Telemedicine has played a key role during the COVID-19 pandemic, allowing non-urgent but vital care to be provided in the safety of a patient’s home, while hospitals and primary care centers focus on emergency treatment. While its benefits are clear during a global pandemic, will it continue to grow and be a part of our lives in a post-lockdown world? What is its value? How will it be used to lessen the burden on health systems and improve quality of care? Before we tackle these questions, let’s first address three common myths.
Myth 1: Telemedicine is just teleconsultation used in primary care settings.
Reality: Telemedicine has many roles in healthcare delivery and spans the entire patient journey.
It can take many forms and is often labelled with a wide variety of terms: digital health, e-health, telehealth or teleconsultation, just to name a few. Ask someone what these words mean and you’re likely to get ambiguous and overlapping definitions.
With the rising demand for digital health and telemedicine applications over the past year, the industry, including regulators and professional associations, is actively working to clarify and define key terms to provide necessary clarity in a rapidly evolving space. Examples include the Healthcare Information and Management Systems Society releasing a definition for “digital health” in March 2020, and the EU Medical Devices Directive expanding to include telemedicine solutions as part of their regulatory framework. The Digital Therapeutics Alliance has also drawn boundaries and classified an important subset of telemedicine technology – digital therapeutics (DTx). Industry alignment is fundamental in creating a shared language and understanding, underpinning the creation of regulatory pathways and assessment framework to advance progress.
We reviewed the multitude of definitions and see telemedicine as, in essence, the provision of clinical services remotely using both virtual and digital interactions at the core of a broad and complex set of digitally enabled healthcare interactions.
The following are not included in our definition:
- Non-clinical telehealth, including telepharmacies, contact tracing and fitness tracking
- Digital applications designed solely for in-person physical settings (e.g. digital lab diagnostics
- Infrastructure that enables telemedicine, such as EHRs/EMRs, FIHR standards and HIPAA-compliant data centers
To bring this definition to life, we show here how it can be applied across the patient journey from prevention through wellness.
- Pre-diagnosis: Keeping populations healthy, preventing disease at its root.
Example: CureApp is a prescription DTx that supports patients with nicotine addiction used in conjunction with a portable carbon monoxide checker and is the first DTx to be nationally reimbursed in Japan.
- Diagnosis: Driving faster patient identification, diagnosis or triage to therapy; plugging gaps in care.
Example: In the U.K., Arc Health partnered with EMIS Health to improve GP access in care homes with its remote diagnostic platform for the patient with a number of connected meters and a camera. The partnership will introduce Arc to 57% of GP practices across the country.
- Post-diagnosis: Supporting remote patient monitoring, disease management or adherence.
Example: FreeStyle Libre, a continuous glucose monitoring system, provides care for more than 2 million people across 57 countries, with reimbursement secured in 37 countries. Studies demonstrate increased glucose control for users who consistently scan.
Myth 2: Telemedicine is a new development that would not exist without COVID-19.
Reality: COVID-19 accelerated telemedicine adoption by amplifying macrotrends and filling both new and pre-existing gaps in care, as the pandemic disrupted in-person physician visits and highlighted existing structural flaws in the healthcare system.
To say that it originated with new technologies at the onset of COVID-19 would be misleading. In reality, most of the technology already existed prior to 2020, exemplified through Teva’s acquisition of Gecko Health in 2015 and Roche’s acquisition of mySugr in 2017.
COVID-19 highlighted structural gaps in the way care is delivered and received. This expedited convergence of needs and expectations pushed the patient further to the forefront, with rightful demands for a better and seamless healthcare experience.
These underlying causes for the surge in this trend will continue to drive the market forward, even as we return to more in-person interactions. A key question remains: If the underlying factors were here all along, why did it take a pandemic for telemedicine to take off? There were significant barriers to telemedicine pre-COVID, such as concerns around privacy, security and trust; usability and integration; digital capability; and know-how. Although these still exist, necessity forced patients, providers and healthcare systems to overcome these barriers to help patients to receive care. Moving forward, security, user experience, cost and access will remain key considerations.
Myth 3: Telemedicine is an over-hyped trend that won’t last after COVID-19.
Reality: Though the number of teleconsultations has gone down in recent months as restrictions are being lifted, telemedicine is here to stay.
1) Levels of telemedicine growth during COVID-19 have increased at an unprecedented pace. During the pandemic, awareness and usage of telemedicine has grown with telehealth claim lines increasing from 0.15% of medical claims in April 2019 to 13% in April 2020, and up to 85% of physicians conducting some of their patient visits via telehealth. Accenture’s research showed that patients are open to new models of care as a result of COVID-19, and digital technologies will be key to fine-tune the patient services model and deliver the intended the impact.
While limited access to in-person visits could create an artificial inflation of the telemedicine market, following analysis of industry reports conducted by Accenture, we see that telemedicine would contract globally post-COVID but would remain above pre-COVID levels, with growth rate predictions for 2019-2025 shifting from 14.5% pre-COVID to 21.8% post-COVID.
2) COVID-19 has caused a shift in attitudes. 48% of patients state they would be more willing to seek virtual care in the future and 54% of primary care physicians intend to continue using telemedicine. The demand is expected to continue due to the tangible value it brings:
- Removing points of friction in the patient experience
- Facilitating access to healthcare (Example: specialists and rural access)
- Improving standard of care by building a holistic picture of patient health, allowing pre-emptive diagnosis and proactive disease management
- Reducing costs for healthcare providers and payers through triage, reduction of travel and minimized hospital stays
3) During COVID-19, governments and regulators have had to adapt. In Germany, Digital Health Applications Ordinance — DiGAV introduced pathways to review the reimbursement eligibility of digital health applications by statutory insurers. In Japan, telehealth regulations and reimbursement conditions by national health insurance have been relaxed. In the U.S., many of the expanded telehealth services temporarily covered by Medicare due to COVID-19 have been made permanent as of December 2020.
Clearly defined regulatory pathways are a fundamental building block for delivery and widespread adoption. As these frameworks continue to develop, companies must pay close attention to this dynamic environment.
The healthcare ecosystem, including life sciences industry, needs to prepare itself for a world where telemedicine and digitally enabled care become the status quo, and address the implications for their businesses. How will they collaborate across this expanding set of telemedicine players? How do they commercialize and succeed in this new context? These are the burning questions for the industry as it adapts to a new reality.