Telehealth creates a new kind of health care experience

Maria knew something was wrong. 

A working mom in her mid-thirties, Maria has diabetes — and she was feeling more fatigued than usual. She thought it could be a urinary tract infection (UTI), so she booked a video visit — a virtual consultation with a physician. The doctor agreed something wasn’t right and sent her off for coordinated and expedited lab work. 

Those tests showed a UTI wasn’t the problem. Maria’s diabetes had been uncontrolled — and worsening rapidly. 

The doctor set the patient up with home remote monitoring so her glucose levels could be tracked outside the medical office, with alerts programmed into the monitoring devices to notify her doctor in case of any issues. Her doctor checked in on her once a month via video visits. And after six months, she showed significant improvements. Her diabetes was back in check. 

“Before using technology, this patient could have easily fallen off a cliff and ended up in one of our emergency rooms,” said Dr. Dennis Truong, an emergency physician and director of the Telehealth/Mobility program at the Mid-Atlantic Permanente Medical Group. 

With technology and an integrated delivery system like Kaiser Permanente, Truong continued, her doctors were able to head that off at the pass. And therein lies the potential and the promise of telehealth. 

“When we say ‘telehealth,’ we’re basically saying that we’re using technology to deliver or collaborate in health care,” Truong explained. “It’s about whatever works to fit care your day, rather than the old paradigm where you had to revolve your care around the doctor’s office.” 

While telehealth is commonly thought of as a recent innovation, it actually dates to the 1940s, Truong said. That’s when physicians began transmitting radiology images via telephone lines. In the 1950s, doctors began transferring electronic medical records by telephone lines. And in the 1960s, closed-circuit televisions were making video visits possible over long distances. That same era brought the advent of remote medical monitoring of animals being sent into space, which was basically a precursor to wearables and remote patient monitoring, said Truong. 

“You had a problem of distance, and you were solving it using whatever technology was available at the time,” Truong explained. 

Now, the advent of the internet and the ubiquity of smartphone technology has led to more rapid and game-changing advances. Truong describes modern telehealth technology as crossing four major “dimensions”: 

• Asynchronous (for example, e-visits, teleradiology, or teledermatology), which includes the secure transmission of images, questionnaires, or records for evaluation and input;
• Synchronous, which involves real-time video visits and telephone conferencing; 
• Remote patient monitoring, the process of transmitting data from at-home devices — which may or may not be wearable — directly to caregivers and the health care team; 
• Mobile health, the ability to access and deliver care from mobile devices, anywhere at any time. 

All of these elements work together to remove barriers to health care for the patient, making it more convenient and cost-effective. Telehealth gives physicians the opportunity to collaborate, bringing multiple doctors together to provide the best possible solutions for a patient, Truong said. 

“Take someone with a wound infection. I can video the surgeon who did the operation into the ER with me, and we can evaluate the wound together,” he said. “It’s nice to have the specialist and the physician working on your care exactly when you need it.” 

And this isn’t limited to physical care. The benefits extend to the field of behavioral health as well, said Katie Wilson, Program Manager of Telehealth/Mobility at the Mid-Atlantic Permanente Medical Group. 

“We’re a large region, and one of our patients had gotten accustomed to their therapist and was having a good experience. Once the patient moved, they would have had to drive 90 minutes to see that therapist. With a video visit, it made it so convenient for them,” Wilson said. “The therapist could still see the person face-to-face and get a sense of how they’re feeling.”

While telehealth has obvious benefits to both patients and prviders, the systems have to be intuitive to achieve widespread adoption. That’s why communication is key, Truong said. 

“We communicate a lot with our frontline physicians, providers, physician leaders to know where the pain points are, and our job is to work together with our IT department, our health plan and our physicians to come up with a joint plan of how to attack this,” Truong said. “It starts with understanding what LEGO pieces you have in your technology box and the processes already working well in your system.”

The next step lies in ensuring that technology is integrated, creating a health care experience in which any doctor treating a patient has all the information he or she could possibly need, Wilson said. 

“The doctor can go right into the medical record, and while they’re in the video visit, they have that medical record open. They have all the information,” she said. “Even if that physician doesn’t know the patient, that patient is known to the system.” 

And that’s only the beginning, Truong said. 

“The next generation is going to allow us to monitor patients seamlessly in their homes or when they travel,” he said. “Home is really anywhere now, and being able to follow the patient everywhere without them having to actively send something to you will be the telehealth of the future.”