I write about telemedicine a lot on this blog because it’s one of the ways I continue to earn some income and it’s interesting to me to see the evolution of this side of healthcare. This particular post is about the future of telemedicine based on where key players are spending their money.

My colleagues unanimously agree that telemedicine is not a good direction for medicine, decrease the quality of the health care they can provide. For the most part, I agree with this sentiment.

However, medicine is a consumer driven retail space and has been evolving in that direction since HMO’s came on the scene. Our physical exams don’t garner as much trust as a chest x-ray or an MRI.

Replacing the clinician with technology isn’t good for patients. They end up emotionally suffering for months because the clinician chose to order a serum HSV 2 antibody test which isn’t diagnostic of genital herpes. Or their OTC biotin intake results in completely inaccurate lab results.

Labs, imaging, EKG, and endoscopies continue to get highly reimbursed by CMS and insurance groups and so we keep ordering them. It’s a patient satisfier and what has been shaping the future of telemedicine.

Patients vie for prescription medications more than ever before – the antibiotic craze blows my mind regardless of the data coming out about the importance of the biome and gut flora. Ironically, we even have fecal transplants to deal with the gut genocide of antibiotics.

Medicine’s Novel Ideas

Let’s not forget that medicine, as it’s currently practiced, is still a novel phenomenon. Antibiotics didn’t even exist properly before the 1940’s. MRI’s weren’t used diagnostically until the 1980’s.

Telemedicine is older than the antibiotic – circa 1880’s. So the future of telemedicine has been paved for 130 years.

There are people alive today who never had access to antibiotics as kids and lived in a time when x-rays were used in rare circumstances.

Patient-targeted information that’s available online is also a fairly recent phenomenon. Previously, a patient would have to comb through medical textbooks and medical journals and still couldn’t get their hands on the practice of medicine which still remains an apprenticeship and is only being transcribed as physicians are turning to medical writing.

The future of telemedicine is certain because it’s a low-yield, high-volume interaction; low clinical information yield but high client turnover. This satisfies the desires of the consumer who reads about how strep throat presents and incorrectly assumes they have strep throat and just need a quick check-in with their clinician to get past the prescribing hurdle.

The Ideal Patient-Selected Medical Practice

I could be reading this completely wrong but my patients would be ecstatic if they could see me in the room and then have a menu to choose all the tests they want based on whatever it is they are worried they have.

They would want me in the room to tell them what they want to hear about the tests. On one hand they’d want to know that an ultrasound is better for evaluating the gallbladder than a CT. On the other hand, they wouldn’t want to hear that the contrast medium in an MRI could be potentially detrimental to their health.

I am not saying this maliciously. It’s the danger of not knowing what you don’t know. And I have considered that perhaps I exaggerate the way patients view healthcare but I can’t help feel that we are treating patients without knowing how they would have faired alternatively, then using the positive outcomes as further proof to keep doing what we’re doing.

What About Telemedicine?

The reason healthcare trends can be predicted is because the big players in healthcare are transparent with their spending and marketing.

When a trend-setters like Kaiser Permanente are aiming to make 60% of all their patient touches digital, you can’t resist telemedicine. KP hires some of the best market research companies to find out what their target audience wants.

Almost every big player in healthcare is investing in artificial intelligence. AI is becoming the backbone and replacing the initial interactions with the patients. This allows for data collection, which itself is incredibly valuable, but also allows for an unbiased interaction with the patient by extracting the clinician.

2017 was an incredible year for telemedicine. The number of VC-backed startups skyrocketed and the number of laws passed to advance telemedicine were just as impressive.

What Customers Want

Patients, now mostly referred to as clients or customers, want:

• transparency in their care
• technology
• making their own decisions about their health
• options
• easier access without dealing with crabby staff
• immediate access to a clinician
• access to specialists
• medications of their choice
• their choice of imaging and lab tests

We have tried denying patients such things for a long time. For no reason other than trying to protect them from the greedy medical industry.

Pharmaceutical companies and medical device companies are the ones driving technology and research. Look at any research paper and 90% are funded by the same entities that are researching the product in question.

I’ve done research, lots of it, with lots of publications; just like the majority of my colleagues. We may not be your traditional scientists but we understand that data can be altered and cooked in order to achieve a desired result.

Fighting The Good Battle

Some of my colleagues still fight the good battle and refuse to give into pain medication requests, antibiotic requests, and unnecessary imaging or lab tests. Though I can’t think of a single one who has been doing so for several decades – it’s the sort of trait that has a very short fuse.

The majority of my primary care colleagues order alk phos and complement levels on every other patient – or whatever is the in vogue – heavy metals, immunoglobulin levels, CA125 or BNP. Vicodin is prescribed prophylactically and a cholesterol of 101 means that the patient needs a statin.

