What Is Telemedicine, Exactly?
By now, you have a pretty good idea of what's happening in the country with the coronavirus. Both the Centers for Disease Control and Prevention (CDC) and the White House are strongly encouraging people to stay home as much as possible, especially if they live in an area where the novel coronavirus, aka COVID-19, is spreading.
It's a weird time for the entire world, but life has to go on. Many people still need to work (albeit mostly from home) and some doctor's appointments that aren't linked to coronavirus still need to happen. And, on the other hand, many patients with coronavirus or related symptoms are being encouraged to contact doctors via phone or video versus showing up to an office, in order to reduce the spread. This is where telemedicine comes in.
Doctors and medical practitioners across a range of specialties are increasingly turning to telemedicine to provide services for patients while maintaining social distancing. Some have been doing it for a while now, while others are scrambling to adapt in light of the current pandemic.
The term "telemedicine" has been thrown around a lot lately, and it's understandable that you might be a little fuzzy on what, exactly, it entails. Here's what you need to know about what telemedicine is, plus how experts anticipate the service might evolve.
What Is Telemedicine?
Telemedicine (or telehealth), is defined by the National Institutes of Health (NIH) as the use of technology to provide and support healthcare at a distance. What that truly means can range widely. For example, it can involve two doctors talking to each other on the phone to coordinate a patient's care or using robotic tech to perform surgery from a remote site. Telemedicine can also be used to remotely monitor a patient's condition, like monitoring blood pressure or heart rate through a device worn by the patient that electronically sends information to a doctor, according to the NIH.
Telemedicine call also be used for other, less serious health issues, like getting a diagnosis or quick prescription when you think you have a minor problem or when you don't have time or the ability to seek care at an office, says Nwando Olayiwola, M.D., M.P.H., chair of family medicine at The Ohio State University Wexner Medical Center.
"It can be done through an old-fashioned telephone call or it can be done through a device that includes voice and video," says Scott Kaiser, M.D., a board-certified family medicine physician at Providence Saint John's Health Center in Santa Monica, Calif. It's not FaceTime or WhatsApp; Practitioners use secure platforms that comply with the Health Insurance Portability and Accountability Act (HIPAA), the law that protects health data integrity, confidentiality, and availability. "It's amazing what's available via different telemedicine platforms at this point and we're seeing more and more [become available]," he says.
What Is Telemedicine Like In the U.S. Right Now?
When you go by the broad definition of telemedicine, most medical providers practice at least some form of it, says Dr. Kaiser; however, some utilize the practice more than others. In 2018, a study from the American Medical Association (AMA) found that about 15 percent of physicians were using telemedicine, and in 2019, a survey from telemedicine company AmWell (formerly American Well) found that that had increased to about 22 percent. Today, that number is likely much higher, with more and more providers hurrying to connect with patients without requiring them to come into the office—both in the wake of COVID-19 and in preparation for any other global health issues that might arise in the future.
Miami-area licensed clinical psychologist Erika Martinez, Psy.D., founder of Envision Wellness, says she has offered telemedicine to her clients for a while now, but her organization is now recommending that everyone consider it. "In the past, I've seen at least two to three clients a week via telemedicine for whatever reason, whether they're traveling, sick, or stuck in traffic," she says. "Now, it's much more."
Martinez's practice has become so engrained with telemedicine that when clients make an appointment, they can choose whether they want to do it at the practice's physical location or online. "If they choose 'video office,' they get a unique link to click on to access the call at the right time," she explains. Given the high demand for telemedicine right now, Martinez says it is possible that you could experience longer wait times or technical difficulties. Luckily, as telemedicine becomes more popular, the systems should become more efficient and providers should hopefully be able to develop solutions for arising issues. (Related: The Best Mental Health and Therapy Apps)
While plenty of major health systems have had telemedicine options, many are using them more now than ever. "It's been a long time coming," says Dr. Olayiwola. "Most people in the past thought of telemedicine as just a convenience. Now, it's not about convenience; it's about necessity." Her organization uses telemedicine for telephone or video visits, calls between doctors about a particular patient, and to connect patients with doctors via a secure email portal.
How to Pick a Telemedicine Service
Right now, there are three different routes you can take to get virtual care.
- Go directly through your doc's office. Your current providers may offer online portals that connect you to your doctor via messaging, calls, video, and more. If you use telemedicine that's provided directly through your doctor's office, your insurance may cover it, says Dr. Olayiwola. But, of course, it depends on your coverage.
- Go through your insurance company. Many of the large insurance carriers in the U.S. (including BCBS, United Healthcare, Signa, Aetna, Humana) all offer some form of coverage for telehealth services as part of their plans. Check-in with your insurance provider to see if they work with a specific platform and what the pricing looks like depending on your plan.
