The growth of telemedicine: Approaching the second inflection point

Telemedicine is growing at the intersection of telecommunications technologies, advances in medical diagnostic and monitoring devices, and information science.

The opportunities associated with the growth of telemedicine can be appreciated by analogies that explore the growth curve inflection points of other industries such as the transformation of the delivery of retail goods and services. Analyses of the expansion of Amazon into part of a new cultural norm and the exponential growth of its value as an enterprise have identified 2 fundamental inflection points.

The first inflection point was the acceptance by consumers of the receipt of electronic content onto electronic devices that they owned. This transformation evolved over many years and was the result of synergies among technologies that increased consumer convenience while reducing content delivery costs. This hard won acceptance was followed by a second more dramatic upswing in growth associated with transformation of their direct-to-consumer portal to a delivery method for retail goods. This involved implementing product selection and distribution process that were more efficient than those of the conventional retail paradigm. In the same way our current suite of telemedicine technologies combined with outstanding healthcare professionals are poised to present a new, more efficient, financially, competitive challenge to traditional health care delivery. It is evolving using the same accurate real-time patient focused analyses that is revolutionizing retail. Healthcare consumers and payers are more than ready for change.

The proliferation and wide acceptance of sophisticated personal electronics has caused an increasing number of patients and families to dream of electronic medical service delivery. Consider your care of an independent minded aging mother who suffers episodes of painful urination followed by mild confusion that resolve with the timely administration of an antibiotic. In today’s healthcare system I must leave my practice to transport my mother to her primary care physician’s office. They compassionately ask her several well-rehearsed questions in a 5-minute combined interview and exam followed by 25-minutes of electronic documentation, a urine test, and a prescription for antibiotics. We then leave the office for her pharmacy to obtain the need pills and another copy of familiar printed materials regarding their administration and possible side effects. We then return to her home and at last administer the antibiotic that will clear her delirium.

Many patents and caregivers see value in electronically supported care delivery pathways. An available provider that has full authorized access to my mother’s records characterized her chief complaint using standardized questions, viewed the results of an at home urine test and arranged direct delivery of the needed antimicrobials to her home. Her telemedicine team used the saved-time for brief followup video enabled interviews to confirm the delivery, administration, and therapeutic effects of the antimicrobial. This approach that prevented her unnecessary transport and that of her medication was more efficient. Telemedicine has passed its first inflection point because patient and families are willing to accept the electronic delivery of medical services.

Consider a comparison of traditional and Amazon style paradigms for the delivery of consumer goods. Before Amazon, consumer goods were transported for display on the shelves of retail stores at the direction of store owners rather than being selected and purchase from a consumer owned electronic device. Retail goods that were ordered by an owner were shipped to the retail outlet and prepared for display according to shop-specific and highly variable practices. To purchase retail goods, consumers came on-site. Because consumer purchases were limited to the goods on display and they had to transport themselves to another shop to get a lower price or a different quality item, they all too often purchased goods that did not meet their needs or expectations. After purchase the consumer was responsible for transporting the goods to their homes. The electronic supported purchase process brought value because it eliminated waste. Consumers now use their devices to identify the retail goods that they desire, and obtain them from efficient distribution centers that use automated inventory and standardized methods of selection, preparation, and packaging to provide them. Consumers track and receive delivery notifications and provide feedback that improved process and product quality. The Amazon paradigm was transformative because it provided greater access to high quality goods at lower total costs.

The first inflection point antecedents of Amazon’s growth have clear telemedicine parallels. In the same way that the acceptance of electronic music and literary content delivery to our phones was enabled by screen and earphone technologies, medical diagnostic and monitoring technologies are available that allow our physicians to extend mobile phone basics to provide medical care when and where it is needed. Indeed, my mother’s physician was able to combine mobile phone and home monitoring technologies to confirm the presence of excess white blood cells in her urine and provide telemedicine enabled care of quality that was equivalent to that of her office visit.

A more important antecedent to Amazon’s second growth spurt was its collection and use of operational data that had largely discarded or ignored by its predecessors. They organized and used this information to influence consumer choice of the source of their purchased goods. Connecting timing and prior purchase profiles to current search terms allowed Amazon to use available screen space to present items of consumer interest that are available in the Amazon distribution system. Critically, they used timing of delivery and return data to monitor and manage the quality of the services that they delivered.

The power of telemedicine tools to transform medical service delivery relates to how transactional information is collected and used to promote quality and limit waste. Consider a distressed child who informs her mother of ear pain and dysphoria. Noting the change, her concerned mother arranges an emergent pediatrician office visit. After transporting the sick child and waiting 45 minutes in the waiting room, her experienced pediatrician notes a fever, examines the mouth, neck, and both ears. Appraising the mother’s distress she writes a prescription for an antibiotic and sends the family to her local pharmacy. The telemedicine pathway is more efficient for both the family and the pediatrician. In the telemedicine option, the mother uses her mobile device to complete a set of standardized ear pain questions, links information from her tympanic membrane thermometer to the encounter, takes a picture of the child, and after viewing an instructional video uses an otoscopic attachment to import images of both tympanic membranes into the encounter. These and other electronically available pieces of information are presented to her pediatrician in a format tailored to efficient care delivery. Sharing the images of the tympanic membranes and reference images allows the mother to accept antibiotics when bacterial infection is suggested and antipyretics when a viral infection is likely to be causing the ear pain.

In addition to being more convenient for the family, it is more efficient to use more of the pediatrician’s time for clinical decision making rather than for gathering, organizing, and documenting clinical activities. Favorable time to service characteristics of the telemedicine encounter, lower rates of inappropriate antibiotic use and complications, the ability to reward providers for correct therapeutic interventions, and the ability to encourages families accept more appropriate care plans and avoid unnecessary diagnostics and therapeutics allows greater access to high quality care at lower cost.

Analogous to how the tracking and monitoring functions of its distribution centers increased Amazon’s worth, telemedicine-enabled medical service centers are able to transform the way we access, provide and consume medical care. The secret sauce of the second inflection point is the better use of available information, the availability of low cost medical accessories for devices that consumers already own, and efficient logistical coordination centers that are connected to patient owned communication devices. Precedents for the creation of value and elimination of waste by using logistical support to bring order out of chaos are all around us. Familiar examples range from getting our children into the family vehicle at an appointed time, to package delivery, coordination of teams to suppress wild fires, support of space exploration, and the organization of military operations.

The key remaining question of the second telemedicine inflection point is who will coordinate the evolution to bring value through health care logistics by solving the riddle of change. The leaders of Amazon had to solve a formidable number of seemingly intractable obstacles including delivery costs, the opposition of local shop and well financed mall owners, closed foreign markets, and intellectual property right related regulatory impediments. Healthcare innovators face regulatory impediments to interstate medical practice, changing approaches to healthcare finance, under developed and inefficient information systems, rudimentary and fragmented logistical services, and entrenched opposition to change from healthcare organizations. Disagreements over healthcare reform and the inefficiencies of our current system have created space for entrepreneurial solutions. Risks to the remaking of our retail distribution system were mitigated by using elecronicicaly acquired operational intelligence to promote consumer preference of the new paradigm. The main lesson from the first telemedicine inflection point is that patients desire and expect electronic assisted retail like efficiencies for their healthcare services. The rewards for those who can create healthcare value by arming our best clinicians with efficient electronic care delivery tools and by making telemedicine encounters available to anyone with a mobile phone may exceed those reaped by Amazon.

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