Imagine opening your medicine cabinet above the bathroom sink in the morning. One shelf is littered with a toothbrush, mouthwash, a spool of floss and a bottle of aspirin. A jar of q-tips, a razor and a box of bandaids sit on another. And on the last shelf, a miniature physician in clean whites holds a tiny tablet, smiles at you, and asks "How are you feeling feeling this morning?"
"If I had to capture what telemedicine and telehealth is all about, this is the one image that tells the story better than anything else," says Roy Schoenberg, MD, co-founder, president and CEO of American Well. "Having a personal physician in your medicine cabinet represents the capability to extend care to where it's most convenient for us."
Today, the argument for telehealth no longer comes from the fringe. But it wasn't always that way, according to Dr. Schoenberg. He says 2016 is actually a very compelling time for the concept of virtual care and virtual visits because quietly, with little fanfare, all of a sudden the industry has reached a consensus that telehealth is here to stay.
A very similar timeline and trajectory of acceptance can be mapped out for Amazon, Dr. Schoenberg says. When the company first launched in the mid-1990s as an online book retailer, the odds were very much stacked against it. Customers didn't trust buying books online without first flipping through them and didn't want to make a purchase with no guidance from a bookseller. They weren't comfortable entering their credit card information online, and there was no shelf display for them to browse through. And perhaps the most challenging hurdle was the removal of immediate gratification — if you order a book online, you don't have anything to show for it, and who knows when you'll receive it?
"It took them about 10 years to chip away all of those different barriers one by one, until around 2005, without anyone paying much attention to it, it became mainstream to buy books online," Dr. Schoenberg says. "We know now in hindsight that the transition wasn't about books at all, the reality is the entire retail industry from that point on changed completely."
Telehealth has arrived at a similar turning point, Dr. Schoenberg says. With virtual care, physicians can't touch the patient, there are immense concerns about the safety of storing and transmitting payment information and medical data online, and a web of unanswered legal questions about prescribing and diagnosing depending on where a patient receives care and where a clinician practices. Above all else, when exchanging goods happens over the internet, costs decrease. But what will that mean for quality?
In 2016, however, most of these questions have begun to resolve themselves. Physicians are understanding why patients in many cases prefer remote care, and patients increasingly understand they don't have to sacrifice care quality or the safety of their data for convenience.
Dr. Schoenberg says this is also reflected in American Well's hard data about telehealth. Ironically, he says, there's very little overlap between a map of the U.S. that shows where the regulatory infrastructure for telehealth is in place and where it is most commonly utilized.
"What that means is that if you're a provider in a state with all the prerequisites for telehealth, you have an enormous patient population waiting to be captured," Dr. Schoenberg says. "And if you find yourself in a state where telehealth is booming, but the regulations haven't caught up, imagine what will happen when those last barriers are removed. No matter were you are, it's a volcano rumbling under your feet."
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