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Telemedicine is Increasingly Important, But Comes With Challenges, Say Route Fifty Panelists

Elijah Labby

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Photo of Graham Mitchell, city manager of El Cajon, California, courtesy of the City of El Cajon

August 11, 2020 — Telemedicine is crucial for treating patients during the coronavirus pandemics, but carries limitations, agreed participants in two Route Fifty webinars on Tuesday.

Dr. Judd Hollander, associate dean of strategic health initiatives at Thomas Jefferson University, said that there are inherent limitations to telemedicine, and that virtual care is often not what people imagine.

“Telemedicine is not medicine — it’s a care delivery mechanism,” he said. “So if I’m a cardiologist, I’m delivering cardiac care. If I’m a lung specialist, a pulmonologist, I’m delivering pulmonary care… so the medical care is the same, and so it is all about workflows and operations and very little about technology.”

At the beginning of the pandemic, Hollander said, regulatory restrictions were loosened and doctors felt the need to take drastic measures.

“You didn’t need to buy an official telemedicine platform that might cost you six figures,” Hollander said. “You could just use FaceTime or something that doesn’t meet the regular security requirements with the regular consent requirements of telemedicine. But hell, this was a pandemic, this was a crisis, we needed to do something.”

Graham Mitchell, city manager of El Cajon, California, said that barriers to adoption of telemedicine, especially among the elderly, can be difficult to overcome. El Cajon has taken measures to increase use and enable the elderly to get the care they need from a safe distance, he said.

“Even I have to ask my 14-year-old son how to do a lot of things on my phone, and I’m relatively young,” Mitchell said. “We know through experience that the best way to teach a senior how to use technology is hands on… [but] during the pandemic, we can’t do that, so we are working on a series of how-to videos.”

Hollander said that there need to be regulatory guidelines on the technology that doctors can use.

“I don’t think the relaxation and using whatever toy you have around your house to deliver medical care makes sense,” he said. “…It’s better if I use an app where I come in and I sign the terms of use and say I agree with what they say. Some of the big relaxations, I think, probably should go away to keep patients safe and secure and make sure that they know what they’re getting care about.”

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