Telemedicine is not new to me. I led a project deploying telemedicine technology in the Amazon jungles of Venezuela and other rural and critical access places in both the State of Bolivar and the Federal District of the Amazons, located in the Southern part of the oil-rich country.
This project occurred during the mid 90s and it was funded by a government grant spurred by the outbreak of the dengue fever.
On one side there was a tribe of Arawakan (Yanomamis) natives as patients, which were suffering from complications of the dengue fever outbreak, along with a small group of physicians, paramedics and engineers, and on the other side, 12 driving hours away, a university hospital with specialists of varied disciplines and a large group of medical students.
The video technology was used to provide the means to allow the university hospital doctors to assess the complications and provide requests for specimens, treatments or recommendations.
The program didn’t last long. The grant dried out and it was too expensive to sustain for any practical means. There were political agendas fighting a tug war behind the scenes, dengue fever became commonplace throughout the Americas and was no longer confined to the jungles which had attracted international media due to its mysterious appeal.
The technology in those days wasn’t by any means primitive but it wasn’t perfect; it was costly and it required a lot of technical overhead to maintain operating adequately in remote areas where even the electricity had to be transported along with it.
Let’s quickly transport ourselves forward quarter of a century through time.
Video technology has advanced significantly in speed and resolution and you can view more detail at a tolerable speed. Tablets and phones came around and video chatting has been readily available from the get-go.
There’s Apple’s FaceTime and Google’s Hangouts which have been popular among the least-aged population. These applications lend themselves to personal video chats.
We have other services that have provided ubiquity and ease of access to video calls and conferencing, such as: Skype, LifeSize, Biscotti, Zoom and Oovoo, among many, that have a presence in some homes and companies.
But despite all of these technologies and the ubiquity and ease of access the consistent adoption is not that high. The use is rather sporadic and capricious.
I am a big fan of technology, reason why I’m a technology engineer and architect. In my house there are 9 computers immediately accessible with video technology. Each one of my 9 TVs has a video camera. Yes, I have a TV in each and every room with the exception of the dining room. Technology is not allowed in the dining room with the exception of the light fixtures. Most of the technology is Skype or Biscotti. I acquired Biscotti to be able to integrate with H.323/SIP based systems. If you did the math, and include the smartphones and tablets, my family and I have access to 25 video capable devices!
For the past 6 years I’ve dwelled at more than one abode so I installed the sophisticated network of video cameras throughout the homes to keep in touch with my family in a personable way, or at least that was my thinking.
Albeit I spent a fortune in video technology it seldom gets used if at all.
So it’s not the technology and the ubiquity of it, it’s the lack of culture of use that impedes its adoption, in my opinion and from my direct experience along with my family. It’s easier to just pick up the phone and call or send a text message. When my family and I communicate from a distance, video conferencing is the last thing that comes to our mind. When we do use it, it has more to do with showing me some new garment or the latest cool trick one of our four legged hairy family members just learnt.
But for some reason, maybe just money, I don’t really know, there are companies out there that are touting telemedicine or telehealth as the next BIG thing in healthcare.
I will not deny that it has an appeal to it but the arguments that the technology promoters use are mostly flawed:
Doctors will have more time to attend patients is a common argument and the most flawed of them all, in my opinion. First of all, the doctors time is finite whether in person or via telemedicine. If you have been a patient lately you must have witnessed that a typical visit consists of several encounters with various clinicians. The attention span of the primary physician you are visiting is similar to that of a squirrel. I’ve clocked this and out of the hour long visit, my primary physician or the specialist interact with me a couple of times in micro-instances of less than 3 minutes each. The physicians in their practice offices attend several patients in the window of an hour. With telemedicine the accustomed orchestrated workflow of the physician and the clinicians comes to a stand-still with a slot of time frozen between the physician and the patient participating in the video link.
This is one more area where physicians view technologists as out of this world, and not in a good sense, and they have a right to have an opinion of that nature!
Just because its beautiful in technology and it looks cool in movies like Star Wars doesn’t mean it will work and fit in a real medical setting.
Another silly claim is that telemedicine can integrate with the EMR and the patients electronic health record. First of all, doctors walk around their practices with the EMR laptop in their hands while moving from patient to patient in the attempt to maximize the results of the orchestration of the entire practice in order to attend as many patients as possible in a specific time frame.
Just to make the above claim true the interoperability requirements are of a maturity level that is way beyond what exists today and probably for the next decade.
Telemedicine will bring the costs down is the one that sounds like a used car salesmen line. Physicians have been fighting for parity laws so that if they are forced to use telemedicine they will be able to be compensated in the same way as if it was an in-person visit. Costs will not go down and efficiency will not improve.
There will be cases where patients would require telemedicine and there should be services that do provide it. But these are special cases and not related to the mass adoption that technology vendors have been trying to push.
I have also observed that physicians use telemedicine or telehealth to capture new patients and attract them to their practices. The story usually unfolds with a patient requiring a prescription and the doctor indicating that he/she can provide the order but for a short period of time and that if the patient requires constant refills he/she must have an in-person visit. Hooked.
But what will happen once the practice has a steady flow of patients. Will the doctor continue fishing for patients via phone or video? I doubt it. Busy doctors don’t have time for petty video-chats.
Technologists will continue pushing technology for the sake of itself. Investors will continue seeking the next unicorn. Some doctors love technology and evangelize it even if they don’t practice anymore. Startups will come and go. All in all, dreams are good for the economy.
So, who wants to video-chat with me today? Doctor?
Clarification note: Telemedicine is referred to in this article simply in the context of audio/video-conferencing that takes place between a physician from the practice site to the home of the patient as the originating site. It is not the intent of the article of stating that the use of telemedicine between practitioners at different locations isn’t valuable. Like I indicated in a paragraph above, there are cases where telemedicine has a lot of value and patients will require this type of service. But mass-consumer scale telemedicine has a long way to go, in my opinion.