By: Alexander Fogel MD, MBA
Dr. Kvedar is a Professor of Dermatology at Harvard Medical School, Chair of the Board of the American Telemedicine Association, Senior Advisor of Virtual Care at Mass General Brigham, and Editor in Chief of npj Digital Medicine.
AF: You’ve been working on telemedicine for the better part of 30 years. Why did it take a pandemic to bring this technology into prime time?
JK: There’s always been a tension between how the world should be and the reality of how it is. Sometimes reality holds you up.
AF: How do you envision the future of telemedicine?
JK: Today’s virtual care is just the beginning. And it works in somewhat limited ways. Virtual care is currently probably best for recurrent, algorithmic treatment decisions for people you already know. But imagine a future with better-quality connections, higher-quality images, remote data gathering, and the ability to interact in a richer way with patients – this is the possibility of telemedicine.
AF: What innovations in telemedicine are here to stay?
JK: A switch has been flipped. I’ll never have to go to a cocktail party and explain what telemedicine is again. Nearly all patients and doctors have now had experience with telemedicine. While this is a major boon to the adoption of telemedicine, the risk is that telemedicine will be pigeon-holed as a “pandemic solution” that will fade as the pandemic does.
During the first major lockdown in May to June, we were seeing between 70—80% of all ambulatory visits conducted over telemedicine. Now it’s closer to 15-25%, which is a more appropriate and sustainable level.
There are a few axes that will determine how and what form telemedicine adoption takes over time. One is the physician-patient axis, which is the balance between physician comfort and patient convenience. Then there is the regulatory-reimbursement axis, because, outside the emergency actions taken during the pandemic, our regulatory structure doesn’t provide the reimbursement for large volume telemedicine.
AF: What will it take to bring telemedicine to the next level?
JK: More home devices that allow multiple exam maneuvers. These need to be available and accurate. Home testing (labs, etc.) to bring more information into the visit. Different visit formats – not just video. Asynchronous telemedicine is particularly well-suited for dermatology if done well. Remote patient monitoring and digital biomarkers have the potential to add further information. And, of course, we need federal and state policymakers to act swiftly to make the temporary flexibilities enacted during the pandemic permanent, to ensure access to telemedicine following the Public Health Emergency.
AF: Can telemedicine enable the personal connection between doctor and patient that is so vital to medical care?
JK: The key qualities that the doctor brings to the visit are EQ and judgment. We’re not just another online source of information. When talking with my patients about their skin, I make it a point to ask “what do you want to do” – it’s their skin, it’s their life. A software can’t replicate this shared decision-making.