To Telemedicine Or Not To Telemedicine? Allison Keane, MD, Neerav Goyal, MD, MPH, and Ellen S Deutsch, MD, MS PAO-HNS Patient Safety Committee
Introduction The COVID-19 pandemic has caused our healthcare system to transform and adjust to accommodate a constantly changing landscape. The effects specifically on the Otolaryngology field have been no less transformative in both inpatient and outpatient settings. One technologic application that has been pushed to the forefront in our field because of the pandemic is telemedicine. For better or worse, telemedicine seems here to stay. We present a “point-counterpoint” discussion about telemedicine with regard to patient safety and healthcare quality. We conclude with areas of agreement and discussion of the future implementation of telemedicine within Otolaryngology.
To Telemedicine The convenience of telemedicine for patients is undeniable. The time taken to turn on a device and log into an application, from the comfort of a home, or without ever leaving the workplace is minimal compared to the time previously spent traveling to and from offices and waiting in waiting rooms. Decreased time away from work and decreased travel also correlates to a decreased cost for patients. Carbrera et al. conducted a systematic review of the cost of telemedicine for otolaryngology patients and found an average savings per patient in the US ranging from $68 to $900.1 Analysis of cost savings by subspecialty revealed the highest savings for patients with otologic and head and neck conditions.1 The convenience of telemedicine has benefits beyond cost savings for patients, including increased access. Telemedicine enables any patient with an electronic connection have a medical visit with an otolaryngologist. Patients previously limited by travel time or cost are able to seek specialty care. This increases access to care for underserved communities, disabled, and elderly patients. The cost and access benefits of telemedicine in otolaryngology were achieved while maintaining patient satisfaction. In a systematic review on telemedicine in otolaryngology, Ning et al. reported patient satisfaction scores of 95% and above for patient-otolaryngologist virtual visits.2 In one of the studies, 88% of patients stated they would use telemedicine again.2 Telemedicine has not adversely affected patient satisfaction with their physician visits. The perspective of the physician is also important. Otolaryngologists have similarly reported high satisfaction rates regarding telemedicine patient encounters. In the same review, Ning et al. discussed five
Not to Telemedicine The convenience of telemedicine is undeniable—within limits and when it works. While telemedicine may save on travel, there are stipulations associated with a telehealth encounter. Effective telemedicine requires the presence of synchronous communication with both an audio and video component. The patient needs a computer with a web camera or a smartphone and confidence in using the telehealth platform. While 85% of Americans in 2021 own a smartphone, in rural environments only 70% have access to the broadband necessary for telemedicine encounters.3 For many physicians, the inequities surrounding telemedicine are clear. A study from Johns Hopkins demonstrated that marginalized racial groups, seniors and patients on Medicaid were more likely to have a telephone visit when doing telemedicine.4 Additionally, the personal comfort of using a “smart” device for telemedicine was an identified barrier. It was not uncommon for patients to require a call by a staff member to help them start the telemedicine encounter.4 Unfortunately, the same patients for whom telehealth may provide increased access are those patients who have the most significant barriers to using these services. Anecdotally, with the rapid implementation of telemedicine during COVID, there was a simultaneous and persistent build out of on site or third-party services to support the telehealth platform. Beyond the access limitations, in its current most pervasive form, telemedicine is limited in the type of healthcare that it can deliver. For patients using their home devices, an otoscopic exam is impossible. Even a clear evaluation of the oral cavity or Continued on page 8
SOUNDINGS | Spring 2022
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