Telemedicine’s Tipping Point

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Sheltering in place has pushed virtual health care into the mainstream. Will we go back to doctors’ waiting rooms?

In February — the month before Covid-19 hit Boston — Partners Healthcare, the huge health system that includes Massachusetts General Hospital, treated 1,600 patients via video visits.

By April, the number of patients seeking care through Partners’ video service had swelled to 242,000.

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We’re not the only ones,” said Joe Kvedar, a dermatology professor at Harvard Medical School and a telemedicine advocate at Partners for three decades, in a May webinar. The same thing was happening across the country as the Covid-19 pandemic made in-person visits at doctors’ offices dangerous for patients and clinicians alike.

Regardless of when the Covid-19 threat dissipates, video visits have crossed a tipping point to become a mainstream way to obtain care, says cardiologist Joe Smith, coauthor of an overview of telemedicine in the Annual Review of Biomedical Engineering. “I don’t think we go back,” he says. “For a long time, hospitals have been the cathedrals of health care where patients have to come. But people are now seeing that they can get their health care in the safety and comfort of their own home.”

Video visits are a form of telemedicine, a term used for technology-enabled ways to deliver virtual medical care (some also use the term telehealth in this context). Telemedicine includes phone calls and secure email, of course, but a lot more as well. Heart-failure patients can be “remote-monitored” in their homes, for example; a smartphone app can alert digestive-disease patients about problems before they occur; and knee-replacement patients can receive physical therapy at home from a virtual assistant named VERA.

Video visits, primarily offered by commercial companies like Teladoc and AmWell, have become more frequent over the years. But they have never become common. Smith, who now runs two telemedicine companies, says that disincentives such as lower payments than for in-office visits and required changes to office processes have discouraged physicians and health systems from embracing them. Thus, many patients are simply unfamiliar with video-delivered care.

“We adopt technology probably slower than any other industry in the US,” Smith adds. “A rubric inside of health care is that change is bad even if it’s change for the better. So it’s been a real challenge.”

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