the demand for medical care outstripping the supply of those who are qualified to provide it (i.e., providers). Certain specialties in some areas of the U.S. and the world at large may at times develop a surplus, such that the local market for that particular specialty becomes oversaturated with specialists of that particular stripe. In those cases, future developments in multi-jurisdictional licensing could allow those specialists the experience of much local demand to provide their services to patients that live in areas without a sufficient supply of care. Through the Interstate Medical Licensing Compact, the ability for physicians to provide telemedicine care to patients across state lines exists today, with 37 states or territories having joined the compact to date.8,9 Cross-border health care has already been adopted in the European Union where patients in one country can use telemedicine to receive care from a provider in a different country.10 Given the ever-advancing interconnected nature of our global society, we predict that telemedicine across borders, be they state or national, will become increasingly more common and necessary as the supply and demand disequilibrium for doctors and patients continues to worsen.

Although telemedicine has been around for the better part of a century, recent use and developments have made it an integral part of health care both today and into the future. References 1. Ong, M. K., Pfeffer, M., & Muller, R. S. (2021). Telemedicine for

Adults. UpToDate. https://www-uptodate-com.uiwtx.idm.oclc.org /contents/telemedicine-for-adults?search=telemedicine &source=search_result&selectedTitle=1~128&usage_type=default&display_rank=1#H56211279 2. Samson, L., Tarazi, W., Turrini, G., & Sheingold, S. (2021).

Medicare Beneficiaries’ Use of Telehealth Services in 2020 – Trends by Beneficiary Characteristics and Location. Issue Brief No. HP2021- 27. Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. 3. Bestsennyy, O., Gilbert, G., Harris, A., & Rost, J. (2021). Telehealth: A quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company. https://www.mckinsey.com/industries/ healthcare-systems-and-services/our-insights/telehealth-a-quartertrillion-dollar-post-covid-19-reality 4. The Harris Poll. (2021). A year of life in the pandemic. https://theharrispoll.com/wp-content/uploads/2021/03/Harris-Poll-

COVID-1-year-FINAL-3.pdf 5. Teoli D, Aeddula N. R. (2021) Telemedicine. NCBI. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm. nih.gov/books/NBK535343/ 6. Institute of Medicine (US) Committee on Evaluating Clinical Applications of Telemedicine. (1996). Telemedicine: A Guide to Assessing Telecommunications in Health Care. Washington (DC):

National Academies Press (US). https://www.ncbi.nlm.nih.gov /books/NBK45445/ 7. Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh,

J., Aljadah, M., Chakinala, R. C., Kanugula, A. K., Solanki, S., &

Chugh, S. (2020). Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Family medicine and community health, 8(3), e000530. https://doi.org/10.1136/fmch-2020-000530 8. Maheu, M. (2020). COVID-19: Telehealth across state lines and international borders. Telehealth.org. https://telehealth.org/covid19-telehealth-across-state-lines-borders/ 9. Interstate Medical Licensure Compact. (2021). https://www.imlcc.org/ 10. Glass, L. T., Schlachta, C. M., Hawel, J. D., Elnahas A. I., &

Alkhamesi, N. A. (2022). Cross-border healthcare: A review and applicability to North America during COVID-19. Health Policy

Open. Volume 3. ISSN 2590-2296. https://www.sciencedirect. com/science/article/pii/S2590229621000356

Johnathon Harris and Matthew Cryer are medical students at the University of the Incarnate Word School of Osteopathic Medicine.