The most obvious problems that telehealth seeks to solve are access, efficiency, and convenience. Telehealth addresses access gaps that exist in healthcare systems (both domestically and internationally), especially for those who live and/or work in rural and remote areas.
These areas typically experience a lack of specialty care or any professional healthcare due to various factors. Extensive research is being conducted to better understand this physician shortage and potential remedies (Rural physician, 2015).
It not only increases access to patient services, but telehealth also increases communication between different providers. It makes it easier for medical providers to consult on legal issues (providing evidence in courts of laws) and to offer advice to schools and universities (particularly on mental health and behavioural health issues, which are a growing area of concern in the United States).
It lowers costs by reducing the need to transport patients or to provide timely access to care to prevent a crisis health situation. It can be used to divert patients from more expensive Emergency Department (ED) services by using telehealth to triage patients before they come into the ED or by using telehealth to provide psychiatric or other specialty evaluation to more quickly transfer patients to the correct non-emergency department. It also opens up the possibility of covering doctor shortages with telehealth doctor networks or having providers at less busy medical centres cover visits at busier medical centres.
For the medic, telehealth brings in additional support and tools for faster diagnoses, more accessible training and education, and emotional support that leads to better decisions, cost savings, and improved patient outcomes (Improved patient outcomes, 2015).
Telehealth Barriers & Limitations
While telehealth delivery has become increasingly feasible, particularly from a cost perspective, there are still technological and regulatory limitations that may impact its success. We’ll briefly discuss these barriers & limitations in this next section.
Lack of Infrastructure
Connectivity (or the lack thereof) has been a key limiting factor for the use of telehealth. Most rural areas have limited internet access whether it’s poor Wifi, spotty cellular coverage, or no connection at all. These technological challenges/limitations were identified as early as 1995 (Puskin).
Even now, with many networks upgraded to 3G and 4G standards, in many places there is still no infrastructure in place to ensure that patients and doctors can be connected in a reliable and cost-effective manner. In areas, such as Africa, that do not have extensive cellular networks, a satellite may play an important role in ensuring telehealth services can be consistently and accurately delivered (The importance of, 2016). Cost, however, may be prohibitive for these areas.
Lack of Power
A related concern is a reliable power supply. Areas (more so in developing countries) that lack consistent power supplies and where power outages may simply be a fact of life disrupt the ability to deliver data between different stakeholders.
Low Patient-Provider Acceptance
The number of consultations provided via video telehealth remains troublingly low in the United States (as well as around the world), some statistics indicate that patients are embracing an increasingly open-minded attitude toward utilizing these services – in particular, the rising first generation of digital natives also known as the millennial generation.
In one 2016 survey, roughly 50 per cent of surveyed patients did not know what telehealth was — indicating that there is a need for greater education and marketing outreach on the part of individual providers and organizations. However, most survey respondents indicated that they were open to certain telehealth concepts, such as online chats or video conferencing with their provider(s) (New study, 2016). There also seems to be a greater willingness to adopt these technologies if the individuals already had had previous interactions with the providers.
For patients, telehealth provides greater access and convenience for their healthcare needs, so perhaps the bigger barrier may lie with providers. For providers, the benefits to them may not be as immediate and while the challenges (discussed below) are many.
Sommer (2018) also suggests that a major hurdle standing in the way of acceptance and implementation is the fact that doctors and other medical professionals are not well trained on how to utilize these new technologies in medical school. If medical schools launched courses on telehealth for students, this would resolve at least part of the challenge (at least as it relates to unease with new technologies).
Poor Usability Design
Healthcare is a unique business model where all the revenue comes from encounters with a provider. Because a provider’s income depends on being able to efficiently see patients, physicians are very wary of anything that will disrupt their workflow without providing clear value. Telehealth systems that do not understand this and other informatics and design concerns (Reddy, Gorman, & Bardram, 2011) will fail to be adopted.
For example, traditional video conference systems (such as Polycom, Cisco) used for telehealth are simply too complicated to be useful to physicians and are nearly impossible to set up for patients in the home. They also require extensive training, IT support and take too many steps to schedule and establish a video connection. Furthermore, many physicians are fearful of such complex technology. They need something simple that will help them be more efficient at what they do.
The development of smartphones and simply designed consumer devices have vastly opened up the possibilities for telehealth. Also, many lessons have been learned from poorly designed Electronic Medical Record (EMR) systems that physicians consider inefficient. Current telehealth designs are more likely to take into account the provider’s workflow and interface in order to better facilitate telehealth.
