The Rise of Telemedicine: A Flawed Blessing

The coronavirus pandemic has moved much of the medical world online, with lasting effects. Photo by Sergio Santos.

The coronavirus has driven many formerly in-person activities, such as work meetings and education, online—doctors’ appointments have been no exception. Similar to other digital arrangements, patients’ satisfaction with this change varies, but one fact remains certain: the adoption of telehealth, also known as telemedicine, will shape healthcare forever. The widespread implementation of telemedicine gives rise to a contentious debate about whether telemedicine mitigates societal inequity as it increases people’s access to healthcare, or worsens it by virtue of being limited to those who can acquire and navigate the necessary resources, such as access to wifi, laptops, and telephones. Instead of abandoning implementation of telemedicine usage, we must improve the flaws that accompany telehealth and capitalize on its benefits. Adoption of telemedicine is like a symptom of disease: it reveals urgent systemic flaws that must be addressed with time and energy, rather than being the problem itself. 

Telemedicine usage provides numerous benefits, including saving patients both money and time and helping reduce the need for transportation. On average, a telehealth visit costs $79, whereas an in-person visit with a physician costs $146. Researchers from the University of California, Davis examined its in-person and telehealth records over the past 18 years and found that virtual clinical appointments enabled their patients to avoid traveling a total of more than 5 million miles. This data also reflects a significant financial environmental impact: had they been in person, these visits would have produced nearly 2,000 metric tons of carbon dioxide, 50 metric tons of carbon monoxide, 3.7 metric tons of nitrogen oxides, and 5.5 metric tons of volatile organic compounds. In addition to telemedicine’s low cost, technology’s ability to improve patient care is appealing. Surveillance cameras and technical software can notify caregivers if elderly clients hurt themselves. Telemedicine is also a great tool in postoperative settings because its increased accessibility and reduced costs enable patients to increase their participation in follow-up appointments. The growing use of technology to assess healthcare during COVID-19 proves that telehealth has the potential to revolutionize healthcare. However, we must address significant barriers to its access and implementation that prevent this reality. 

Despite these benefits, telemedicine also presents a series of challenges to equity in medicine. Not all patients have access to the necessary technology and technological infrastructure, including devices (smartphones, tablets, computers, etc.) and high-speed connectivity. People may be unable to repair their mobile phones’ damaged cameras, to pay the costs of cellular data, or to fulfill their monthly landline bill. Additionally, not all patients are technologically literate enough to attend or engage fully with providers during telemedicine appointments, which can be a key contributor to distrust of telemedicine. Such distrust can stem from patients’ belief that they receive worse quality care in a virtual appointment compared to an in-person one. These barriers to access disproportionately affect certain racial and socioeconomic groups; linked with racial inequality rooted from colonization in the United States, many who encounter this barrier because of low socioeconomic status have been subject to state sanctioned neglect across generations.  

Those with low socioeconomic status cannot leverage the appropriate technology at their desired time or place, leading to prolonged treatment delivery. Many people of color, then, would be at a higher health risk with a complete shift to telehealth. Furthermore, one’s inability to access telehealth can be due to inadequate infrastructure in one’s hometown; in rural areas, around 25% of the population, or 14.5 million people, cannot access high-speed Internet. 

Although many patients do not have access to the requisite technological devices, infrastructure, and knowledge to properly participate in telehealth appointments, these issues alone do not negate the importance of telehealth in the pandemic and beyond. Rather, these barriers represent areas that require greater development in technology and public policy to extend telehealth’s benefits to all. While people’s varying accessibility to technology, patients’ discomfort with online appointments, and the general distrust of telehealth are simply a few examples of serious issues in using telemedicine, telehealth’s benefits illustrate the importance of mitigating these issues. It is imperative that the government, physicians, and software developers invest more time, effort, and money into perfecting telemedicine to satisfy both providers and patients. The COVID-19 pandemic proves that telehealth is an invaluable resource that is here to stay. It is vital to direct more focus towards overcoming the challenges in telehealth and helping our healthcare experience evolve into a more helpful, cheaper, and equitable option.

A possible solution to overcoming these challenges includes investing money in community centers, healthcare systems, and technology stations. For example, training community members to navigate the telehealth technology can enable them to help people who seek assistance with their medical appointments. If towns can provide stable Wifi, multiple laptops or iPads, and volunteers who can gain other community members’ trust and navigate technology, we can mitigate inequities in telehealth access and literacy.

There are currently government programs funding the acquisition and expansion of telehealth equipment and services, like the Telehealth Network Grant Program (TNGP) which aims to “expand access to, coordinate, and improve the quality of health care services [as well as] expand the quality of health information available to health care providers, and patients and their families, for decision making.” The government must create more of these types of programs, as well as invest in already existing ones, to foster telemedicine’s growth in more communities and make telehealth more equitable. 

Throughout the campaign and transition, Joe Biden and his administration have been advocating for policies to level the playing field and increase access to affordable healthcare. On Thursday, January 28, he signed a set of executive orders to expand access to healthcare and enroll more citizens. Part of his healthcare platform must include an increase in investment to telehealth programs to increase funding for programs, access to technology, and telehealth literacy and awareness. Telehealth is the future of healthcare, and the Biden administration must ensure that it is available to the groups that need it most.

Alyssa Sales is a CPR staff writer, a second year in Columbia College, and a pre-med student intending to double major in Neuroscience and Behavior and Creative Writing. You may find her on the phone with patients to evaluate their satisfaction with telemedicine.