The COVID-19 pandemic has led to a boom in telemedicine, especially when public and private health insurers have agreed to reimburse it. Now, with the pandemic subsiding and its effects on daily life, many healthcare providers seem ready to go back to the old ways. But even though telemedicine has been overused during the pandemic, it was almost certainly underused before. Here are some insights from a source I didn’t expect: a group of doctors, medical students, and telemedicine professionals involved in the Ukrainian relief efforts. Jarone Lee, Wasan Kumar, Marianna Petrea-Imenokhoeva, Hicham Naim & Shuhan He offers some ideas in “Telemedicine in Ukraine shows that high technology is not always better” (Stanford Social Innovation ReviewMarch 2, 2023)
The authors describe their work with a Ykrainian-built telemedicine platform called online doctor, and find hundreds of Ukrainian and Russian-speaking healthcare providers who have volunteered to participate. Surveys of healthcare providers in Ukraine report widespread use of the platform.
Doesn’t that seem to apply in the US? The authors write:
In the United States, 80% of rural areas qualify as federally designated “medical deserts”. This means that approximately 30 million people live at least one hour from the nearest hospital offering trauma services. In addition, many people suffer from chronic illnesses or social barriers that prevent them from accessing health care in doctors’ offices and hospitals. Telemedicine could be an effective solution to reduce their suffering. For example, telemedicine could allow an anxious person to receive mental health therapy from the comfort of their home, while a patient who noticed a suspicious bump on their skin could have a virtual consultation to help determine its severity. .
The authors point out that many of their telemedicine contacts in Ukraine occurred via text message.
Texting has the obvious advantage of requiring less connectivity, especially in a war zone. It has also become a generationally ingrained practice around the world as many people may struggle with video calling. But texting also allows for a more productive use of a scarce resource: clinicians’ time. They can respond asynchronously, when it suits them best, just like patients. With texting, telemedicine can treat many more patients than if it relied on synchronous technology. American suppliers are beginning to impose themselves. CirrusMD is a virtual “text-first” primary care platform, where patients begin each visit by texting a physician. They can send images or host video calls and receive referrals to specialists. Asynchronous messaging allows for greater back-and-forth between a busy clinician and the patient.
There is a tradition in health care delivery – a tradition that has some rational basis – that health care providers should meet with patients and do a reasonably thorough examination before treatment. But surely there are times when a full in-person visit seems like overkill. The authors cite a study involving children who had had appendectomies. Some of the families had access to a text message for questions; some did not. Those who had texts ended up in the emergency room less than half as often. It is suspected that there are many other examples.
For some previous articles on telemedicine, see: