Healthcare in the United States is struggling.

We need better care, more innovation, and to drastically cut the cost of care. We need everyone in the US to be insured, and we need to make sure that regardless of income, you have access to fantastic healthcare.

It is possible that small, incremental changes aren’t going to get us where we’re trying to go — it’s important for us to act boldly and to dare to rethink how we do medicine. But the reality is that our mindset tends to trap us into using even groundbreaking technologies in old fashioned ways. And a new VA program is no exception.

As Fierce Healthcare reports, the VA has gone in big with a new telehealth program. 

In a span of just 11 months from 2017 to 2018, veterans received care in 2.3 million episodes of telehealth. About half of these were video "visits" from veterans to providers; the other half was VA staff accessing or reviewing data sent via similar means.

It's inspiring to notice how much traction telemedicine has gained in the last several years. It has truly gone from something that very people understood or knew about — to something that many people will have contact with as a patient at some point soon. And I also applaud the willingness of the VA to adopt a new technology and implement it in an expedient manner. 

That said, I worry that the VA has found a more affordable way to provide care — having veterans have virtual visits with providers rather than in-person visits — but not a better way to provide care? In one way it is better: veterans don't have to leave home to be "seen" by a provider. But I worry that the quick telehealth virtual consult might lose the richness that an in-person visit can offer. For instance, perhaps the "doorknob" questions won't happen — those offhanded questions a patient asks once the doctor's hand is on the doorknob, on their way to another appointment... which often turn out to be the most important part of the visit. 

Beyond that, the expansion of these telehealth visits makes me think of another time in our history when we used a new technology in old fashioned ways. When the telephone was invented, no one could fathom wanting to have a conversation by phone — so the first phones were actually a tool to read telegrams aloud. We used our old fashioned telegram concept to shape how we used the new technology of the telephone. 

Similarly, we often use telemedicine as a "better version of the telephone" — and that's precisely what these VA telehealth visits are. Just as with the telephone, weak points of the system abound: no medical collaboration occurs because it is simply a 1:1 call; the case and information isn't archived or accessible to other team members or accessible for learning; schedules have to be coordinated for each visit to occur. It's using telemedicine as a fancier telephone — just as we initially used the telephone as a fancier telegraph.

I think it's important that we try to envision the highest and best use of the telemedicine technology we now have. To me, that means using it to facilitate asynchronous medical collaboration among medical teams. Because ultimately, that is the way to provide better care, not just cheaper care.