During the pandemic, telemedicine demonstrated it’s power. As we begin to make the shift back to in-person clinical care in a post-pandemic world, it’s important to look at the lessons learned during the pandemic. This will help guide us in how to move forward and improve telemedicine delivery.
The History 
The use of telemedicine is not new. Early uses date back to the 1960s when NASA needed a way to monitor the vital signs of astronauts and provide healthcare in space. NASA also tested and refined versions of telehealth for use with rural and indigenous populations here on earth.
Since then, telemedicine has evolved quite a bit. When the world was hit by the Covid-19 pandemic, use of telemedicine became more popular than ever. Out of sheer necessity, and a need for public safety, organizations quickly implemented telemedicine in place of in-person clinical care. Both audio and video telemedicine were quickly put into practice.
Government also moved quickly to support telemedicine. For example, the federal government provided telemedicine-specific funding and removed existing regulatory barriers. Making policy changes authorizing payment parity and medical coverage expansion allowed for telemedicine delivery to America’s most at-risk populations.
What Is Telemedicine?
In order to apply lessons from the pandemic to telemedicine, let’s break down the basic terminology. The main services under the telemedicine umbrella are:
- Videoconferencing – Visits that include a live interaction and require high-speed internet and a video-capable device.
- Telephone visits – Audio-only calls that require a phone connection.
- Remote patient monitoring – Technology used to transfer patient information to electronic health records (EHRs) through wearable smart devices. These data points are later used by healthcare providers to help determine care for patients.
Equity In Access to Video and Audio-only Telemedicine
Rural, low-income, and minority communities have faced many barriers in accessing health care. The pandemic put a spotlight on those inequities and highlighted the need for solutions. While the use of telemedicine solved some access issues, in some populations it revealed others.
For example, one study compared the use of telephone and video forms of telemedicine in an academic medical center. It found that use of video was lower among people who were Black, American Indian, male, preferred a non-English language, had Medicaid or Medicare, or were older. Asian Americans, however, were more likely to use video telemedicine.
A different study by Ivy Benjenk and colleagues published in Medical Care reached similar conclusions. The study found that Hispanic and Black Medicare beneficiaries were more likely than White beneficiaries to report “no access to technology” required for telemedicine (30% and 28% vs. 14%). Older adults, those with lower incomes and those who were not primary English speakers were more likely to lack the technology.
A legislative analysis of a 2021 telemedicine bill from the California Health Benefits Review Program also supports the data above. The analysis concluded that patients of color, and those who are older or rural, were more likely to use phone visits than video visits during the pandemic.
Maybe Good Enough, But Not a Replacement for In-Person Care
There is good evidence that video telemedicine can produce patient outcomes that are similar to in-person care. And both patients and providers report high levels of satisfaction with it. Even “teledermatology” has high potential for improving the management of skin diseases. For certain medical services, like behavioral health, audio-only visits are “at least as effective” as in person visits. Until more research is done outside of mental health services, promoting audio-only services post-pandemic will be very difficult.
Despite the convenience, access, and safety telemedicine provided in the pandemic, a majority of patients still prefer in-person clinical care. That’s exactly what a national poll by NPR, the Robert Wood Johnson Foundation and the T.H. Chan School of Public Health at Harvard conducted in August and September of this year found. About 42% of respondents said someone in their household had used telehealth during the pandemic. Of those, 82% reported satisfaction. Yet nearly two-thirds (64%) would have preferred to see their nurse or doctor in person.
Telemedicine Lessons From the Pandemic
Telemedicine shows tremendous promise for meeting the needs of patients. It may also be cost-efficient and time saving. But there is still a significant amount of work that needs to be done to address equity gaps, and to identify and promote best practices.
As we navigate the post-pandemic landscape, we must apply the lessons we learned during the pandemic. If done right, telemedicine could help make our healthcare system more accessible and affordable, particularly to the historically underserved. To do this, we should take the following steps:
- Ensure that all health care providers have the resources to adopt video telemedicine. This particularly includes those who serve low-income, minority, and rural populations. The Biden-Harris administration is investing $19 million to expand telehealth nationwide. This includes funding for centers of excellence that will serve as academic incubators of best practices.
- Expand programs that provide smartphones and internet service to low-income Americans. Making sure everyone has the technology is a critical step. Additionally, patient preference and willingness for adoption is equally critical. A lack of willingness to use the technology will limit the reach of telemedicine.
- Lastly, institutions must develop research-based, best-practice guidelines to increase patient safety and satisfaction. Developing best-practices, especially using a human-centered user experience (UX) framework, will lead to better system designs and greater patient adoption.
The telemedicine app is great. My dad had a heart attack, it was a crucial time for us and as the pandemic was going on we were more stressed about the hospital, telemedicine app helped a lot during that time. We consulted the doctor about his medicines via telemedicine every fortnight. We also opted for a medicine delivery app during that time as it was convenient and we were much safer at home. Inspired by this my company developed an on-demand medicine delivery app as well as a doctor consultation app.