When the American Telemedicine Association was established, the goal was to promote the use of two-way speech and video between a provider and patient or for a doctor to view and interpret medical images at a distance. This revolutionary concept provided access to higher quality medical care in rural areas and for patients who were unable to travel. Today, as technology continues to evolve and the needs of healthcare grow, being able to simply communicate with a patient and receive vital signs or medical records at a distance is no longer cutting edge.
Many healthcare organizations and private companies are currently using telehealth as their basis for providing the most advanced care through this “new technology.” But similar two-way technologies are now available to anyone with a digital cellphone and blue-toothed enabled peripheral. Like the telephone, the telecommunications equipment has become a consumer commodity. Consumers are using the technology to bypass local primary care providers by seeking medical advice from a host of online healthcare services. A survey of nearly 650 healthcare consumers – 40 percent of whom self-identified as a younger healthcare consumer – found that the digital consumer experience is of high priority. Ninety-three percent of patients expect to use digital tools that facilitate patient-provider interactions. Eighty-five percent said the same about virtual care access, 97 percent about online scheduling, 92 percent about online payment tools, and 94 percent about online price transparency tools.
Some of the services using telehealth have also become routine. For example, teleradiology has become so common may soon be a “standard of care.” Hospitals not able to instantly access a radiologist in the middle of the night may face charges of negligence.
While telehealth helps the problem of access, the leading problem today is not patient access but meeting the demands of a growing number of people in need of care and improving the quality of care for the complexity of their needs. According to the Health Resources and Services Administration the demand for primary care physicians will grow by 14 percent from 2010 to 2020:
- 81 percent of projected increased demand comes from population growth and aging
- 19 percent from increased access to care from the expansion of health insurance.
At the same time, the Association of American Medical Colleges has warned of a pending shortage of over 20,000 by 2020 and up to 120,000 physicians by 2030. Finally, the increasing complexity of needs and the shortage and burn-out rates of providers have all contributed to a large number of medical errors. Multiple studies have estimated that medical errors are responsible for 100,000 to 200,000 deaths per year.
Ironically, by simply making healthcare more accessible, telehealth has compounded the problem. The fear originally expressed by CMS staff was that broadscale use of telehealth would lead to an exponential number of additional claims for services rendered. A study in Health Affairs regarding the use of online telehealth services concluded that while “telehealth visits are about 50 percent of the cost of a physician office visit and less than 5 percent of the cost of an ED visit” it also caused an increase of 88 percent in utilization. 
We can’t go on like this.
There are too many needs and not enough people to provide services. One important answer is using machine learning and automated processes for monitoring, diagnosing and treating patients. AI is being successfully used in a variety of other industries including manufacturing, financial services, entertainment, online retailing and smart-home personal assistants. In healthcare, it is just getting started.
Of course, there are those who disparage such uses. Some have painted a picture of machines taking over the world. Others fear computer malfunctions. These warnings have preceded almost every advance over the past century. A few professional societies have warned that it will replace doctors. That may be an issue for the American Medical Association, but not necessarily for patients who need help.
Those vendors and providers who rely solely on such 20th century communications will be left behind. Telehealth has successfully expanded access to health care but moving forward telehealth, as well as all approaches to the delivery of healthcare, must incorporate artificial intelligence. Embracing AI to meet the rising demand and diminishing supply in healthcare will help eliminate the fear of increased utilization and help offset any increase in demand generated through easier access. Telehealth already uses digital information, AI takes advantage of such existing technology and makes it smart.
Many stakeholders share the benefits:
- CEOs – enables rapid growth and efficiencies in an increasingly competitive market.
- Providers – provides critical help in using the mountains of research in medicine and dealing with increasingly complex cases.
- Insurers – most certainly will lead to cost reductions.
- Patients – results in better and cheaper care and reduced medical errors.
That is why PATH was created. PATH was established to stimulate the use of AI, automation and robotics in healthcare services, whether it is delivered within a hospital or clinic or using telehealth to a home or other location. Identifying best practices, advocating for regulatory and payment changes, promoting attractive business models, and bringing together a coalition of stakeholders can create a “pathway to success” and assure consumers, providers and payers about its safety and effectiveness.
If you are interested in learning more about this next wave, come join us at www.pathhealth.com.
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 I might note that the move by CMS to embrace telehealth is yet another sign that it has passed the notion of being innovative.
 Some vendors have added their own patient record to their technology, duplicating what almost every health provider already has in place. Thus, their claim to fame is how well their EHR can integrate with that used by their customer.
 Black Book Market Research, LLC, Survey press release, July 9, 2018.
 “Projecting the Supply and Demand for Primary Care Practitioners Through 2020”, November 2013, Health Resources and Services Administration Bureau of Health Professions National Center for Health Workforce Analysis
 The Complexities of Physician Supply and Demand: Projections from 2016 to 2030, American Association of Medical Colleges, HIS Markit Ltd., March 2018
 “Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending” 10.1377/hlthaff.2016.1130, HEALTH AFFAIRS 36, NO. 3 (2017): 485–491