Patient Expectations for Telemedicine

By Joel Schindler, Phd
Joel Schindler

During the COVID-19 pandemic, state-mandated stay-at-home orders forced many patients to consult with their physicians remotely – for the first time. This type of telemedicine takes advantage of easily available online platforms that allow visual connection, such as Zoom, Skype, or FaceTime, all of which grew in popularity during the pandemic, fostering comfort and familiarity for many people, including new users. But there is a big difference between visiting with grandchildren, book clubs, or colleagues online and experiencing a doctor visit this way.

How will patients react to continued use of telemedicine? Will patients accept remote doctor visits to replace in-person examinations? Will they look for telemedicine to supplement current treatment models? The overriding question vis-à-vis telemedicine is after the pandemic is over will patients accept NOT seeing a physician in person if there is no stay-at-home order?  Preliminary patient feedback suggests generally positive reactions to this increased use of telemedicine. However, while some aspects of telemedicine offer obvious benefits, other aspects of its value remain unclear.  

If telemedicine is to take its place as an integral part of healthcare in the long-term, it must be scrutinized to answer critically important questions. Healthcare is beginning to be recognized as the two-way street that it has always been. Patients’ attitudes, knowledge, and comfort level are just a few characteristics that define the quality of the patient’s role in the relationship. Therefore, as the use of telemedicine increases, it is critically important to understand patients’ understanding and acceptance of the many issues involved. The following suggestions are just some of the issues that must be studied and addressed.

Types of conditions

For what types of conditions will patients accept telemedicine?

During the pandemic, many patients “saw” their doctors to evaluate symptoms that might be harbingers of COVID-19 infection. Although the illness could evolve into potentially dire situations, initial evaluation of “flu-like symptoms” is not complicated. Monitoring fever and symptom progression could be done at home and reported to physicians remotely. Initial prescription of over-the-counter fever reducers, fluids, rest, and physical isolation were relatively simple for doctors to discern remotely.

However, routine preventative and maintenance exams for healthy patients and ongoing treatment, follow-up, or diagnostic visits for patients with chronic or recent acute situations are very different from evaluation of flu-like symptoms, even outside of the pandemic. Do patients believe that all physician office visits can be replaced by telemedicine?  If not, which types of visits are patients more inclined to accept via telemedicine?

There are also major differences between general practitioners, who see patients for well visits and evaluate initial symptoms, and specialists, who may have a different level of relationship with chronically ill patients. Will all types of practices offer telemedicine options?  If not, will the availability of telemedicine options become a deciding factor for patients when they choose physicians? Will patients leave practices that don’t offer telemedicine?

Quality of medical evaluation

Patients, as consumers, have extremely high expectations for the quality of their medical care. If the quality of telemedical care turns out to be lower quality than in-person visits, are patients prepared to accept that lower quality in return for the convenience or other benefits of telemedicine? Do patients perceive benefits other than convenience with telemedicine? How do patients want telemedicine quality to be evaluated?  Will telemedicine Standards-of-Care be developed universally or by specialty-specific organizations?                                        

Quality of communication 

One of the great challenges for all patient-physician interactions is communication. It can be difficult for patients to clearly communicate their concerns, leaving gaps in physicians’ information and understanding. It can also be even more difficult for patients to understand what physicians tell them. Patients may lack the technical sophistication to understand complicated medical information. Or anxiety about their condition gets in the way of their understanding. Or both. The electronic medium might make the process even more challenging. Will the newness of the technology further impede comprehensive communication? What will patients expect in terms of their ability to communicate with and understand their physicians? Will a new “language” be developed that can be better used to leverage the nature of telemedicine? If an electronic doctor visit is followed by a written transcript or summary, could overall communication be improved by telemedicine?

Engagement selectivity  

Many medical visits require some type of actual procedure, even if routine.  Blood needs to be drawn or images taken for diagnostic purposes.  Immunizations must be administered to prevent future disease. If telemedicine becomes the norm, will patients still be willing to visit a doctor’s office for such procedures? Or will patients prefer to rely on telemedicine and avoid such in-person procedures?  Or will patients come to expect that some types of routine procedures be brought to them?  What “protections” will patients expect to come into the office for procedures that are impossible to perform over an electronic connection?  

Costs and insurance coverage

Patients incur both direct and indirect costs to visit a doctor’s office. In addition to the direct cost of the visit, patients incur indirect costs that can include travel expense, time away from work, or childcare to be able to go to the doctor without children.

Telemedicine could mitigate some of the indirect costs plus the time savings of simply not needing to travel to the doctor’s office.  Will patients perceive a telemedicine visit to be a “lesser” visit?  Will they expect to pay less for a telemedicine visit?  Will patients look for physicians who will charge less for telemedicine visits?  Will insurance companies reimburse the costs of telemedicine visits the same way they reimburse in-office visits?  If insurance has tiered reimbursement for telemedicine versus in-office visits, will patients make changes to their physicians to minimize the out-of-pocket cost to them?        

Technology

As the role of technology continues to grow in daily life, it is to be expected that healthcare will also be included in that evolution. However, there are dramatic differences in how technology can be accessed across the country and across socioeconomic striations.  Will telemedicine exclude certain segments of the population because they do not have the knowledge or tools to access the medium?  Will technology standards be developed?  Will programs and apps automatically be included in all new devices and easily uploaded to current devices?  With their use be simple and logical?  Will physicians’ offices be able to train patients on how to use the tools for telemedicine visits?

Being technology savvy is also an issue.  The generation that needs the most medical attention, older individuals, is less tech savvy than the younger generation that tends to avoid engagement with the medical community.  How will generational differences impact how telemedicine is practiced? 

Cybersecurity

Data security is a tremendous concern across all types of electronic activity. Intentional hacking is a very real threat. Next to financial information, a person’s health-related information is their most personal and sensitive data; perhaps even more valuable than financial data. Will patients be willing to share their medical information via a telemedicine visit?  What added protections will patients expect in order to feel comfortable sharing such information?  Will patients expect physicians’ offices to provide additional cybersecurity and protections?  Will failure to do so reduce patients’ enthusiasm for telemedicine as a viable approach to engage patients?

In the upcoming weeks, MarketVision Research will be conducting surveys with patients designed to address these and other questions around the viability of telemedicine moving forward.  As the post-COVID-19 world begins to emerge, the future of telemedicine and how patients will embrace it as a medical option will be an important component of that emergence.    

About the Author:

Joel Schindler, Phd

Dr. Joel M. Schindler brings a unique blend of experience and insight to healthcare market research. Dr. Schindler received a Ph.D. in molecular biology, held faculty positions at several medical schools and served as a program director at the National Institutes of Health (NIH). Following his NIH tenure, Joel began his career in marketing and marketing research including the last 18 years specifically in the pharmaceutical/biotechnology marketing research arena. Dr. Schindler has published extensively in both the biomedical and marketing arenas.