The Rise of Telemedicine

You wake up to get ready for work—you go to brush your teeth, look in the mirror and notice a brand new bright red rash under your right eye and think to yourself, “I can’t go into the office with what appears to be a pepperoni tattoo on my face!” So you call into work, let them know you will be an hour late, just enough time to visit the walk-in clinic. 

You arrive at the walk-in clinic expecting to see a fully licensed physician, but instead, you are  greeted by an Assistant Physician who informs you they will perform the full examination, relay key details to the doctor, who will appear via secure video conference. You will have a chance to talk to them and they will prescribe medication, give you a lab/x-ray requisition, or send referrals as they see fit.

Welcome to the world of telemedicine. 

As a telemedicine assistant myself, I cannot give exact statistics on what portion of walk-in clinics operate through telemedicine, even in my jurisdiction, the province of Ontario, Canada., but to give you an idea of how common they are: I have worked with three physicians groups, each with eight to 20 physicians serving 30 to 90 clinics in the province without leaving their home or office, and their practices are continuously growing.

Advancement in technology continues to permit more and more of the previously unimaginable, every single day. The medical assistant on-site is trained to ask all the questions and perform necessary physical exam maneuvers, exactly as the doctor would if they were there in person. We can send photos of your rash to the doctor so they can see for themselves what is going on, and get a better idea of how to treat it, but ultimately we can predict the diagnosis and treatment you will receive. 

For decades, a person was required to go into a doctor’s office and wait an unpredictable amount of time in a waiting room, even with an appointment for the exact time to arrive, just to have a quick chat with their general practitioner confirming that their medications are achieving their desired effects and are well tolerated with minimal side effects experienced to continue their existing treatment for another three months. 

Fast forward to today, where a simple prescription renewal can be done over the phone or secure video conference between a patient and a fully licensed physician. Doctors can now bill for their virtual services and get reimbursed for their time just like with their physical appointments. Telemedicine services are now fully covered by OHIP, our provincial universal health insurance.

*Enter the pandemic*

With isolation protocol and distancing requirements increasing everywhere, Telemedicine services in places where a network was already established skyrocketed since March 2020 and became better established in other places.

One of the first well documented examples of COVID induced telemedicine usage surge came from Western China. Sichuan province connected all of its hospitals together using the main hospital of Chengdu, China as its hub, just days after the state of emergency was declared. This was to allow for better service integration and streamlining of virtual visits. They were even involved with an enhancement of the 5G dual gigabit network specifically for the purpose of the increased demand of virtual medical consultations. (1)  

At NYU Langone, the epicenter of the USA outbreak daily virtual visits increased by over 680% from 102.4 average daily visits by March 2 up to  801.6/day by  April 14  2020. (2) 

Several advantages exist for telemedicine in the climate of a global pandemic. Patients can still be served as needed while minimizing contact, thus limiting the spread of communicable infections. It can also be used to screen the patients to determine to what degree testing  by Public Health is recommended for them, without increasing the risk of transmission in a clinical setting. In addition to the obvious benefits, there have already been video conferences between patients and several different departments, to allow for an integrated multi-disciplinary approach in a single communication, which can really accelerate finalizing a plan for the patient’s care that all participants can agree on. (3)

Structure of remote healthcare consultation as recommended by public health
  1. Hong, Z., Li, N., Li, D., Li, J., Li, B., Xiong, W., Lu, L., Li, W., & Zhou, D. (2020). Telemedicine During the COVID-19 Pandemic: Experiences From Western China. Journal of medical Internet research, 22(5), e19577. https://doi.org/10.2196/19577
  1. Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc. 2020;27(7):1132-1135. doi:10.1093/jamia/ocaa072
  1. Ohannessian R, Duong TA, Odone A. Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Health Surveill. 2020;6(2):e18810. Published 2020 Apr 2. doi:10.2196/18810

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