Here’s what to expect for the future of telemedicine | 5 Questions

Anyone who has not had a telemedicine visit yet, please raise your hand.

No one?

We thought so.

During the pandemic, this fledgling method of delivering health care took hold, and took off.

At PennMedicine, telemedical visits went from 300 to 500 a month in February 2020, to 7,000 to 8,000 a day by that April.

What surprised some people was that it was so successful that it’s no longer considered a temporary adaptation. Many think telemedicine is here to stay.

One of them is Bill Hanson, a critical care physician who is also chief medical information officer and vice president at PennMedicine. He spoke to us recently about what’s ahead. Telemedicine will require advances in technology, additional training for medical staff, and perhaps a whole new workforce.

When we talk about telemedicine, it’s sort of like the blind man and the elephant. A lot of people have their own version of what telemedicine is.

Actually, telemedicine has been around a long time. The word comes from Greek, meaning “medicine from afar.” Centuries ago, ships carrying plague patients would fly pennants when they neared port and would be required to sit at anchor for 40 days. “Quarantine” comes from the word forty.

» READ MORE: Telemedicine is here to stay, but how much you pay for a visit could change

Historically, we’ve had remote radiologists reading American films during our nighttime, their daytime. A lot of hospitals don’t have radiologists on 24 hours a day. So they would buy a service — this goes back 10 to 15 years — where a radiologist in, say, Australia, would analyze the films. We learned that the radiologist and the physician at the local hospital don’t have to be connected in real time.

For 10 years, PennMedicine has had tele-ICU, where critical care nurses and doctors can look after patients 24 hours a day, in their ICU beds, from a central command center. It could be down the hall, or miles away, since we monitor patients at several hospitals. That was hugely helpful during the pandemic, when all our ICUs were overwhelmed. It also helped when we were trying to cut down on traffic in the room, lessening the risk of infection. Where appropriate, a physician at one location could examine a suspected COVID patient at another.

Today, in the pandemic area, when most people think of telemedicine, they think of a provider and a patient on an audiovisual connection, having an interaction. But, again, telemedicine is a grab-basket term that covers a whole lot of cool new stuff.

Originally, as the pandemic began, the general rank and file said the technology is not up to where it needs to be for providers and patients to be able to use it effectively. So we were all surprised at the speed at which both providers and patients picked up how to use this. It wasn’t just tech-savvy young people. My mother is 91, and she and many of her friends were able to use it.

The degree to which you could have, maybe not an ideal, but an effective interaction shocked a lot of providers.

Telemedicine is unquestionably here to stay. Providers, patients, insurers, the federal government — no group is saying we should back off from telemedicine. What we’re trying to do is figure out where it adds additional value to an encounter. Here’s a simple example: If we have a transplant patient in Lancaster who is going to have the transplant procedure at HUP, much of the evaluation by the transplant team can take place telemedically so the patient doesn’t have to travel.

Parkinson’s patients sometime have trouble traveling to the neurologist. After I had a hip replacement, I had a question about the incision. I was able to show it via telemedicine to my provider, who said, “it’s fine, you don’t have to come in.”

The question is, insurers don’t want to see an increase in medical care consumption because of telemedicine. Because it’s easier to have an appointment with telemedicine, their concern is that people will have more medical encounters. On the other hand, if we can deal with the common cold or other simple ailments promptly, we may avoid costly medical care in settings like the ER later. Someone might have something that, if they push off medical care, might worsen but might be caught with a simple telemedical visit.

With telemedicine, we can also keep potentially infected patients from infecting others by coming into an office or emergency room.

That’s a very good question. I’ll give you an example. When I started doing tele-intensive care, I had been at bedsides for a long period of time. But I realized there were certain things I could do better remotely. By standing back and watching a patient through the camera, I had a broader — say, a 30,000-foot view — of what was going on. I might be able to spot something that a physician in the room, focused on a specific procedure, might not notice. If we caught a problem early, we could be preventive, not reactive.

You don’t learn telemedicine in medical school as of yet. But at Penn, we try to put a brand of telemedicine out there that is as professional as possible. We want people to do their encounters in a professional setting, dressed appropriately. No bedhead. No children screaming. Maybe a logo in the background. We’ve been diligent about teaching our professionals how to have a good telemedicine encounter.

Ultimately, will telemedical care be something people specialize in? I think the answer is a guarded yes. There are some intensive care doctors that are really good at bedside, and some that are very good in a telemedical setting. For some, telemedicine may be a way to achieve a better work-life balance.

Ten to 20 years from now, I think the extension of the tools we use as doctors — the stethoscope, for one — will get pushed more and more toward the patients where they are. The patient won’t have to come to the doctor. The medical service will come to them. There are already models of little carts that have a stethoscope attachment and otoscope attachment that a trained medical assistant uses to facilitate an exam for a doctor who is remotely located.

Just recently, there was a whole email thread in my inbox about Bluetooth or WiFi blood pressure cuffs. There are apps and devices that allow you to do a partial EKG. The Apple watch has a feature that will detect atrial fibrillation. Pulse oximeters became widely used during the pandemic. A lot of diabetes patients are wearing 24-hour a day glucose patches that are Bluetooth-enabled and will alarm for high or low blood sugars.

The evolution of technology — and the skill of the people using it — is going to help us take care of patients that we know are sick and evaluate patients that might be sick.

I’m a student of medical history and medical care evolution. It’s fascinating. If you go back 100 years, there were no fields, more or less. There were medical doctors who did nonsurgical things, and there were surgical doctors. And maybe dentists, so three fields. With time, medical disciplines became increasingly specialized. There used to be a specialty called eye, ear, nose and throat. Then a new field called ophthalmology branched off from it. Anesthesiology branched off from surgery.

There probably won’t be a department of telemedicine per se. But there will be people in different disciplines who will become telemedicine pioneers, telemedicine experts. You’ll see telemedicine scatter through different specialties.

We’re beginning to talk to medical school students now about the implications of technology on their future. Telemedicine is a perfect example of that. It’s going to be a part of their future, almost regardless of what specialty they go into.

It’s a complicated, fascinating, and exciting new field.

The Future of Work is produced with support from the William Penn Foundation and the Lenfest Institute for Journalism. Editorial content is created independently of the project’s donors.