There is no doubt that the COVID-19 pandemic has challenged our healthcare system like nothing before. We have confronted other diseases like influenza, tuberculosis, AIDS and even the opioid epidemic; but we have never before shut down the world economy or put the citizens of the entire country on quarantine.
Whatever the response, the consequences will be far-reaching, especially for physicians who will be expected once again to rapidly adopt new technology. Rather than resist, we should take the opportunity to explore how digital healthcare can restore the primacy of the doctor-patient relationship.
Physicians—and surgeons in particular—are always accused of being old school, set in their ways or late adopters. Granted, by definition, doctors are schooled for years to absorb a significant amount of information derived from years of research and clinical observation. It is only when training is completed that we are allowed to veer off the prescribed path and tailor treatment to better fit a patient’s needs.
It is from the patient who “didn’t read the textbook” that we learn most. Therefore, surgeons are actually programmed from the start to adapt to new situations, guided by years of knowledge and experience. How else would we be able to safely use new devices, learn new procedures or prescribe new therapies?
However, over the past decade, we have seen doctors struggle to enter data, write orders or properly document into electronic medical records. Despite the many generations of physicians who have now “grown up” with technology, rather than getting better, we seem to have gotten worse and electronic health records are still the number one cause of physician burnout.
Part of the reason is that no one ever bothered to ask the physician—or the “end user”—what would mirror our workflow best. Instead, billers and schedulers were given priority; it’s no wonder many companies built electronic records on top of their existing revenue software. Now, with digital healthcare upon our doorstep, we have the opportunity to not just embrace the technology but also decide for ourselves how best to use it for our patients.
Telehealth is not a new concept. The software for secure video conferencing has been around since astronauts first entered the space station. We have been using digital technology to read images from afar, to render second opinions and to connect intensivists to critical care units.
Until now, the average brick-and-mortar surgeon has not had the chance to use it for their own patients. Granted, surgery is a contact sport, and the physical exam is critical to our decision-making— most of the time.
However, a good history and a review of available data is a significant part of any diagnosis, especially in a nonurgent setting. As long as communication exists directly between both physician and patient, why couldn’t a virtual examining room be as effective under the right circumstances?
There is no doubt that telemedicine visits may be less convenient for the physician, and there are challenges for the patients, too—particularly among the elderly population. The concept also requires a different workflow for follow-up care; you can’t simply tell patients: “Check with the front desk on your way out.” But if we work through these issues as end users, we can adapt the technology to fit our needs rather than the reverse, as was the case with electronic records. Digital technology can streamline access, eliminate wasted steps and connect the patient to the proper point-of-care faster.
The cost of running an office will decrease as some office hours become virtual. Thus, more attention can be given either to new patients or to those who have to be seen in person. On the patient side, many would be grateful not to have to leave work, wait in a crowded waiting room for a five-minute follow-up or take up an appointment slot that can be given to a new patient.
In addition, remote specialty care can limit transportation costs and challenges for the elderly in long-term care facilities. In other words, the benefits of telemedicine when incorporated into an existing practice may far outweigh the costs.
Which brings us to the challenge: Once the smoke clears, and the insurers and the Centers for Medicare and Medicaid Services (CMS) start to pay attention, will telemedicine remain reimbursable on a par with in-person visits? Or will claims be adjusted for site-of-service? Will physician licensing extend beyond state lines? All of these issues will need to be worked out, but it is important that we remain actively engaged.
The wait times for specialists will only become worse as treatments become more specialized, and after many years of limiting residency positions, it will take just as many years to train enough doctors to meet the demands of the near future.
Direct-to-consumer models are driving medicine toward lower cost/higher value options, and with expanded health savings accounts and new federal requirements for price transparency, physicians have the opportunity to eliminate obstacles and be directly accessible. Digital healthcare enables a stronger doctor-patient relationship. Together we can reinvent healthcare. It is our responsibility not just to be part of the solution, but to lead the way.
Paula M. Muto, MD, is a general and vascular surgeon based in the Boston area. She is also CEO and founder of UBERDOC, a web app that connects specialists and patients.