- Enroll directly with a telemedicine platform. If you want quick care from home and don't have the above options, you can seek care online with telemedicine platforms that are available for anyone to use. With these services, though, you typically pay out of pocket. iCliniq, for example, offers different plans, including paying $30 for 50 hours of chatting and $40 for 100 hours of chatting. Doctor on Demand accepts health insurance, but your insurance provider may not cover telehealth (you'll have to check in advance).
A Few of the Big Telemedicine Companies
CareClix: This is a service medical providers can use to allow doctors to conduct consultations with patients from any device via an app or plug-in.
Doctor On Demand: Doctor on Demand provides a range of services—urgent care, behavioral health, preventative health, and chronic care—to patients online. To use it, sign up online. You can be connected with a doctor within minutes.
MyTelemedicine: Like Doctor On Demand, MyTelemedicine allows patients to connect with healthcare providers by video. Patients can quickly reach a doctor through their app, online, or via phone.
Teladoc: Teladoc lets patients talk to a doctor, therapist, or other medical experts by video or phone. Simply set up an account, fill out information about your medical history, and you can be quickly connected to an expert.
iCliniq: This service allows customers to connect with medical experts by video, chat, phone, or by doing a query. Like many patient-provided services, you can access someone 24/7.
Amwell: Amwell works with hospitals and health insurance companies to help them launch their own Telehealth offerings (ex: Cleveland Clinic's "Express Care" or Anthem's "Live Health Online"). They also have a direct to consumer platform that can be accessed through amwell.com or on the Amwell app where any patient/consumer can enroll for access to virtual urgent care, behavior health, nutritional health, pediatric, and women's health, among others.
Ro: Ro is a more niche telemedicine platform, offering three digital health clinics: Roman for men’s health, Rory for women’s health, and Zero for fighting smoking addiction. It offers instant digital access to physicians who can help you manage specific conditions and your prescriptions through their in-house pharmacy.
When to Use TeleMedicine
For all its perks, telemedicine isn't perfect. "Telemedicine is not a replacement for in-person physician care, but rather, a complement to a patient's overall care," says Melynda Barnes, vice president of medical affairs and research at Ro, a patient-driven telehealth company.
Telemedicine can be helpful for things like therapy sessions and more minor issues, like diagnosing a rash or figuring out what to do if you have a cough and you can't figure out the source, says Dr. Olayiwola. It can also be helpful for follow-up visits, she says. For example, some physical therapy clinics now offer virtual follow-up sessions so they can coach you through new exercises after they've already assessed your injury.
But if you're having more severe symptoms like trouble breathing or unexplained swelling, it's probably better to see your doctor. Your doctor can typically order routine blood testing at a lab, says David Cutler, M.D., a family medicine physician at Providence Saint John's Health Center in Santa Monica, Calif. But, for example, if you suspect you have a urinary tract infection or an STI, "it may take an examination to find out what's going on," he says. "For example, it's difficult to diagnose herpes without looking at the lesions." (That said, there are at-home STD tests on the market.)
If you're interested in telemedicine but aren't sure where to start, talk to your primary care physician. They may offer telemedicine services that you're not even aware of, says Dr. Olayiwola. And, if you have a particular issue, they should be able to guide you on whether you can handle it over the phone, video, or via email, or if you still need to come into the office, says Dr. Cutler.
Where Do We Go from Here?
Understandably, there's an increasing interest in telemedicine right now.
"Telehealth can be an amazing tool to ensure people have access to healthcare without having to go into a clinical setting," says Dr. Kaiser. Not only that, but telemedicine can also help reduce strain on the medical community and increase access for patients, he says. Telemedicine can also help provide care quickly, track the spread of illness to help with containment, and provide trusted health information, says Barnes. Given the current COVID-19 pandemic, these benefits are critical to slowing down the spread of disease.
Still, some people have trouble with the concept. Martinez says some of her clients who had previously done in-person appointments were "resistant" to start doing telemedicine sessions. "I would love people to understand that it's just as effective as an in-person session," she says. " It's a very calm situation and you can get a similar effect to an in-person session online. I wish more people would understand that."
Still, doctors acknowledge that telemedicine can't do everything. Surgeries, some aspects of physical therapy, certain areas of ob-gyn visits, etc. will likely never be replaced by telemedicine, says Dr. Olayiwola. (Related: How Technology Is Changing Healthcare)
And experts expect telemedicine opportunities to continue to grow. "Telehealth resources are very valuable at any point, but they become increasingly valuable during this kind of viral pandemic," says Dr. Kaiser.
"I think we are absolutely going to learn…that we can do telemedicine, we can do it really well, and we're going to do it at scale," says Dr. Olayiwola in agreement. "We're at the tipping point and, once we do this, it's hard to go back. People will realize they can get care this way."