The Potential Opportunities and Pitfalls of Telehealth

In a recent paper, Yale cardiologists emphasize the importance of balancing quality and equity with practicality in telehealth.

During the pandemic, medical centers, including Yale, quickly developed telehealth programs to reduce exposure to the virus that causes COVID-19. Experts predict that telehealth will remain a part of the healthcare system even after the risk of COVID has subsided. In addition to reducing the risk of catching something in the doctor’s office, telehealth eliminates the need to travel there. In a word, it’s convenient. But there can be a trade-off between convenience and quality when telehealth replaces in-person visits, caution Sarah Hull, MD, MBE, assistant professor of medicine (cardiology) and associate director of the Biomedical Ethics Program at Yale School of Medicine, and colleagues in Paper published September 30, 2022 Yale Journal of Biology and Medicine. In the paper, Hull and his fellow Yale cardiologists explore these trade-offs, as well as concerns about health care disparities and unintended consequences that may arise from the use of telehealth. The authors also suggest practices that the medical community can use to get the most out of telehealth.

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Trade quality for convenience

Telehealth has limitations. As the authors note in the paper, “there can be trade-offs for convenience, where the absence of a physical exam or an overlooked nuance in nonverbal communication can lead to a missed diagnosis.” Patient surveys have reported that patients find in-person visits to be more thorough than telehealth appointments.

Distributive justice and unintended consequences

While telehealth is often touted to increase access to health care and reduce health care disparities, it has the potential to exacerbate inequity, the authors note. If people who previously had little access to health care begin to use telehealth—and telehealth is of lower quality than in-person medical care—then the shift to telehealth does not eliminate the health care disparity. Instead, the disparity shifts: Medically underserved populations, including people of color, low-income people, and people living in rural areas, go from less access to health care to lower quality health care compared to better-served populations. .

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A possible unintended consequence of the shift from in-person care to telehealth is an increase in clinician burnout, which was a problem even before the telemedicine boom. As the authors note, “too much screen time and too little face-to-face time with patients due to electronic medical record requirements has already been cited as a major contributor” to burnout.

Recommendations

To ensure the best results from telehealth, it is important that all patients have computers or equivalent devices and receive all the assistance they need to benefit from their telehealth visits. Incorporating digital diagnostic tools, such as “wearables” like smart watches, into visits could improve care. Physicians should also receive training, beginning in medical school, on how to provide telehealth. Hull and his colleagues write that health systems should create standards for the optimal balance between telehealth and in-person visits—and between quality and convenience.

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Additional Yale authors are Joice Oen-Hsiao, MD, FACC, and Erica Spatz, MD, MHS.

Yale’s Department of Internal Medicine is among the nation’s leading departments, bringing together an elite cadre of clinicians, investigators, educators, and staff at one of the world’s top medical schools. To learn more, visit Internal Medicine.

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