From ATMs to PTMs
I vividly remember the first day I walked into the bank and saw that there were no longer any people working behind the counter. Instead, I waited in line for my turn to interact with a teller virtually, via a screen in one of several semi-private cubicles. I now know that this device is called a Personal Teller Machine, or PTM. (Like an ATM, but enhanced with a human being located somewhere else in the world.)
Although my virtual bank teller was personable and the transaction surprisingly easy and efficient, I felt a bit dazed and unnerved throughout the experience. When had all these changes taken place? What had happened to the tellers whose faces had become familiar to me over the years? Is this how my parents felt when suddenly everyone stopped telephoning and started texting? I realized that it had been a while since I’d been to that bank, and a paradigm shift had occurred in my absence. I must have missed the memo, virtual or otherwise.
I freely admit that I still prefer interacting with bank tellers IRL (In Real Life). Whether it’s rational or not, I feel better when I can develop a face-to-face relationship with the people who are supposed to be the stewards of my savings. I always thought I’d feel that way about my doctor, too, but the pandemic has changed my views.
Fortunately, telemedicine has been a steadily growing mode of delivering care for over 50 years. Early applications included technologies developed by NASA for use in monitoring biometric data of the early astronauts as well bringing health care to remote indigenous and rural communities. Since the 1970s, the healthcare industry has increasingly relied on telemedicine to improve health outcomes where geographical barriers would otherwise limit clinical practitioners’ interactions with patients. However, the broader term “telehealth” has only become part of the public vernacular fairly recently. The World Health Organization states that “some distinguish telemedicine from telehealth with the former restricted to service delivery by physicians only, and the latter signifying services provided by health professionals in general, including nurses, pharmacists, and others,” but acknowledges that the two terms are often used interchangeably.
Telehealth: Model of the Future?
About a year ago, I began receiving pamphlets in the mail from my health insurance company touting the benefits of their new “Teledoc” service. Using the handy app, I’d be able to consult with a doctor “24/7 anytime, anywhere to get a diagnosis, treatment and prescription when needed.” I think this sounds great! So why haven’t I used this service yet, even when my whole family was very ill last winter? Maybe I didn’t want to have to meet a complete stranger while at my worst. Perhaps creating yet another login and password seemed daunting. Or—most likely—I just plain forgot that this was an option.
Whatever the reason, I am apparently not alone. According to First Stop Health, a leader in non-emergency telemedicine services, although an overwhelming majority of midsize to large employers offer telemedicine benefits, a 2018 survey showed that less than 2% of employees had used them. However, it seems likely that this percentage will increase since millennials increasing eschew traditional primary care providers and prefer telehealth options.
The COVID Correlation
Enter the virus. Nearly overnight, telehealth has become mainstream by necessity. An in-person doctor visit could be a death sentence for the most medically fragile patients. Moffit Cancer Center, Tampa’s largest cancer research and treatment institution, reports that virtual visits have increased 5000% percent since the pandemic made its way across the ocean. Similarly, telehealth options for mental health have become of utmost importance during this time of social distancing. Many states have loosened regulatory restrictions to increase “telemental health” access.
The public is clearly ready to make the shift to this new paradigm. But can hospitals keep up? Using internet search data trends, an April 2020 JMIR public health analysis shows that there has been a direct correlation between the spread of COVID-19 and the public’s interest in telehealth. However, the study did not show a significant increase in the proportion of hospitals providing telehealth services. According to the study’s authors, “more practical investment is needed [in] telecommunication infrastructures.”
Now more than ever, those working in medicine need to adapt rapidly to build infrastructure that seamlessly integrates the best, most efficacious solutions. The virus could be with us for a long, long time. We had all better be ready for a telehealth paradigm shift.