Video-Visit-Enabled Practices Are Wasting Capability

Marcia Frellick

April 12, 2019

PHILADELPHIA — Although some telehealth services are available in more than half the practices in which internists and subspecialists work, having the technology does not equate with use, according to results from a survey conducted by the American College of Physicians (ACP).

Some physicians might not even be aware that telehealth capability, including video visits, is already available in their electronic health records (EHR) systems, said ACP President Ana María López, MD.

"You have to turn on the application, and that might have a cost," she told Medscape Medical News.

ACP surveyed a random sample of 1449 members 65 years and younger from October 2018 to January 2019 to measure the availability and use of telehealth technology. Results from the 233 respondents (16.1%) who provide outpatient care were presented during a news conference here at the ACP Internal Medicine Meeting 2019.

The respondents shed light on the availability and use of video visits with patients, e-consults with other doctors, remote patient monitoring, remote care management and coaching, and data integration from patient wearables.

E-consults were the most widely implemented service, but only 18% of the practices with the technology reported making use of video visits every week.

Table. Telehealth Use in Practices With Technology Available
Type of Telehealth Weekly, % Never, %
Video visits 18 39
E-consults 63 9
Monitoring 39 21
Management 50 27
Wearables data 30 20

ACP is developing practical resources tailored to internal medicine — including web-based toolkits and online education modules — to help users get started in telemedicine, said Tabassum Salam, MD, vice president for medical education at ACP.

The resources will help physicians identify which patients are good candidates for telemedicine and understand how to integrate the technology into workflow, she explained. They will also include guidance on vendor selection and the navigation of regulatory, reimbursement, and licensure issues.

The first focus will be on video visits; education models will begin to roll out in late summer or early fall, Salam reported.

Although the level of use is relatively low in all five telehealth categories, 10% to 20% of respondents reported that they are considering implementing the technology in each category in the next year.

Internists are often not the people making decisions about telehealth implementation in their practices, the survey indicates. However, it is important for internists to be part of the development as telehealth spreads so that the mistakes that occurred when EHRs were implemented can be avoided, said Andrew Dunn, MD, chair of the ACP board of regents.

Conflicting standards for new systems and disorganized, irrelevant, or erroneous data in records have frustrated professionals.

Another concern as telemedicine advances is that government initiatives could divide the "haves and have nots," Dunn pointed out.

"Patients with lower health literacy and lower economic status and lower technology literacy are going to be excluded. Any system that's going to be built needs to think about that upfront," he told Medscape Medical News.

Wider use in skilled nursing facilities might be the next opportunity for telehealth. Patients are often readmitted to the hospital for something that a teleconference could easily have addressed, he explained.

It is hoped that legislation will be introduced "that will give skilled nursing facilities more incentive to incorporate telehealth services and remove some of the barriers," Dunn said.

López, Salam, and Dunn have disclosed no relevant financial relationships.

American College of Physicians Internal Medicine (IM) Meeting 2019. Presented April 11, 2019.

Follow Medscape InternalMed on Twitter @MedscapeIM and Marcia Frellick @mfrellick


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: