Authored by Phuoc Le, M.D. and Sam Aptekar
“Kijan ou ye? How are you?” I asked my patient, a fifty-five year-old Haitian-American woman living in Dorchester, Massachusetts. It was 2008. I had been her primary care doctor for two years and was working with her to reduce her blood pressure and cholesterol levels. “Papi mal dok– I’m doing ok doc.” We talked for 15 minutes, reviewed her vital signs and medications, and made a plan. I then electronically transmitted a new prescription to her pharmacy. The encounter was like thousands of others I’d had as a physician, except for one key difference– I was in Rwanda, 7,000 miles away from Dorchester and 6 hours ahead of the East Coast time zone.
At the time, I knew that telemedicine – the practice of providing healthcare without the provider being physically present with the patient – was a resourceful means of working with rural populations that have limited access to healthcare. However, I had no idea that just ten years down the road, many health professionals and policymakers would laud the emerging tech field as the answer to inaccessible healthcare for rural communities. While I’m aware of telemedicine’s promising benefits, I’m certain that it cannot, on its own, solve the most pressing issues that continue to afflict the rural poor and underserved.
Ever since the invention of the telephone, providers have been practicing telemedicine. However, not until the advent of advanced technologies such as high-speed internet, smartphones, and remote-controlled robotic surgery, has the field of telemedicine started to beg the question: “Do we still need in-person interactions between patient and doctor to provide high quality healthcare?” This question is particularly important for patients who live in rural areas, where a chronic shortage of providers has existed for decades.
In a recent article by Forbes magazine, “Telemedicine: The Latest Futuristic Tech Prediction from the Jetsons to Come True,” Joe Harpaz praises the burgeoning industry as the solution to inaccessible healthcare among rural populations in the United States. Referring to telemedicine’s growing popularity among medical professionals and tech entrepreneurs, Harpaz writes, “This future promises a world where the distinction between telehealth and health dissolves, leaving us with one universal term: healthcare.” To be sure, Harpaz’s take is in line with the popular opinion on the growing industry that seeks to provide care for patients without a medical provider being physically present.
Smart glasses, health apps, interactive patient cubicles, and robots that bring live video calls to a patient’s bedside are a few innovations among the slew that are currently attracting investors from all over the world. According to Mordor Intelligence, global telemedicine will be worth $66 billion by 2022. With the ubiquity of telemedicine quickly approaching, it is critical that we take an honest look at not only what problems telemedicine can help alleviate, but also those that exist beyond the reach of telemedicine’s capabilities.
Telemedicine certainly stands to benefit some of the most rural communities in the United States and throughout the world. Rural communities make up about 20% of the U.S. population, but access only 9% of the country’s healthcare providers. Far too many rural patients are expected to travel hours to reach a medical specialist or get a routine check-up, forcing them to take time off work, pay for transportation, and wait excessive amounts of time before receiving a critical procedure or prescription. A recent study that examined the use of telemedicine in 24 rural hospitals in Kansas, Oklahoma, Arkansas, and Texas found that telemedicine saves hospitals money by allowing them to outsource specialist consultations, and saves patients money by promoting financial stability. According to Indian Health Services (IHS), which in 2016 awarded $6.8 million to provide telemedicine to 130,000 American Indians and Alaskan Natives in the Great Plains area, “telemedicine can be one of the best ways to get health care services where they are needed most…strengthening access to care at IHS health facilities in Iowa, Nebraska, and North Dakota.”
For rural communities with limited access to healthcare, telemedicine can provide an effective means of increasing that accessibility. But healthcare providers should not consider telemedicine a panacea that will eliminate the issues of accessibility and equity in our healthcare system. Everyone deserves access to a clinician who can physically examine and treat patients. For my patient in 2008, the ability for me to treat her blood pressure remotely from Rwanda was surely predicated on my in-person relationship and rapport that I had built up with her, in person, over the prior two years. Ensuring that “healthcare” becomes a “universal term,” as Harpaz predicts above, will take far more than technological innovation; it requires continued advocacy for structural changes in a healthcare system so that it provide everyone, regardless of income or geographic location, with access to the best possible healthcare providers.