Dialing in to Telemedicine

Telemedicine has been in use for at least a century — when a bladder surgery was guided via morse code in rural Australia by the founder of what later became known as the Royal Flying Doctor Service.

With widespread broadband adoption in the developed world, telemedicine has evolved as the future of healthcare. Why? It’s incredibly convenient — for both doctor and patient — the costs are often reduced, and it brings primary care physicians to places that would otherwise go without. In rural areas of the United States, for instance, many lack access to quality care, and anyone who requires particular expertise, such as transgender patients or those with addiction issues, are generally out of luck.

What’s more, business is booming. In 2015, telemedicine already constituted an $18 billion-dollar global market, which is projected to more than double by 2021. Major players, such as Amazon, Apple and Humana have plans in the works:

Amazon, Berkshire Hathaway and J.P. Morgan came together to create Haven, a healthcare consortium with the goal of lowering healthcare costs. While it has yet to launch, telemedicine is among its offerings.

Apple conducted a study with American Well to monitor heart health, and it’s easy to forsee numerous telemedicine applications for the latest version of Apple Watch.

Humana merged with Doctor on Demand to launch virtual primary care plans, a first.

While it might look like startups are late to the party, niche opportunities abound. For women experiencing menopause, there’s Ro, which also sells products for erectile dysfunction and addiction. Another startup, Hims also provides ED medication and Hers, launched by the same company in 2018, provides birth control pills, and skincare prescriptions, among other things. If I were to list all the startups taking advantage of the estimated 13–25% annual growth of the industry, I think I might even exhaust myself!

Yet some of the challenges that kept telemedicine from flourishing for the past two decades remain. In America alone, 30% of the rural population doesn’t benefit from broadband, yet many insurance companies do not cover audio-only consultations. Over-prescribing is a real concern; a recent study showed that children were much more likely to be prescribed antibiotics when seen virtually versus in person. (As over-prescription becomes the norm, antibiotics become less effective.) Only 32 states have enacted “parity” laws requiring insurance companies to reimburse telemedicine appointments at the same rate as in-person visits. Quality control is another worry; in one study, when 67 volunteers with standard medical issues (sinus infections, UTIs, etc.) brought their health concerns to a virtual appointment, one in four was misdiagnosed, or received no diagnosis at all. Finally, while it may be hard to believe, one issue that telemedicine faces is lack of awareness; one survey showed that 82% of the American population was unaware that they could visit their doctor remotely.

I’m happy to say that my experience with telemedicine has been overwhelmingly positive. This winter, my entire family went down with the flu, one by one, like dominoes. First it was me. Then my eldest son. By the time my husband got it, I was about to set up yet another appointment and then I thought wait, telemedicine! Usually, a prescription for Tamilflu requires a flu test, but when I talked to the doctor over the phone, he said, “Two cases in your own home, that’s proof enough for me.”

Clearly telemedicine isn’t the right choice every time — it may not always be ideal for urgent care, for instance. As one doctor noted, “There is a built-in barrier to getting testing,” though a New Hampshire pediatrician recently told lawmakers how she’s gotten around that — with a device that walks you through how to give yourself an ear exam. But for routine visits, for people who live far from in-person options, and for specialized care, it can save time and money.

I think we’ll eventually get around the hurdles were currently facing, but I wonder if traditional healthcare providers are hearing the call? Although I believe we’re reaching a tipping point where we’ll have mass adoption, the move toward telemedicine isn’t being made across the board. While it’s a missed opportunity for providers, that only means it’s ripe for innovation. What will your telemedicine startup be?