Why telehealth in cardiology is a double-edged sword, per Hoag's Dr. Subbarao Myla

Setting the expectations too high for telehealth's expansion in cardiology could have unintended consequences, says Subbarao Myla, MD, director of the cardiovascular catheterization laboratories at Newport Beach, Calif.,-based Hoag Memorial Hospital Presbyterian's Jeffrey M Cantor Heart & Vascular Institute.

Dr. Myla recently joined Becker's cardiology podcast to discuss how heart care may evolve in the near future, sensor technology developments for heart monitoring and more. 

Here is an excerpt from the podcast. Click here to download the full episode. 

Note: This response was lightly edited for length and clarity. 

Question: How do you see heart care evolving in the next 18 months or so?

Dr. Subbarao Myla: Right now, I expect telehealth to expand, increase care, and perhaps democratize to a degree, healthcare [disparities.] But at the same time, I am concerned that we're setting up for failure. The current telehealth is essentially a glorified FaceTime. There is no sensor-based input of vital signs. Physical exam, frequency of visits, and the non-verbal communication, [are] vital when I see my patients in the office. 

Face-to-face [with telehealth] is missing, but by setting the expectations high I'm concerned the quality won't match that expectation. This can cause concern for abuse. There may be reduced payments to telehealth. It increases the risk of missing a vital diagnosis and potential malpractice risk in the near term future. 

This lack of contact with the patient, I think it increases the gap and threatens the physician-patient relationship. We already have many alternative sources of getting the first knowledge base. It could be the AI, the chat box, or the minute clinic or the healthcare extenders. 

The challenge, research is showing, [is] many of them are actually increasing the testing because of the limited range of expertise and practicing at the top of their license, without the critical decision-making and living through failures and the experiences of an MD. You try to compensate by doing more tests, ordering more MRIs, CAT scans, or giving unnecessary narcotics or antibiotics. You are inviting a different mindset. You have antibiotic resistance, you run the risk of an opioid crisis. These are some of the ramifications that we will be seeing in the near future

On the more exciting side, I think this idea of same-day discharge and the ambulatory surgery model that CMS has proactively embraced starting Jan.  1, 2021, will accelerate that migration.

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