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Update: Telemedicine - An Integral Part of the Future of Healthcare

Uli K. Chettipally, MD., MPH. Physician Innovator, Technology Enabled Care


Telemedicine as defined by the American Telemedicine Association “is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” Terms like Telehealth and eHealth have been used interchangeably with telemedicine. To look at it another way, there are several elements involved in defining telemedicine: 1. Distance, 2. Information exchange, 3. Communication technology and 4. Improvement in health status.

Although telemedicine has been around for more than 40 years, its importance and use have been growing recently. There are several reasons for this.

The first one is the increase in access and decrease in the cost of the technologies used in telemedicine. It is now possible to use a smartphone for most applications in telemedicine. The ubiquitous nature of the Internet and the increase in bandwidth of the pipes connecting the network has greatly increased the amount of information that can be exchanged. Patients are now used to the technology that has provided a lot of convenience in procuring services in other sectors and expect the same from their healthcare provider. On the other hand, the cost of providing face-to-face interaction has been steadily rising. With more regulations, the cost of running a healthcare facility has gone up.

Telemedicine encompasses several modes of communication. Voice, video, and text are the most commonly used modalities. This communication can be synchronous, where the provider and the patient are engaged in the exchange of information at the same time, or asynchronous where there is a difference in time between the transmissions of information. Although synchronous communication is more efficient, asynchronous communication can be more convenient for the patient and the busy provider. The proliferation of apps for smartphone, growth of wearables and mobile health applications that make remote monitoring possible, is helping fuel the use of telemedicine.

There are several advantages of using telemedicine as an extension of regularly provided healthcare services. The main ones are convenience and cost. Patients living in remote areas and patients with disabilities, which make them less mobile, have the greatest benefit from using telemedicine services. Busy professionals also appreciate the convenience factor. The cost of providing care decreases, as a minimal physical structure to house the technology is needed to provide this service. This can help the environment with a decrease in driving that one would need, to go to a physical appointment. This can also decrease the amount of office space, parking etc. needed.

Lack of reimbursement for telemedicine services has been a hurdle for adoption in the past. With the change in the healthcare business model, from volume-based care to value-based care, this will become less of a problem and more of an advantage for delivering cost-effective, convenient care. With the increase in companies providing the technology, increase in the speed of connectivity, and decrease in the cost of equipment needed, the barriers to providing telehealth care have dramatically decreased.

Although specialties like radiology, dermatology, psychiatry, have been at the forefront of technology adoption, this method of providing care is revolutionizing primary care and every other medical specialty. With smartphones acquiring medical device capabilities, the use cases have been growing dramatically. There are some pitfalls, as with any type of technology use in medicine. The main ones include, not being able to get a ‘full picture’ that only a face-to-face visit can provide and losing the human connection that can happen only through touch. In order to minimize these negative effects, one should include telemedicine as a supplement to regularly provided care and not as a replacement.

In conclusion, there are major changes occurring in healthcare, technology, and culture. This confluence of changes is creating a perfect storm for telemedicine to grow and expand.

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