Telehealth has been touted as a way to increase access to care in underserved areas. There certainly is some truth in that, but telehealth alone is not sufficient, otherwise it adds yet another silo to a healthcare industry littered with silos, according to a new article in the policy journal Health Affairs.
“Many experts have suggested that telehealth services for underserved populations require integration with the wider healthcare system; however, they require more than that. Telehealth requires integration into a well-functioning healthcare system that has the capacity to address all the additional patient needs that telehealth generates,” wrote Lori Uscher-Pines and Dr. Ateev Mehrotra.
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Uscher-Pines is a policy researcher at RAND Corp. Mehrotra is a healthcare policy expert at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center in Boston.
What’s often missing, Uscher-Pines and Mehrotra said, are diagnostic testing and in-person follow-up care. “Introducing telehealth into underserved communities generates new demand for services such as procedures or tests that can’t be done through video conferencing,” they wrote.
The researchers came to their conclusions by studying the nonprofit Medical Alumni Volunteer Expert Network (MAVEN) Project and teledermatology company DirectDerm.
“In the environments in which these two programs operate, telehealth seems to have so much promise. However, we learned in our evaluations that bringing in telehealth won’t reduce the burden on the dysfunctional healthcare system,” Uscher-Pines and Mehrotra wrote.
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In about 10-20 percent of remote dermatology screenings, they found, the patient needs a biopsy or other procedure that can only be done in person. About 38 percent of screenings for diabetic retinopathy via telehealth in one study they cited needed in-person follow-up — and affected patients often then had to wait months for an appointment.
To address these problems, Uscher-Pines and Mehrotra suggested that telehealth services might work with local care providers to open up slots for specialists to see referrals. If there aren’t enough specialists available, telehealth providers might consider hiring some, as DirectDerm has done by setting up its own clinics in the Central Valley of California.
Specialists should also consider moving changing some of their current referral appointments with patients to electronic communication with primary care physicians. This would make them more efficient and free up time slots for telehealth referrals.
“The solution is not to bring in episodic, disconnected telehealth and assume it will fix our problems,” Uscher-Pines and Mehrotra concluded. “Rather, we must experiment with more comprehensive strategies that combine telehealth and the necessary in-person care so that we are digitizing a better, more efficient and more equitable healthcare system.”
Photo: Mercy Health