In a recent article the question was posed  “Direct-to-consumer telemedicine: Has its time come?"  According to the ATA telemedicine is defined as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.”  In 1996 when Claritin began ads on television spawning a multi-billion dollar industry of direct to consumer sales telemedicine truly arrived in prime time. 

Telemedicine takes many forms and the real question is how and when can telemedicine improve a patient’s clinical status in a safe, cost effective, high quality manner. 

Does most health care require an authentic relationship?

According to the Merriam-Webster Dictionary authentic is defined as "real or genuine."  The question implies that telemedicine does not allow for a real doctor/patient relationship to developed.  Telepresence robots like the VGo have been used in a variety of clinical settings including hospitals, nursing homes, assisted living facilities, patients homes, and even in classrooms for students to ill to attend class. There is a growing body of evidence that telemedicine consultations have higher patient satisfaction scores than routine office visits.  A recent paper presented at CHI Conference on Human Factors in Computing Science reported that students did not distinguish between the robot and the student controlling the robot from home. In other words the students treated the robot as a student and not an extension of the student.  With the average follow-up office visit lasting less than 15 minutes telemedicine my in fact be more authentic as the patient will be in familiar environment spending no or less travel time and  having the doctors undivided attention.

How do we define quality in this new environment?

The Institute of Medicine defines healthcare quality as the extent to which health services provided to individuals and patient populations improve desired outcomes.  For patients with limited mobility, resources or those living in remote areas telemedicine might be the most satisfactory approach to making a diagnosis and providing therapy.   Since it is believed that diagnoses are missed, incorrect or delayed between 10 and 20 percent of cases when patients are seen and examined by physicians it would seem that seeing a patient in person is no guarantee of quality.  I am not advocating the abolition of the doctor patient relationship nor the need for in person visits but we now have many instances of excellent care being rendered with telemedicine.  Much of the reluctance to telemedicine is a function of fear, finances and licensure.

Is the technology up to the task? 

I believe that technology is a tool.  When I was a Chief Medical Officer and new technologies were purchased by the hospital the medical staff was required to determine how it would ensure that physicians utilizing the instrument were properly trained and their outcomes monitored.  Telemedicine is unique in that there are no new tools.  Telemedicine is in its infancy and we are seeing the public gravitate to the ease and convenience of telemedicine in certain circumstances.  I believe that as payment methods change and people are asked to bear a greater percentage of their healthcare costs remote telemedicine will become routine and may in fact be a dominant form of care for many.

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