On July 15th, Solve.Care organized a highly successful roundtable discussion on the topic, “Will Telemedicine be the ‘New Normal’ Post COVID-19?”; attracting over 900 registrations from all over the world. Doctors Ashraf Affan – a pediatrician, Swapna Vaidya – a psychiatrist, Evan Lipkis – an internal medicine physician, and Ashis Chawla – a surgeon, joined the panel discussion moderated by Solve.Care’s Chief Medical Officer, Dr. David Hanekom. The conversation took up questions regarding the feasibility of telemedicine, how the various obstacles that currently hamper its full realization can be overcome and what virtual healthcare in the future might look like. Anyone interested in telehealth, or healthcare more broadly, will want to watch the roundtable in its entirety. The video of the roundtable can be seen here.
The following is drawn from the roundtable discussion.
1. How has COVID-19 affected your practice?
The panelists agreed that the pandemic had prompted an abrupt shift to telemedicine which, up until that point, hadn’t had much traction. For Dr. Chawla in Toronto, all the preliminaries to surgery are now conducted remotely. Dr. Affan in Jacksonville, Florida remarked that, without telemedicine as an alternative, his pediatric practice was confronting a 70% reduction in visits; parents were understandably reluctant to come in, a development that had implications for the time sensitive administration of vaccines and prescription refills. Dr. Vaidya, a psychiatrist, found that 80 – 90% of her patients coped well with the transition to teleconsultations, amongst them patients with highly-complex issues.
In a follow-up question on the effects of the pandemic on clinicians themselves, Dr. Vaidya discussed her volunteer work for the Physicians Support Line. Dr. Vaidya remarked that, in the aftermath of a Covid-19 surge, frontline physicians are naturally adversely affected (anxiety, depression, suicidal ideation). Dr. Lipkis in Chicago, a general internist, also spoke to the immense stresses everyone, whether patient or physician, was experiencing as a result of the pandemic. A therapeutic resource like the Support Line has been integral to the morale of many.
2. What are the challenges and inefficiencies in current telemedicine systems you have experience with?
For each of the panelists, adoption of telehealth solutions involved a learning curve. Did patients appreciate what they were being told? In the absence of in-person visual cues, it can be difficult for a physician to know if a patient has understood important information. A patient’s informed consent is essential to virtually any form of treatment. The patients themselves had their own difficulties with connectivity and technical problems. For Dr. Lipkis, most platforms are less than optimal in that they cannot assure privacy, are needlessly complex, and exact too many fees. Dr. Affan shared this opinion. As far as he was concerned, there’s room for simplification.
3. How would you implement the blockchain in order to eliminate worries over security and the various delays that hamper conventional telehealth platforms?
This question was addressed to Dr. Chawla who felt it would be ideal to have the payment and administrative features in a single convenient setting on the blockchain. The blockchain affords unique advantages: auditability for immediate verification and security such that breaches of confidentiality would be virtually impossible.
4. Your thoughts about a Global Telehealth Exchange where patients have access to credentialed physicians and clinicians from all over the world?
The benefits are obvious: physicians can control prices, seeing a specialist needn’t necessarily be financially burdensome for the patient. Equally as important, or perhaps more so, there’s no wait. “A Mayo clinic can be just a second away.” Simplified, and instantly verifiable payment mechanisms enable care providers to focus on engagement, not administrative formalities that largely exist at the expense of patient centricity.
5. What are your thoughts about the SOLVE token as a mechanism to circumvent some of the needless complexities around payment?
Dr. Vaidya considers a blockchain ecosystem of this sort being a “utopia of medicine”. Its opportunities reminded her of her father’s own practice in which he had patients of his choosing whom he charged on the basis of what they could pay. She went on to speculate how a global telehealth exchange could serve collaborative care for chronic diseases, every one of which has a psychological dimension. A point raised earlier by Dr. Chawla was repeated: the promise of providing healthcare in underserved areas where specialty care is scarce to nonexistent.
6. Are you hearing of telemedicine solutions fraught with difficulties, or physicians signing up with five or six platforms in an effort to overcome the deficiencies of this one or that one, unforeseen incompatibilities and all the rest? Does this make sense in terms of practicalities? Aren’t we going to see more and more virtual care, whatever the type of medicine practiced?
Dr. Affan took up this question. His practice went through two to three telehealth offerings, none of which were ideal. He then turned to the larger issue of waste in the American medical sector. One trillion dollars is estimated to be lost, annually, to a pervasive lack of interoperability; i.e. a lack of communication between the various systems that broadly regulate healthcare. This systemic noise isn’t just expensive, it effects continuity of care and in doing so, it also jeopardizes patients’ health.
In conclusion, there was a consensus that, whatever the course of the pandemic, telemedicine had assumed a vital role in healthcare that was unlikely to change. There was also general agreement that some platforms are better than others and that the best of all would function on the blockchain. Blockchain technology, like telemedicine itself, offers too many benefits to ignore. For one, a frictionless blockchain ecosystem in which the bulk of administrative tasks were automated would, in comparison with current siloed systems, provide incalculable savings.