More Than Half of Internists Are Using Telehealth – and Growing

A new study released in April reported that more than one-half of America’s internal medicine doctors are actively using telemedicine in their practices. The American College of Physicians (ACP) survey sought to track telehealth usage patterns. This article will look at current usage trends and some of the barriers to adoption that ACP members report.

“As telehealth payment and regulatory burdens are removed, physicians are more likely to use these services for the care of their patients. ACP believes very strongly that telehealth can be a valuable tool to improve access, quality, and decrease cost especially when used in the context of a valid physician-patient relationship”
Andrew Dunn, MD, FACP
Chief, Division of Hospital Medicine of Mount Sinai Health System
Incoming Chair of ACP

Telemedicine is the use of digital technologies to conduct a healthcare encounter. The technology connects doctors or other clinicians with patients in entirely new ways, freeing up patients from traveling to an office to receive care.

The ACP 2019 Internal Medicine Meeting in Philadelphia served as a forum this year for the release of a new study of members and whether they’re leveraging telehealth. The study consisted of 1,449 member surveys distributed, with completed responses received from 233 members, at a 16% response rate. All of the internists provided outpatient care. Of those that responded, 72% were general internal medicine specialists and 28% were subspecialists.

The study found that 51% of internists now regularly use telemedicine in their practice. They use these tools in a number of ways. For example:

• 33% of ACP members use e-consults. Another 10% of the members surveyed are considering using these digital tools. E-consults typically simplify the process of seeking a consult from specialists. In this case, internists may take some test results and upload them to a specialist for review. Or, the doctor could take a picture of a patient injury site and upload it to the EMR. Then the specialist could access the data, review the patient charting, and make a recommendation. E-consults can also be used when patients seek a second opinion. The study found that 63% of the doctors surveyed use e-consult telehealth tools every week.
• 14% of ACP doctors use remote patient monitoring to track the health of their client when they leave a hospital or other clinical care facility. Another 11% of ACP members are considering the use of these tools. Remote patient monitoring is particularly effective for chronic care conditions such as diabetes that require frequent monitoring and patient education. About half of the doctors currently using remote patient monitoring say they have worked it into their practice every week.
• 18% of ACP doctors use telemedicine video visits and another 17% are considering the use of these tools. Live video or synchronous two-way communication is just one form of telehealth to create communication between the clinician and the patient. Video conferencing uses cameras and the Internet on a secure HIPAA-compliant connection to bridge the gap between doctors and their remote patients. However, the study noted that having access to video visits does not mean doctors use these tools each week. Of the survey recipients responding, about 19% use telemedicine video visits weekly.
• 24% of ACP doctors are using remote care management and coaching, and another 11% plan to use these tools eventually. mHealth Intelligence reports, “Healthcare providers who use telehealth or mHealth tools to coach patients with chronic conditions are seeking market improvements in clinical outcomes.” Using virtual technology to increase contact with patients while cutting down on unnecessary office visits, particularly with chronic care disorders is the best way today to engage patients in better outcomes.
• Finally, 9% of ACP doctors around the country are now integrating the data from patient wearable devices, like Fitbit for example. Another 9% are considering this activity in their practice. Wearables are electronic devices that connect with the patient’s skin and use the digital transmission of data to both track and transmit information. The data could be transmitted to a dashboard for an app or perhaps to a clinician. Today, wearable devices that track biometrics or other patient data are widely used in healthcare today. They are also popular with consumers seeking to increase exercise or monitor other activities.

The ACP research showed that some providers use multiple telehealth tools at varying points within their practice. But the report identified other issues, as well, including barriers to access preventing more ACP doctors from using these tools.

Ironically, of the providers not using telehealth, more than half said they were interested in trying them. These doctors cited various barriers to telehealth adoption, including:

• 42% of ACP doctors said they find it challenging to integrate telehealth into their current workflows.
• 36% say their patients do not have access to the telehealth technology that they would need to meet with doctors. Specifically, patients need a smartphone or computer with broadband.
• 29% of ACP members say they are concerned about the potential for medical errors when using telemedicine.
• 23% say they are worried about data and PHI security.
• 18% did not identify a barrier preventing them from using these tools.

Generally, the ACP study noted that regulatory, licensing, and reimbursement issues remain a barrier to widespread telehealth adoption.

The ACP reports that they remain committed to encouraging the widespread use of telehealth tools by ACP members. The Incoming Chair of ACP, Andrew Dunn, MD, FACP, Chief, Division of Hospital Medicine of Mount Sinai Health System, was quoted in the report as saying a number of regulatory burdens have recently been lifted, including:

• Medicare has released a new physician fee schedule with codes for virtual check-ins, remote evaluation of patient images, and e-consults.
• The patient’s home is being added as an originating site by CMS for mental health and substance abuse treatment.

ACP concluded their report by stating they support the expanded role of telehealth in primary care.

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