Although decades old, telemedicine is now growing at an accelerated rate, with no end in sight. In fact, we are only at the beginning of a complete transformation in the way health care services are provided, affecting those who provide them, those who receive them, how they are provided, and where health services are available. For long-time observers of telecommunications technology markets, such growth is not unexpected. Long ago the banking industry underwent a dramatic change as consumers gained ubiquitous access to their cash from ATMs and later to a host of other financial services over the Internet. Today, no one would even think of opening a bank without offering its customers access to ATMs and other online services. Similar revolutionary changes have transformed entertainment and retail commerce. Therefore, the banking, entertainment, and retail commerce industries have completely changed, with new service providers, new services, and increased consumer choice and power.
The same trend is affecting health care today. However, for telemedicine, a few barriers still remain. Limited reimbursement under Medicare and other fee-for-service programs, slow adoption and even resistance by some physicians, and insular medical practice and licensure rules by states are but a few of the challenges. Perhaps the greatest challenge the industry and the leaders of governments face is unburdening the regulations that impede the ability of providers to use telemedicine and blocking consumers from accessing the care they want and desperately need, whenever and wherever it is needed.
Despite these obstacles, the use of telehealth by health systems, insurers, governments, and consumers has moved forward, resulting in reduced costs, improved quality, and expanded access to better health care. Payers, health systems, and providers are recognizing its importance and the growth in the market has long passed the point of no return. The transformation is now underway and the changes, the investments, and the buzz have become almost overwhelming.
Of course, telemedicine has not touched each part of health care services in the same way. Specialty services have been the foundation for the growth of telemedicine but the rapid expansion of remote primary and urgent care has helped reshape the landscape. The result of all these changes is the transition of telemedicine from stand-alone projects or programs to an integrated transformation of health systems and the formation of new health delivery networks.
Among specialties, no doubt the largest transformation has been and will continue to be in medical imaging. Radiology, once a service that was largely confined to the walls of a health facility, is now more often a freestanding service and radiologists no longer need to be standing by, waiting to read images. Almost 50 years ago radiology started going digital and soon thereafter started transmitting images to other locations. This year almost 10 million patients in the U.S. will have an image read remotely. The combination of Picture Archiving and Communication Systems (PACS) and sophisticated telecommunication network hubs has made radiology a predominantly remote service. As the sophistication in imaging, the need for subspecialists, and as the use of computer diagnostics increase, there will be a growing need and a growing market for the use of teleradiology. Such services have become so widespread that within a few years ubiquitous, 24/7 access to radiological services will probably be considered a legal standard of care for all hospitals and entire imaging departments of some hospitals will be contracted out to an offsite remote service.
Other specialties that are witnessing rapid growth include remote ICU monitoring, now available for about 30 percent of all ICU beds in the U.S.; telestroke services that will help over 100,000 patients in 2017; and telemental health services with approximately 500,000 patients receiving some form of therapy remotely. These services will grow and many more will be added to the list in the years to come. In particular, remote mental health services are set to grow the fastest over the next five years, as providers and patients have shown the greatest enthusiasm for using telemedicine and as it becomes integrated into other online health services.
Online primary and urgent care services offered to consumers have grown by double digits over the last few years. In 2016 over 1.2 million such services were provided online with patients coming to sites either through their employer, or private insurance company, or other referrals. Spurred by increased coverage by insurers and employers and increased demand by consumers, these services are currently largely provided by independent companies either employing their own physicians or providing a software platform for a health system to use their own providers. Several trends will further accelerate such services in the next few years:
Rank and file primary care providers will be expanding their night and weekend coverage for their existing patients by either incorporating video and voice services to their patient portals or contracting with a third party to provide such services. As the universe of primary care practices offer such services, it will become as universal as magazines in their waiting room.
Health systems and provider–payer systems such as Kaiser and the University of Pittsburgh Medical Center are also starting to incorporate online consults to expand their footprint and retain customers as well as increase their line of consumer-friendly services.
Online consumer-initiated medical services will be quickly picked up by other types of specialty services including mental health and physical therapists. It will also be a component of large technology and retail companies that have been exploring ways to enter the health care market.
Soon to be introduced is the ability of patients to take their own vital signs and images at home and send them to providers as part of online services. This will increase the number and quality of services that can be provided, adding even more convenience to consumers and further accelerating the use of such services.
Health care systems are accelerating mergers and acquisitions as well as consolidation in an effort to expand their markets, reduce costs, and sharpen financial performance. Telemedicine has become a component of C-suite strategic plans used to spread brand awareness, increase referrals, and reduce the costs of providing multiple specialist and subspecialists across multiple facilities. As the nation moves toward fewer but larger health systems, as the health systems take on both a payer and provider role and as new entrants enter the market, telemedicine will be used as a glue, as an accelerant, and as a new offering.
Finally, while this is a lot of change, there is one more innovation that could result in even greater changes in the delivery of health care: the introduction of artificial intelligence (AI). AI may not replace doctors, but it could take the guess work and professional intuition out of the providers’ hands, causing even greater deployment of technologies into the home and local marketplace, resulting in significant disruptions in the health care market and allowing the patient more convenience, lowered costs, and greater quality of services. From vision correction prescriptions to automated lab tests to monitoring and making adjustments to drugs used for chronic care, AI can open up a new world at the patient’s fingertips.
All of these changes spell a huge uptake in the use of telemedicine. The result will be the ubiquity of health services, improved quality of care, and reduced costs. Health care is just starting on a transformation much like that which changed the way consumers access financial services, see movies and television, buy books and clothes, and communicate with one another. Health care will never be the same and, hopefully, we may never want to go back to the way health care is delivered today.
Founding CEO, The American Telemedicine Association