I don’t want to say that we’re losing the battle but retail medicine isn’t going away anytime soon. It’s not just primary care doctors who are giving in but surgeons are performing surgeries that they’d never want for themselves or a loved one.

Future of Telemedicine In 2018 & Beyond

Now on to the fun stuff. I don’t mean to paint a grim picture of medicine so let’s focus on the good stuff that’s coming to a clinic near you.

There will be a ton of new personal medical devices coming to the market in 2018. With the backbone, the software, having been developed, it’s really easy for device manufacturers and hobbyists to create the right hardware.

Personal Technology

In 2018 expect most patients to have their own:

• dermatoscopes
• holter monitors
• EKG’s
• continuous blood pressure monitors
• otoscopes
• retinal cameras
• continuous glucose sensors
• pulse oximeters
• tissue perfusion sensors
• intelligent apps that read rashes
• spirometers
• home specimen test kits

The future of telemedicine rides on the back of advanced hardware technology. Though in years past it was software that was designed around hardware, the current cheap methods of hardware production have turned that paradigm around.

Specialty Telemedicine Sites

Most telemedicine sites are focused on primary care and a lot of family medicine and internal medicine physicians are providing the care to such patients without adequate representation by specialists.

It’s harder for patients to get in to see specialists so I expect that side of telemedicine to blossom.

The argument that having telemedicine for specialists will decrease their overall reimbursement is unwarranted. The shortage of healthcare professionals and the lack of access to them is so dire that it will increase everyone’s income, not decrease it.

Diagnosing vs Guiding

Healthcare professionals have a big burden on their shoulder to make the right diagnosis and come up with the next steps. We see so much vertigo but so little subclavian steal syndrome that we shuffle these misdiagnosed patients around for years.

Not only do we under-diagnose some diseases but we over-diagnose others such as ALS – which then prevents the proper diagnosis from being addressed in a timely fashion.

With the help of AI, patients will get screened for the most uncommon of diseases, allowing the clinician to focus on the common things and improve their management of the less common.

The future of telemedicine is tightly dependent on deep machine learning and artificial intelligence technology. The telephone or video consult is only the tip of the iceberg of a telemedicine visit.

Shorter Clinic Wait-times

There will be an initial lag but clinics could become less crowded – or maybe that’s wishful thinking. The lag will likely exist because patients won’t adopt telemedicine in a timely fashion.

After some time, when telemedicine becomes the norm, patients will learn self-selection and turn to telemedicine for basic things and preset for F2F visits for higher acuity needs.

Higher Clinic Acuity With Longer Visits

As more patients turn to telemedicine for their bread and butter care, higher acuity patients, older patients, and more complicated patients will take up the clinician’s time in the clinics.

More services will be offered in the clinics and higher risk testing will be shifted out of the inpatient setting to the outpatient setting.

Medical groups such as Healthcare Partners have been doing this for a long time. Their outpatient mini hospitals have been running successfully for over a decade – staffed by hospitalists and occasionally ER doctors.

Health Vending Machines

Vending machines aren’t just there for tampons and condoms. They can also dispense medications, offer point-of-care testing, and accept specimens for testing/cultures – these already exist but limited due to state regulations.

I find this exciting. Imagine patients being able to pick up their medication refills from a vending machine. Sure, you’d need a pharmacist to babysit it but babysitting technology is now the norm in damn near any field.

2018 will be the most exciting year for the retail pharmacy industry. Have you followed CVS’ moves since 2014? Navarro, Target, Aetna… Vanguard surely has noticed.

Busier Clinicians

I know specialists are busy – you guys and your 15 patients a day! (jk) But with telemedicine springing up everywhere, expect to have a lot more patient-touches.

Sure, you may not have to diagnose and treat each one you’ll interact with. But both the primary care docs and the specialists will have to be connected a lot more and interact a lot more with the patient, their family, and their staff.

Transcribed Visits

Scribes are becoming a lot more prevalent and most of my colleagues who use them are quite content. The future of telemedicine involves digital transcription services.

The digital scribe is already being rolled out and could make documentation much easier. Recording an entire visit is akin to cops wearing body cameras. It creates way too much data but once the cybersecurity piece is solved, it’s something that many companies want to roll out and push through legislature.

http://ctel.org/2017/12/telehealth-in-2018-what-can-we-expect/
https://www.fiercehealthcare.com/it/health-it-priorities-for-2018-cybersecurity-patient-generated-data-artificial-intellegence
https://connectedmed.com/topofmind2018
https://www.pharmacist.com/pharmacy-vending-machine
https://www.addiction.com/5394/will-next-prescription-come-vending-machine/
https://www.specialistsoncall.com/
http://tele-specialists.com/why-telemedicine.php
http://www.upmc.com/healthcare-professionals/physicians/telemedicine/services/Pages/default.aspx
http://www.md-plus.com/specialty-telemedicine.html