In the early 1960s while planning for the moon landing, NASA recognized the need for power tools that could be safely operated in space. The space agency partnered with Black and Decker to develop hand-held drills that could extract rock samples from the moon. Several years later, this research was used to develop the popular Dustbuster vacuum. Around the same time, NASA wanted to know the impact of space flight on the human body. To assess whether space flight was compatible with human life and to treat astronauts in space, NASA pioneered the development of telemedicine technology.
In 2020, why is the world awash in cordless vacuums, but less than ten percent of U.S. adults have ever had a telemedicine visit? The coronavirus, or COVID-19, could—and should—forever change how telemedicine is used.
Telemedicine, the use of technology to connect patients and remotely located health care providers, has been with us for decades but has not yet transformed health care in the way ATMs have transformed banking or cordless vacuums have transformed household clean up. Despite all the hype and promising growth in recent years, we find telemedicine visits still make up just a tiny fraction of health care encounters in the United States.
Perhaps in this current crisis, we are finally at the tipping point, and telemedicine will start to spread like the infectious diseases it is poised to treat. Telemedicine is ideal for the ongoing infectious disease emergency because its core characteristic, the physical separation of patient and clinician, supports “social distancing” efforts and thereby can slow the spread of the virus. In a large-scale quarantine scenario, patients sitting at home could get care for COVID-19 or obtain routine care for their chronic illnesses through telemedicine. As a result, telemedicine can help prevent clinic waiting rooms from becoming sites of transmission.
Telemedicine can also help with the critical triage role: Who needs to be tested for COVID-19, and who should come to the hospital? Even within a hospital, physicians and nurses could provide some aspects of care via telemedicine to patients in isolation, thereby reducing disease transmission within the facility. With the reports of deaths among Chinese physicians, U.S. clinicians are understandably worried about their own health, and treating patients via telemedicine could be a welcome alternative.
Telemedicine is ideal for an ongoing infectious disease emergency because its core characteristic, the physical separation of patient and clinician, supports “social distancing” efforts.Share on Twitter
There is growing precedent for using telehealth in emergencies. After Hurricanes Harvey and Irma, we explored how affected states allowed out-of-state physicians to deliver care via telemedicine. Australia recently temporarily expanded telemedicine for those impacted by bushfires. Telemedicine is already being used for COVID-19 response in several ways. Health systems are converting scheduled office visits to video visits to keep patients out of the office. A telemedicine robot that was used with the first U.S. COVID-19 case allowed doctors to communicate with the patient in isolation. Large telemedicine companies are screening patients for COVID-19.
However, widespread use of telemedicine in this crisis will be hampered by myriad regulatory barriers. For example, Medicare only covers telemedicine for patients in rural areas, and patients cannot receive services at home. Many states require an in-person visit before telemedicine can be used.
In the setting of a public health crisis, emergent changes are needed. The CDC has issued guidance to health care facilities, directing them to explore telemedicine alternatives to in-person visits. The emergency funding package passed by the House expands access to telemedicine for treatment of COVID-19 related illness. We believe we need to go further.
The key point to remember is that older adults and those with chronic disease are the most susceptible to COVID-19 infection. They account for the vast majority of physician visits in the United States, and we believe the key is to help them get care via telemedicine during a prolonged pandemic. Medicare could allow telemedicine visits to occur in any location. States could pass regulations allowing for patients to receive telemedicine visits from any licensed physician in the United States, not just those that are licensed in their states.
There are, of course, potential risks that could come with opening up telemedicine visits in this manner. Physicians, for example, could become overwhelmed by telemedicine visits with the “worried well.” And video visits have their limitations. A video visit does not allow for an examination of the lungs. As there are no real treatments for COVID-19, all telemedicine providers in the outpatient setting can really do is help with triage and reinforce standard messaging (e.g., stay home if sick). However, if treatments do emerge, telemedicine may be a way of rapidly increasing access to such care.
Despite these risks, we face an unprecedented public health crisis. Telemedicine's time may finally be here. It hasn't caught on as quickly as the cordless vacuum, but telemedicine has potential to be a key component of the response to COVID-19 and future public health crises.
Ateev Mehrotra, M.D., is an associate professor of health care policy and medicine at Harvard Medical School and a physician at Beth Israel Deaconess Medical Center. Lori Uscher-Pines is a senior policy researcher at the nonpartisan, nonprofit RAND Corporation.
Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.