A new article in the New England Journal of Medicine takes a controversial stance on the topic of whether an in-person doctor's visit is always "Plan A."
Perhaps, the author argues, we are moving towards a time when patients will be better served by a model in which in-person visits are actually the "last resort" of care.
Our take? Yes and no. Read on...
In "In-Person Health Care as Option B", Sean Duffy and Dr. Thomas H. Lee advocate for a new framework for healthcare visits. Rather than seeing telehealth visits or other virtual options as "in the meantime" approaches or ways to cut costs, they argue that perhaps patients can be cared for better when in-person visits become much rarer, only used when absolutely necessary.
They describe the analogy of a tech support ticketing system, as might be used at your favorite software company. Perhaps a patient would submit a "ticket" with their concern or medical issue... it would be handled first via telehealth means (even automated or low level support at first)... only being "escalated" to an in-person visit if absolutely necessary. And the ticket wouldn't be closed out until or unless the initial complaint was resolved.
The technology is there, the authors contend. “Smartphone penetration of the mobile-phone market increased from 17% to 81% between 2009 and 2016.” And the reality is that in many ways, our medical system is already moving in this direction: "At Kaiser Permanente, for example, 52% of the more than 100 million patient encounters each year are now “virtual visits.”
One important point that the authors make is that doctors are often approaching care this way currently -- but with improvised methods that aren't really meeting the provider's or the patient's needs. True enough: “Virtual visits are more convenient, but there’s a difference between recreating an in-person approach with digital tools and designing the safest and most efficient way to achieve an optimal outcome." Further, if doctors are simply using text messaging, email, or informal photos to replace a visit, that's not a safe or sustainable way to replace the richness and HIPAA-compliance of a real visit. Also, improvised approaches tend to be lesser replacements for in-person care, rather than innovative ways to save money AND get a better result.
Although we agree that there is a lot of potential to rethink how we approach clinical visits in healthcare, we also worry that the authors' approach isn't appreciating some of what can be lost if telehealth approaches aren't designed thoughtfully.
For instance, the example of the tech support "ticketing" analogy would fall severely short of our goals for any medical visit. Sure, the patient's complaint needs to be addressed. But medicine is more complex than software.
So any approach to increasing the use of telehealth solutions also must:
- Support medical education.
This means that simple videoconferencing or "e-visits" likely aren't sufficient, as they don't create an archivable, searchable, teachable record of the encounter.
- Provide holistic care to the patient.
Support not just solving the immediate problem, but truly caring for the patient -- which doesn’t always just mean solving only the problem the patient presents with.
- Enable providers to collaborate effectively.
It would be a tragedy if telehealth caused a further silo-ing of providers across specialities and across the continuum of care.
Healthcare needs innovation, certainly. And technology will be a crucial part of any solution that stands a chance of survival moving forward. But we advocate for approaches that truly support access, education, and collaboration -- not just completing a ticket and checking off a box for a patient.
To learn more about alternative technologies for telehealth, download our Quick Guide to Hybrid Store and Forward Telemedicine®: