By Vikram Savkar, Vice President and General Manager of the Medical Segment at Wolters Kluwers health theory, Research and practice business
During the pandemic, almost every healthcare provider in the country had to switch to telemedicine quickly and unplanned for the majority of their consultations and activities. Corresponding a study by the RAND Corporation, there was a 20-fold increase in the telemedicine usage rate after March 2020. This transition has been carried out well and successfully for the most part, but only because of the heroic creativity and dedication of clinicians across the board.
With few established practices to rely on, it fell to every hospital, department, clinician to more or less invent ways to conduct virtual consultations in dermatology, cardiology, oncology, and more. There was much trial and error, but the commitment to quick learning meant that the community as a whole was able to achieve decent levels of quality of health care for patients through the internet.
However, it is now clear that telemedicine will be a permanent and sizable segment of health care; some estimate that by 2021, more than 20% of health care will be virtual. As a result, every aspect of the telemedicine health ecosystem must move away from an “emergency” mindset and focus on establishing scalable, sustainable processes that ensure that a steady shift to telemedicine promotes equity, access and quality. Health care providers themselves are actively participating in this effort, and medical schools must now evolve to reflect this new normal.
Medical schools have added some telemedicine training to their programs in recent years, but these have been more of a side job. Now it will be crucial that telemedical training is more closely integrated into the core curriculum. What is referred to as “webside manner”, for example, differs significantly from “bedside manner” and must be taught explicitly – both in the classroom and during the rotation of internships and in residencies.
Doctors need to learn how to develop relationships with patients they do not see face-to-face, how to assess potential domestic violence threats when the patient may not be able to speak freely, and how to collect emergency contact information if they do is a critical event during the consultation for which the doctor must call the emergency service. They must also learn to use the unique ability of telemedicine to closely monitor and document social determinants of health, such as asking patients to show the contents of their refrigerator. And they have to learn to bridge the “digital divide” and ensure that patients without broadband or smartphone access are not exposed to inferior telemedicine.
In addition, the development of techniques to diagnose and treat certain disease areas such as dermatology or cardiology will be more challenging. How should a doctor rate a rash to determine appropriate treatment if the patient connects to a small phone over a low bandwidth network? How should the doctor assess eye movements as part of a neurological exam? There is no obvious and natural way to adapt traditional assessment approaches for these types of activities to a virtual environment. The medical community must learn from trial and error and research, publish results in peer-reviewed journals, agree on community-wide best practices, and then teach those best practices as a core part of the curriculum in the medical school.
Use of digital health tools
The greatest challenge is likely to lie in the area of so-called “digital therapeutics”. This is the growing number of digital tools out there designed to help healthcare providers automatically track and respond to the condition of patients. Great strides have been made in diabetes care, for example, with a number of successful automated monitors that are now regularly used by insurers, health care providers and individual clinicians to help patients control their glucose levels more consistently and precisely. Similar success stories exist in areas as wide as cardiology and neurology. Taken together, these digital tools have the potential to deepen patient-centered care.
But the sheer amount and novelty of these digital health technologies presents a challenge. Which ones are believable? Which are based on repeatable research and knowledge? Which cybersecurity and data protection problems address appropriately?
As a result, we are already seeing some reluctance in the marketplace as some of the larger insurers as well as companies – who have been early adopting tools that they believe can help minimize chronic illness among their employees, and therefore their insurance costs – more and more reluctant to adopt new tools. Many of these early adopters are now pushing for the market to unite into a smaller group of broader and more fully tested technologies.
Clinicians as individuals will find it even more difficult to sift through the range of digital therapeutics now available. Increasingly, medical schools need to develop courses to help students develop an understanding of the appropriate and careful use of digital tools in their health strategies. This doesn’t mean clinicians have to become technology experts; However, you need to understand the risks and know who to turn to or what resources to consult in order to make informed decisions about risks and opportunities.
Dimensioning the future of telemedicine
Whether these new approaches to telemedical education will be a useful but small part of future medical education or will become a basis for the training of future clinicians remains to be seen and depends largely on how much health care itself is shifted into a virtual mode .
Finally, when telemedicine makes up 40 or 50% of health care, I would expect that there will be certain rotations and maybe even residencies in telemedicine, or that health care providers will set up training departments themselves to research telemedicine best practices and promote their clinicians .
Cost is likely to remain the central issue in the broader healthcare ecosystem. However, it is likely that the rise in telemedicine will raise the dialogue about access modalities to a very important level in the coming years. This in turn will significantly change the future design of medical education and training.
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