If you want to know what’s happening in telemedicine and where it’s headed, one of the best people to ask is Michael Gorton. Along with Byron Brooks, MD, he founded Teladoc, the leading company in that space. Gorton recently took the helm at MediOrbis.
Telehealth advocates actually made a good amount of progress over the 19 years since Gorton cofounded Teladoc, but obviously never so much as during the few months that we’ve been scrambling to handle the COVID-19 pandemic. Gorton says that in the early years, his company and their allies had several key accomplishments:
- They won recognition from regulators that a doctor can successfully diagnose and treat many conditions remotely.
- They pushed the regulators to get rid of the rule that a patient must have at least one face-to-face visit with a doctor before engaging with the doctor online. They pointed out that boards have always allowed cross-coverage. (That’s where a doctor you don’t know takes your 10:00 PM phone call to your regular PCP’s office.)
- Progress is being made in letting doctors treat patients in states where they doctors are not licensed. I always thought requiring licensing on a state by state business was absurd. Who says that a doctor licensed in California can equally well treat suburban middle-class white people in Orange County and lower-class Latinos in Salinas? The differences you find within states is much greater than what you find between states.
Although Gorton decided not to take on this battle, others have done so and may see victory soon. The motivation for doctors and regulators is to provide remote health care to under-served regions. In fact, Gorton sees an increase in international telehealth.
Doctors are now telling Gorton that telehealth has already saved tens of thousands of lives during the COVID-19 pandemic. This is partly because patients are getting advice online, but mainly because they can get treatment without exposing themselves and others to danger by going to the clinic. In fact, even going outside involves some risk.
Telemedicine is therefore ready to unfold its wings and seek new heights. Gorton believes it will soon enter the consolidation phase all industries go through, where the current roster of telehealth companies, numbering in the thousands, will be winnowed out and leave just a few. To be successful at telehealth, then, what should a company offer? He suggested the following features:
- Save the doctor several precious minutes by evaluating and classifying the patient’s needs before the visit starts.
- Make online consultations more efficient, thus allowing the patient to pay less while the provider earns more.
- Replace the GP’s initial evaluation of the patient’s problem, allowing the GP to spend more time on building relationships and counseling the patient on chronic health problems.
- Offer second opinions over telemedicine. These can be done physician-to-physician and patient-to-physician.
- Apply artificial intelligence to the data submitted by devices in the patient home, to identify risks and suggest interventions.
- Improve data exchange between patient records.
- Improve the security of virtual connections.
Many of these are being implemented at MediOrbis. When a patient calls up, the system poses a set of questions to classify the problem. It can determine whether a patient needs a GP or specialist, and what kind of specialist to connect the patient to. This is what patients used to do during a visit to the general practitioner. So MediOrbis automates work that used to be done by a GP.
However, Gorton says, telemedicine can streamline the GP’s work so much that they can work fewer hours for much more pay. They can make a much better living even though they charge just $35 to $45 for a telemedicine visit, as opposed to about $110 for an in-clinic visit. In short, Gorton sees telemedicine as a win-win.
There doesn’t have to be fancy AI in the telephone intake system; it’s just a matter of descending through a tree of questions and answers. AI could be used to determine the right questions and what medical conditions are associated with each answer. That’s the role played in health care by IBM’s famous Watson engine, for instance: it sweeps through the medical literature and finds possible diagnoses for collections of symptoms.
Eventually, AI could augment the question-and-answer process itself. It could also process the data about blood sugar, pulse oximetry, patient activity and whatever else devices can produce and send to the doctor.
I’m looking forward to a rebalancing of clinic and home in patient care. Current telemedicine offerings are setting the stage for much bigger things. We don’t just want to reproduce the experience of a clinic visit over the Internet. We want to make treatment a day-by-day experience in the home. That means a bigger role for technology, while preserving the clinicians’ crucial role of listening and making informed decisions.